Safiya McCarter, ND, LAc, is a naturopathic physician and licensed acupuncturist, currently practicing in Silver Spring, Maryland. In addition, Dr McCarter is a presenter on topics regarding diversity, equity and inclusion. Prior to entering into full-time clinical practice, she was an administrator and educator, and co-director of the Daniel K. Church Center for Social Justice and Diversity at Bastyr University. Dr McCarter currently serves on the boards of the American Association of Naturopathic Physicians (AANP), the Midwifery Education Accreditation Council (MEAC) and the Academic Collaborative for Integrative Health (ACIH).
Integrative Medicine: A Clinician’s Journal (IMCJ): At the American Association of Naturopathic Physicians Convention and Exhibition this summer, the theme will be “100 Years of Licensure: Celebrating the Past, Present, and Future of Naturopathic Medicine.” Why don’t we start by talking about what aspects from the past of naturopathic practice are most relevant for practitioners in the current era?
Dr McCarter: There has been an ongoing conversation in the profession about being more modern/mainstream or more conventional. On a spectrum, nature-cure is to one side, moving toward incorporating more Western medical tools along with our naturopathic medicine tools on the other. And there are some that feel there is less of an emphasis on nature-cure presently in both the education and practice of naturopathic medicine.
So there has been an ongoing conversation about how we can reach back and re-engage with some of those reasons why so many folks were attracted to naturopathic medicine and really getting to the fundamentals of health. In light of all that we know and all of what research is showing us in the present day, some of those nature-cure therapies that we’ve used are now validated, but research has also brought about additional tools that we can incorporate into our practice, as well.
Newer naturopaths now want to get steeped in some of those more traditional therapies. Physicians who have been practicing for 20-plus years bring along with them a wealth of knowledge about therapies they have used, which have been incredibly effective in the patients they have seen. These therapies may rely more on making sure that the body is in a state where it can optimally heal itself without reliance upon medications or even supplements, for example.
So, I think that acknowledging that connection to the past, celebrating that connection, and making sure those roots of naturopathic medicine are alive and well is vitally important and in line with what many of the newer physicians and students drawn to naturopathic medicine versus allopathic medicine want to see and want to learn.
IMCJ: As naturopaths see their scope of practice growing a little bit, and—as you mentioned—there is a little bit more emphasis on the modern, there has been some chatter about whether naturopathic use of pharmaceuticals remains true to the core principles of naturopathic practice. Could you comment on the debate?
Dr McCarter: That is definitely a part of this whole conversation. And there is, of course, room for growth. There is so much diversity in the way that we are practicing, and there are going to be ways of practicing that resonate with some individuals more so than others. It is also a matter of access and scope of practice; where you are, geographically, determines, in part, how you practice and the tools available to you, as well.
So, how you strike that balance between foundational Naturopathic principles versus more modern therapies is a nuanced conversation. A number of factors go into it. There are still folks in states such as Washington and Oregon, for example, who have a very broad scope of practice and still rely heavily upon foundational nature-cure therapies, and who are incredibly effective in spite of access to such a broad scope. That is what resonates with them as individuals and how they see themselves working with patients to restore health and wellness. I also think there are those that also believe that the use of judicious use of pharmaceuticals is in fact in line with our principles while at the same time utilizing more natural therapies. Personally, I believe there is room for both. Ultimately, we do what is best for the patient and in line with standard of care.
IMCJ: Looking toward the future, the shortage of general practitioners in the mainstream medical ranks has been fairly widely acknowledged. Does this present an opportunity for Naturopathic medicine?
Dr McCarter: I do. I think that our training allows us to provide great general primary care. That is where we shine, even though there are naturopaths who are becoming a bit more specialized. In general practice—primary care—the focus is often on the fundamentals; we are guided by our principles, which I see as a large part of what primary care deals with. So naturopathic physicians can absolutely fill in those gaps where there is a shortage of primary care practitioners.
IMCJ: You authored a paper that addressed the global conversation about health. Describe the role naturopathic physicians can play in promoting health and wellness globally?
