The German Heilpraktiker has been the subject of several of my posts. Some claim that it is an example of a well-established and well-regulated profession. Others insist that it is a menace endangering public health in Germany.
Who is right?
One answer might be found by looking at the training the German Heilpraktiker receives.
In Germany, non-medical practitioners (NMPs; or ‘Heilpraktiker’) offer a broad range of so-called alternative medicine (SCAM) methods. The aim of this investigation was to characterize schools for NMPs in Germany in terms of basic (medical) training and advanced education.
The researchers found 165 schools for NMPs in a systematic web-based search. As the medical board examination NMPs must take before building a practice exclusively tests their knowledge in conventional medicine, schools hardly include training in SCAM methods. Only a few schools offered education in SCAM methods in their NMP training. Although NMP associations framed requirements for NMP education, 83.0% (137/165) of schools did not meet these requirements.
The authors concluded that patients and physicians should be aware of the lack of training and consequent risks, such as harm to the body, delay of necessary treatment, and interaction with conventional drugs. Disestablishing the profession of NMPs might be a reasonable step.
Other interesting facts disclosed by this investigation include the following:
- There is no mandatory training for NMPs. Some attend schools but many do not and prefer to learn exclusively from books.
- The training programs of the NMP schools comprise an average of 7.4 hours per week of classroom teaching for an average of 27.1 months.
- Course participants thus complete an average of ~600 hours of training. (A degree in medicine takes an average of 12.9 semesters. With a weekly working time of 38.9 hours, this amounts to ~15,000 hours of training excluding internships etc.)
- Three-quarters of all NMP schools do not offer any practical teaching units.
- If training programs do contain practical instruction, it is usually limited to individual weekend workshops in which the measurement of vital data, physical examinations, and injections and infusions are practiced.
- The exam that NMPs have to pass consists of a written test with sixty multiple-choice questions and a 30 to 60-minute interview on case studies.
- The examination covers professional and legal anatomical and physiological basics, methods of anamnesis and diagnosis, the significance of basic laboratory values as well as practice hygiene and disinfection.
- Not included are competence in pharmacology, pathophysiology, biochemistry, microbiology, human genetics and immunology.
- The average 600 hours of training of an NMP is thus ~5% of that of a medical student.
- If an NMP fails the exam, she can repeat it as often as she needs to pass.
- The day after the exam, an NMP can open her own practice and is allowed (with only very few exceptions) to do most of what proper doctors do.
So are NMPs a danger to public health in Germany?
I let you answer this question yourself.