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Purpose: Since 2003, 4 more states have joined the ranks of now 15 states licensing naturopathic physicians (NDs). Qualified NDs residing in unlicensed jurisdictions sometimes obtain licenses from other states licensing NDs. The purpose of this study is to implement a methodology based on number of out-of-state licenses to gauge the demand for licensing among NDs in unlicensed states and to identify likely candidates for successful legislative efforts regarding licensure. Methods: Counts of out-of-state ND licenses issued through Arizona, Connecticut, Oregon, and Washington, the four states with naturopathic medical schools, were used as a surrogate for interest in licensing among states not offering licensing of NDs. Results: In 2005, a total of 457 U.S. NDs obtained out-of-state licenses from the states of Washington (159), Oregon (159), Arizona (79), and Connecticut (60), with 59% of these out-of-state NDs applying from nonlicensed states. States with low (1—13) or moderate (18—27) numbers of out-of-state licensures constituted 69% of the NDs, while the remaining 31% of NDs who fell into the high (43—58) out-of-state licensure category were from only three states: California, Colorado, and New York. Discussion: Of the three states with high out-of-state licensure, California has recently passed licensure legislation. Previous studies have indicated that New York and Colorado scored high on legislative innovativeness. Should licensing of NDs be passed in these two states, the possibility exists that legislation would spread to adjacent and other proximal states.

New York and Colorado as Critical States in the Diffusion of State Licensing of Naturopathic Physicians