Dr McCarter: I have been saying this for quite some time: naturopathic physicians, specifically, are uniquely trained and positioned to address issues of social justice, the intersection of social justice and health, and the determinants of health, just by nature of our training. When we look at the changing demographics of the United States, or even globally, those are conversations and training that we need to have.
The adverse impact that stress can have on health is well known. And so we are talking about having a certain level of comfort, skill, and fluency in addressing stress as it has to do with racial tension or feelings of discrimination, for example, or as it has to do with gender identity or sexuality. Because of the nature of our training and how we tend to practice—particularly, the time that we, as naturopathic physicians, have when working with our patients—we can address those things. We can give individuals the space in the primary care setting to speak to those issues so that stress will not adversely impact their health. We can give them tools or referrals so that they can build the resiliency to deal with those issues more effectively than self-medicating or just suppressing those kinds of feelings.
But again, the ability to navigate those kinds of conversations takes quite a bit of work. There is language that needs to be learned and there are skills that need to be obtained. While naturopathic physicians are in great position to address those issues in a clinical setting, training must specifically address how to navigate those conversations.
The paper that you’re referencing, I wrote with two colleagues of mine. We were teaching, in this case, midwifery students how to navigate those kinds of conversations in the midwifery world. As part of my other responsibilities when I was at Bastyr University, I also taught classes where I would teach students how to bring in conversations about race if we suspect that the stress that is contributing to someone’s elevated blood pressure is caused by racial tensions in the workplace. “Is it appropriate for that to come up in the clinical setting,” is a question that I was asked often. The classes I taught would give students, through role-playing or just relating clinical pearls from my experiences, tools that they would be able to use to navigate those kinds of conversations.
If we are going to address global health issues, we have to be prepared to talk about issues of poverty, of class, and of all of that goes into global and local health issues. It is very important that we have that kind of training, so that we are able to successfully navigate those kinds of clinical encounters when that information or when those topics arise.
IMCJ: The article mentions the advantages of addressing, not just the individual and community determinants of health, but also the social and spiritual determinants in order to specifically affect the epidemic of noncommunicable disease burden worldwide. Would you share your thoughts on that issue?
Dr McCarter: When it comes to those kinds of things, the issue or the challenge has been how to strike a balance between what you know and understand medically, physiologically, and a patient’s cultural or social practices. A particular food group, for instance, may be a large part of a person’s culture, but that individual may also be part of a group that is more prone to certain diseases. How do you have a conversation about substituting that food for something else, so that you lessen the chances of a particular disease process related to diet progressing, when the food in question is closely tied to a person’s cultural experiences and social experiences?
So again, I think it goes back to having a skill set where you are able to respectfully navigate those kinds of conversations, you are able to relay information about why certain changes may need to be adopted, and you are able to explain it in a way that is understood by the person with whom you are sharing the information. And also, if the individual is unwilling to make those changes—for any variety of reasons, be they social, spiritual, or financial—then what other options are available? What other ideas, as a practitioner, can you suggest in that moment to offset whatever it is they may be doing so that the impact on their health is decreased. You strike a balance between your knowledge and experience as a practitioner and that individual’s personal choices, and social and cultural practices.
IMCJ: At this point, it is still early in the game as far as planning for the conference. Are any other ideas taking shape for celebrating the past, present, and future of naturopathic practice at the conference?
Dr McCarter: We do have a collaborative relationship with the NMSA, the Naturopathic Medical Student Association, and through that cooperation we are going to include joint offerings this year. Typically, programming for both groups at the conference has been offered at the same time, but not necessarily intermingled. This year, attendees from AANP and attendees from NMSA will be able to freely attend sessions being offered by either organization. The student-run organization, will provide sessions on topics that we may not be thinking of as AANP, and AANP attendees may bring perspective to those sessions that the students otherwise would not benefit from. That is another way that we are addressing the future, through this collaborative relationship and these co-offerings with the NMSA.