Credentialing: Understanding the Education, Training, Regulation, and Licensing of Complementary Health Practitioners
On this page:
- Key Points
- Keep in Mind
- Credentialing, Licensing, Certifying—What’s the Difference?
- Education and Training
- NCCAM’s Role
- If You Are Considering Going to a Complementary Health Practitioner
- Key References
- For More Information
Health care providers’ credentials—the licenses, certificates, and diplomas on their office walls—tell us about their professional qualifications to advise and treat us. In the United States, local and state governments and professional organizations establish the credentials that complementary health practitioners need to treat patients. This fact sheet provides a general overview of the credentialing of practitioners and suggests sources for additional information.
- There is no standardized, national system for credentialing complementary health practitioners. State and local governments are responsible for deciding what credentials practitioners must have to work in their jurisdiction.
- The credentials required for complementary health practitioners vary tremendously from state to state and from discipline to discipline.
Keep in Mind
- Regulations, licenses, or certificates do not guarantee safe, effective treatment from any provider—conventional or complementary.
- Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
Credentialing, Licensing, Certifying—What’s the Difference?
Credentials is a broad term that can refer to a practitioner’s license, certification, or education. Government agencies grant and monitor licenses; professional organizations certify practitioners.
Certification can be either a prerequisite for licensure or, in some cases, an alternative. To get certified or licensed, practitioners must meet specific education, training, or practice standards. Being licensed or certified is not a guarantee of being qualified.
States use the following approaches to credential practitioners:
- Mandatory licensure: requires practitioners to have a license for providing a service.
- Title licensure: requires practitioners to have credentials before using a professional title.
- Registration: requires practitioners to provide information about their training and experience to a state consumer protection agency.
States’ requirements for granting a license vary considerably. They may require those seeking a license to do one or more of the following:
- Graduate from a certified program.
- Meet certification requirements of a national organization.
- Complete a specified amount of training.
- Pass a written exam (sometimes a practical exam is also required).
- Participate in continuing education.
States also vary widely in the services that they allow complementary health practitioners to offer patients. For example, some states permit acupuncturists to recommend dietary supplements to their patients, while other states specifically prohibit it.
Education and Training
Professional organizations offer certification examinations to graduates of accredited education and training programs. Certification qualifies them for state or local licensure. For example, in many states acupuncturists who do not have a doctor of medicine (M.D.) degree must be certified by the National Certification Commission for Acupuncture and Oriental Medicine to get licensed. Some of the other professional organizations involved in certification include the National Certification Board for Therapeutic Massage & Bodywork, the Council for Homeopathic Certification, the National Board of Chiropractic Examiners (NBCE), and the North American Board of Naturopathic Examiners.
Schools and educational programs across the country train complementary health practitioners and prepare them for certification in their field. The U.S. Department of Education authorizes specific organizations to accredit education or training programs. For example, it has authorized the Council on Chiropractic Education to accredit chiropractic colleges and the Accreditation Commission for Acupuncture and Oriental Medicine to accredit acupuncture programs.
Differences in Licensing Requirements for Complementary Health Practitioners
The requirements for treating patients vary considerably from state to state and among the different practices. For example,
- In all 50 states and the District of Columbia, chiropractors must be an accredited Doctor of Chiropractic (D.C.) and must pass special state exams, exams administered by the NBCE, or both.
- Only 17 states and the District of Columbia license naturopathic physicians. In general, licensure requires graduating from an accredited 4-year naturopathic school and passing a postdoctoral board examination.
- Most states regulate massage therapists by requiring a license, registration, or certification. However training standards and requirements for massage therapists vary greatly by state and locality, but most states that regulate massage therapists require a minimum of 500 hours of training.
The mission of the National Center for Complementary and Alternative Medicine (NCCAM) is to define, through rigorous scientific investigation, the usefulness and safety of complementary health approaches and their roles in improving health and health care. NCCAM is not involved in the clinical training, credentialing, or licensing of complementary, alternative, or integrative practitioners.
If You Are Considering Going to a Complementary Health Practitioner
- Understand your state and local government’s requirements for licensing and certification of practitioners, and the limitations of those requirements.
- Select a complementary practitioner with the same care you would use in choosing a conventional medical provider.
- Do not use an unproven product or practice to replace proven conventional care or as a reason to postpone seeing a health care provider about a medical problem.
- Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about complementary health approaches, see NCCAM's Time to Talk campaign.
For more information on selecting a complementary health practitioner, see NCCAM’s tips on Selecting a Complementary Health Provider.
For More Information
The NCCAM Clearinghouse provides information on NCCAM and complementary health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
A service of the National Library of Medicine (NLM), PubMed® contains publication information and (in most cases) brief summaries of articles from scientific and medical journals.
DIRLINE (Directory of Health Organizations) is an NLM database that contains locations and descriptive information about a variety of health organizations, including associations and organizations related to complementary health approaches.
- Baynham-Fletcher L, Babiak-Vazquez AE, Cuello D, et al. Credentialing complementary practitioners in a large academic cancer center. Journal of the Society for Integrative Oncology. 2008;6(4):169–175.
- Cohen MH, Nelson H. Licensure of complementary and alternative practitioners. Policy forum. Virtual Mentor [online journal]. 2011;13(6): 374–378. Accessed at virtualmentor.ama-assn.org/2011/06/pfor1-1106.html on April 23, 2013.
- Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. Annals of Internal Medicine. 2002;137(12):965–973.
This publication is not copyrighted and is in the public domain. Duplication is encouraged.