Seattle's Child

Your guide to a kid-friendly city

ND versus MD pediatrics

Dr. Helen Kinsel, ND provides naturoathic pediatric care at Seattle's One Connection Healthcare.

MD, ND or both? Which pediatrician is right for your family

What to expect in each care setting

Before I learned about naturopathic doctors  — and long before I became a naturopathic doctor and midwife myself — I believed their approach to health was grounded more in history and tradition than in evidence-based science.  

The truth is most naturopathic medicine (and increasingly in Seattle, contemporary medical care) is “integrative medicine” — thus combining conventional medical approaches with holistic, natural practices and therapies that have been used around the globe for thousands of years to prevent or treat illness. 

That may be why one of the most common questions we receive as naturopathic pediatric doctors (NDs) is, “What is the difference between you and an MD?” 

ND, a lean toward nature

Many Naturopathic Doctors (NDs) lean more toward natural remedies and therapies to avoid the use or overuse of pharmacological prescriptions or invasive conventional treatments. In the Seattle area, we are well-resourced: this region has many well-trained and experienced NDs and MDs. In fact, with the wealth of both types of doctors in Puget Sound, it can be a challenge to figure out just the right fit for a family.  

One of the most common questions we receive as naturopathic pediatric doctors is, “What is the difference between you and an MD?” 

Similarities and differences

This question is, of course, complex. We practice in many similar ways, such as utilizing tools like blood tests and detailed health history. We work with specialists to address and possibly solve health concerns. 

In other ways, we may differ.  Naturopathic doctors start with the underlying belief that your symptoms are not the problem, rather they point us in a direction and help us discover issues  underlying the symptom. Sometimes symptoms do need to be treated in order for people to make life-altering changes or choices. This is part of the naturopathic approach to whole health. 

In Washington State, NDs and MDs are both licensed as primary care providers. Both professions are also overseen by boards within the Department of Health, which is where regulatory and disciplinary matters are handled.  ND schooling and training, which includes botanical and nutritional therapies, prepares us to provide all the primary care services you would expect to receive from primary care medical doctors – providing blood pressure checks, listening to heart and lungs, conducting annual blood tests or cancer screenings, and providing immunizations for the whole family.

Pediatric specialties

Like MDs, NDs who practice and specialize in pediatrics have completed additional clinical and classroom training in the areas of primary care pediatrics and family medicine. Our professional associations provide pediatric-focused post-graduate residencies and they oversee board exams.  

However, unlike MD pediatric providers, NDs are not required to complete a residency or sit for a board exam to offer pediatric care.  

An ND can begin their clinical practice after a four-year undergraduate and a 4- to 5-year naturopathic doctorate degree.  In contrast an MD will complete a four-year undergraduate degree, 4-year medical degree, and at least 3 years of residency prior to practicing.  

Photo by nortonrsx

What to expect from an ND

What is it like to work with an ND pediatrician? There are a few core elements that you can expect from an ND who is engaged in primary care pediatric and family medicine:

  • NDs use conventional prescriptions and over-the-counter medications as well as natural therapeutics like botanical medicines, nutritional support, supplements, and lifestyle modifications. They take a patient’s risk level, beliefs, and biases into account when suggesting treatments.
  • NDs order blood draws, make referrals for ultrasound, X-ray, and other imaging, give immunizations, and refer patients to occupational therapy, physical therapy, acupuncture, or other specialized therapies or services.
  • NDs tend to offer longer appointment times for well-child visits as well as acute/urgent visits. In most cases, families have direct access to their ND physician or a backup physician after hours in contrast to a nurse line or hospital hotline.
  • NDs encourage discussion and invite parents to ask questions about immunizations and take a family’s risks, beliefs, and biases into account when suggesting a schedule.
  • NDs accept most health insurance plans, including Medicaid, for visits, immunizations, and procedures.
  • NDs look at your child and your family as a whole; the care of the child is not separate from understanding the parents, caregivers, family, and community in which they live and grow. For example, if a condition affects both a baby and parent (for example yeast is impacting both a breastfeeding parent’s tissue and a baby’s mouth) treatment will be prescribed for both family members.
ND versus MD

Photo by Halfpoint

What to expect from an MD

  • MDs may recommend multivitamin, iron, or Vitamin D supplementation but are less likely to prescribe botanical medicines, dietary supplements or herbs for treatment or prevention. Many will consider patient beliefs and biases when suggesting treatments. 
  • MDs typically work in a larger pediatric group. While you may see your designated provider for your regularly scheduled visits, visits for urgent concerns or after-hours calls may be managed by other providers in the group. Most often well-child visits as well as acute/urgent visits are 20 minutes.
  • Depending on the region, MDs may have more ready access to social workers or hospital-based services for higher-level needs or more medical complexity.
  • MDs accept most health insurance plans, including Medicaid, for visits, immunizations, and procedures.
  • MDs are more likely to ask families to follow the CDC immunization schedule. Some practices may have restrictions on delayed or alternate vaccine schedules. In rare cases, MDs may choose not to work with patients who decline vaccines. Conversely, many MD pediatricians today, like NDs, invite discussion and questions about immunizations and will work to navigate a schedule that meets a family’s needs. 
  • MDs order blood draws, make referrals for ultrasound, X-ray, and other imaging, give immunizations, and refer patients to occupational therapy, physical therapy, or other specialized therapies or services.
  • MDs may recommend some baseline supplements such as a multivitamin, iron, or Vitamin D as necessary. 

Unlike most medical doctors, NDs are very often small business owners, working with small clinical teams and a single backup ND physician. Most medical doctors, on the other hand, practice in larger practice groups with mutually agreed-upon practice policies, appointment time limits, and guidelines. MDs may have hospital privileges and those privileges may permit them to admit patients to the hospital or “round on” (follow) their patients in the hospital.  NDs do not have privileges that allow them to formally admit patients to or follow them in the hospital, yet their patients can be transferred to hospital care either as a walk-in with records in-hand or by calling hospital-based physician lines to hand off to an on-call physician.  

All of these things – how much time a provider will take with your child during visits, affiliation or care relationships with hospitals, and direct access to your child’s doctor – are factors to consider when choosing which form of primary care medicine, medical or naturopathic, is best for your child and family.

What about  both? Integrating care

Do you have to choose one over the other? The simple answer is no. 

Many families work with both an ND and an MD to cover their child’s healthcare needs. However, it’s important to know that most insurance plans will only cover services in one location. That means you can’t get two well-child visits covered if you want your child to visit both an ND and an MD. You may have to pay a copay or out-of-pocket for some visits if you have two primary care pediatric providers.

Many ND and MD providers in the Seattle area work together and collaborate informally, and there are a few practices in which MDs and NDs work together in the same clinic.  More often than not, the coordination or the integration rests with the family and open communication amongst the combined care team.  

Get to know them before you choose

The best way to decide which type of doctor is best for you is to meet providers and ask questions. Is the provider curious about you and your child? Do they listen, give you credible information and offer evidence-based advice and clinical input? Look for a provider who is truly a caregiver.  

Photo by Cheryl Murfin

What to ask potential MD or ND pediatricians

You will interact with this provider or group, and the clinic and its staff, a lot in the early years of a child’s life. Check out the frequently asked questions and detailed provider bios on practice websites, or send an email with your questions as you consider different providers. You might also reach out with your question to online community groups to gather insights from people who have worked with providers you are considering. What was their experience like? Here are some of the questions I was asked most often by prospective patients:

  • How long have you been in practice?
  • What additional training have you done to support your work as a pediatric provider?
  • What can we expect as treatment options when our child is sick?
  • Are you on call? What does that look like to access care after hours?
  • What is your practice model (i.e. solo, residents, group)?
  • Do you have admitting privileges or a process by which you can follow our care in the hospital?
  • How do you approach the conversation and questions about immunizations?
  • Of the more natural therapeutics, which ones do you utilize the most and why?
  • Do you prescribe conventional therapeutics (i.e. prescription medications or over-the-counter medications)?
  • How would you describe your balance between natural and conventional therapeutics? Why?

A two-way relationship

Finally, consider this as you explore which provider, MD or ND, is best for your child and family: 

The root of the word Doctor is docere, which means teacher. Medicine and healthcare should be teaching and learning experiences that are bi-directional – two-way. That means the patient and doctor learn from each other. With that in mind, choosing the “right” provider for your children is also a reflection of the way you and they learn and grow best. It can take a few tries to find the right match or mix of providers and therapeutic approaches. That doesn’t make any provider type bad or wrong. It just means there is someone or some mix for everyone.  

More at Seattle’s Child:

Is it allergies or a sinus infection? | Ask the Pediatrician

The PUMP Act: A win for babies and businesses

More nearsightedness in kids than ever

What every new parent needs to know about newborn jaundice

About the Author

Dr. Sunita Iyer, ND, LM

Dr. Sunita Iyer is a naturopathic physician and licensed midwife who has cared for families in the area for 15 years. Currently she is an Associate Teaching Professor in the School of Nursing & Health Studies at University of Washington Bothell, and taking a hiatus from clinical care while providing mentorship to newer or pivoting naturopathic physicians. Life with her son, two dogs, and the magnificent PNW has been an incredible gift.