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The Newsletter (Autumn 2003) of the National Ayurvedic Medical Association
State Licensure and Ayurvedic Practice: Planning for the Future, Managing in the Present

By William A. Courson
(Administrative Director, the New Jersey Institute of Ayurveda at
the Starseed Center for Yoga & Wellness - Montclair, New Jersey)

Ayurvedic practitioners are not licensed in the United States or any of its political subdivisions, and its practice is not regulated in any fashion by state or federal agencies. Acceptable standards of proficiency for clinicians are set by individual schools that in some cases have received state approval as educational institutions, and Ayurvedic practitioners produced by these institutions are taught how to practice legally within a limited scope of practice so as to avoid legal liability for engaging in the unlicensed practice of medicine. Thus Ayurveda presently occupies a position in the United States roughly analogous to the practice here of oriental medicine and acupuncture in the early 1970's, or to the practice of naturopathic medicine in the large majority of states which do not officially sanction its practice.

Within the United States, the 50-odd State Legislatures and their corresponding State Boards of Medical Examiners are impelled to enact and enforce licensing legislation only when market forces justify such a measure: that is, when there exist a sufficient number of Ayurveda schools and practitioners, greater public interest in Ayurveda, and a certain level of economic concern on the part of other health-related professional groups. Scrutiny on the Ayurvedic profession and the individual practitioner will only increase as Ayurveda becomes more popular, and we as its teachers, practitioners, students and supporters need to safeguard the profession at this critical juncture in its short history outside of India.

All of the major Ayurvedic professional groupings in the United States have advocated the installation of licensing schemes. The California Association of Ayurvedic Medicine (CAAM) has among its goals the creation of "a recognized definition of Ayurveda and the scope of practice for the Ayurvedic profession … the formation of an accrediting agency for Ayurvedic schools and colleges [and] the creation of a state-approved license for the practice of Ayurveda." The National Ayurvedic Medical Association (NAMA) lists among the organization's aims the need "to establish and maintain standards of education, ethics, professional competency and licensing." The recently founded (1999) American Academy of Ayurvedic Medicine (formerly, American Ayurveda Association) cites the need to "obtain the necessary recognition for Ayurveda as a health care discipline, obtain licensure for practitioners in US States, and develop practice guidelines, quality of care and standardization of products" as among its primary aims.

Clearly, a day is coming (and will likely not be long in coming) when state licensing will have become an omnipresent reality. What can the Ayurvedic profession do today to ensure that the coming reality conforms to its desires and the needs of the wider community?

Such measures could and should embrace, firstly, the harmonization of standards for professional membership in existing Ayurvedic organizations via a program of competency testing (possibly coupled with clinical exposure); secondly, the setting of standards for training programs whose graduates will fill the ranks of those associations; and thirdly, the implementation of arrangements for self-policing and patient protection within and among the various professional organizations.

Currently, NAMA provides for a category of "Professional Member," the requirements for which according to NAMA's literature include "established criteria" which in future "will be voted on by the Board after receiving input from the membership." Seemingly, those criteria will involve the satisfactory passing of a "NAMA approved practitioner examination and … other NAMA requirements for providing private Ayurvedic health care consultations and therapies to the general public."

CAAM Professional Membership requirements include the completion of a minimum of 350 hours of Ayurvedic training to include anatomy, physiology, pathology, therapeutics, psychology, diagnosis, and case management, as well as experience in managing a minimum of twenty-five different clients utilizing Ayurvedic care. Additionally, the applicant for Professional Member status must currently practice Ayurveda, maintain professional ethical standards, and be a member in good standing of CAAM.

The American Academy of Ayurvedic Medicine, the youngest of the nation's Ayurvedic bodies, limits its professional membership ("Active Members") to practitioners who have completed five and a half years of training (i.e., the B.A.M.S. course of study) in a recognized Ayurvedic college in India or abroad. A category of 'Associate Member' exists for those whose training in Ayurveda was obtained from what are described as "bona fide institutions" in the United States, but no explanation of what constitutes a "bona fide institution" appears to exist.

Limited resources and much precious time and effort could be saved - as well as the prestige of the profession enhanced - with the creation of an inter-group credentialing authority awarding a mutually recognized credential (e.g., certified ayurveda practitioner, clinical ayurveda specialist, etc.). with a common scope of practice.

Secondly, in addition to the harmonization of standards for professional credentialing, the setting of standards for Ayurveda training programs elaborating such issues as program length, course syllabi, program content, and instructor qualifications either by existing associations or via some to-be-created common accreditation entity is a project worthy of consideration.

Thirdly, the implementation self-policing and patient protection mechanisms within and among the various professional organizations will likely go a long way in promoting public perception of Ayurveda practitioners as a community of responsible professionals whose first loyalty is to their patient's well-being.

In addition to measures that can be taken within existing Ayurvedic organizations, it is critical that individual practitioners practice in a fashion consonant with local law until licensing statutes are enacted. Two things need to be borne in mind by the practitioner in this situation: firstly, what are the contents of traditional Ayurvedic praxis? Secondly, what is defined by the law as comprising the practice of medicine?

A very few practitioners and practitioner educators have claimed exemption from state licensing laws defining the practice of medicine owing to what they feel is the markedly religious character of their practice of Ayurveda. Thus, Berkeley, California's Ayurveda Healing Arts Institute/Medicine Buddha Healing Center makes the claim that, owing to constitutional barriers to the support (or otherwise) of religious institutions their healing work "falls outside the jurisdiction of the Food and Drug Administration, the Internal Revenue Service, the Social Security Administration, the California State Medical Board, [and] the California Bureau for Private Postsecondary and Vocational Education …"

This seems to be an approach that is rife with risk. The mere fact that a practitioner or group invokes constitutional provisions is no guarantee to freedom from prosecution, the practical effects of which can be economically and professionally devastating. Such an approach as well is hardly likely to elevate the image of Ayurveda in the eyes of a majority of the public and those of fellow health professionals. Finally, the assertion that Ayurvedic practice falls within the purview of the Constitution's "establishment of religion" clause may be simply wrong: so-called "faith healers" have been convicted and imprisoned for their activities, many rightly so.

As a rule of general application, it is best in one's professional conduct to emphasize Ayurveda's distinctiveness. Thus, one does not "treat patients and their diseases" but "educates and provides information to clients." The practitioner of Ayurveda does not "diagnose" the presence of disease (he or she "analyzes Doshic imbalances" and their causes) or "prescribe medications" (he or she instead "suggests" herbal supplements, nutriceuticals, etc.). There is no apparent reason for the conscientious practitioner who has educated him- or herself to the requirements of the law as it applies locally to need feel apprehension for exceeding Ayurveda's permissible scope of practice, even while unlicensed.