Selecting a Complementary Health Practitioner: Credentialing, Licensing, and Education

The Bottom Line

• There is no standardized national system for credentialing complementary health practitioners. State governments are responsible for deciding what credentials practitioners must have to work in that state.
• The credentials required for complementary health practitioners vary widely from state to state and from discipline to discipline. 

Credentials, Licenses, Certification—What’s the Difference?

Health care providers’ credentials—the licenses, certificates, and diplomas on their office walls—tell us about their professional qualifications to advise and treat us.

Credentials is a broad term that can refer to a practitioner’s license, certification, or education. In the United States, 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 always a guarantee of being qualified.

How States Credential Practitioners 

• 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 an approved program.
  • Meet certification requirements of a national organization.
  • Complete a specified amount of training.
  • Pass an exam.
  • Participate in continuing education.

State laws vary widely in the services they allow complementary health practitioners to offer. For example, a national survey of laws governing chiropractic showed substantial differences among states in the number of services and practices that chiropractors are allowed to perform. 

Education and Training

Professional organizations in some complementary health professions offer certification examinations to graduates of accredited education and training programs. Certification may play a role in qualifying graduates for state licensure. 

For example, in most states acupuncturists must be certified by the National Certification Commission for Acupuncture and Oriental Medicine or pass that organization’s exams to be licensed. Some of the other professional organizations involved in certification include the National Certification Board for Therapeutic Massage & Bodywork, 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. 

Examples of State Requirements for Specific Types of Practitioners

• 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 school of naturopathic medicine and passing a postdoctoral board examination.
• Most states regulate massage therapists by requiring a license, certification, or registration. Training standards and requirements vary by state, but most states that regulate massage therapists require a minimum of 500 hours of training.

Credentialing Practitioners To Work in Integrative Health Settings

Complementary health services are increasingly being provided within hospitals or integrative care settings. Some health care organizations are developing and standardizing their procedures for deciding which practitioners are qualified to work for them. Requirements may include establishing competency (such as proof of training), licensure or certification, background checks, continuing education hours, proof of malpractice insurance coverage, and experience working in the field or specifically in a hospital or research setting.

NCCIH’s Role

The mission of the National Center for Complementary and Integrative Health (NCCIH) is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health approaches and their roles in improving health and health care. NCCIH is not involved in the clinical training, credentialing, or licensing of complementary health practitioners.

Key References

• 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.
• Chang M. The chiropractic scope of practice in the United States: a cross-sectional survey. Journal of Manipulative and Physiological Therapeutics. 2014;37(6):363-376.
• Cohen MH, Nelson H. Licensure of complementary and alternative practitioners. Policy forum. Virtual Mentor: AMA Journal of Ethics [online journal]. 2011;13(6):374-378. 
• Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. Annals of Internal Medicine. 2002;137(12):965-973.
• Hayes M, Muhota J, Nguyen L, et al. A framework for credentialing naturopathic physicians in academic health centers: Oregon Health and Science University. Journal of Alternative and Complementary Medicine. 2014;20(3):217-218.
• Nedrow A. Status of credentialing alternative providers within a subset of U.S. academic health centers. Journal of Alternative and Complementary Medicine. 2006;12(3):329-335.
• Stumpf SH, Hardy ML, McCuaig S, et al. Acupuncture practice acts: a profession's growing pains. Explore. 2015;11(3):217-221.

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NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your health care provider(s). We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCIH.