Hierarchies of Harm in Holistic Health & Medicine

What you are about to read is a 7,200 word outline of the extensive research I have done on the intersections of power, hierarchy, authority, and capitalism within the context of holistic health and medicine.

Some of what I am about to share here may seem like an odd conclusion after nearly 6.5 years of pursuing a Doctor of Naturopathic Medicine degree; all while having received a clinical Master's degree prior to this.

Truthfully, I have accumulated hours, days, weeks, months, and even years of data, research, and personal reflection trying to make sense of my chosen professions under a capitalistic paradigm. This research has evolved with my personal politics as a leftist actively exploring alternative economic systems such as socialism and forms of horizontal organizing like anarchism.

What I have written here is genuinely not an effort to be outright controversial but rather a call for a deeply needed conversation meant to propel holistic health and medicine professions forward with more equitable and egalitarian organizations that do not replicate or uphold many of the structures of power harming our professions and those that seek to enter our professions. Whereas this article is not solely focused on a singular profession, it provides an in-depth and nuanced dialogue that is long overdue across all major holistic health and medicine professions within the Western world.

Unethical Business & Capitalism

As I wrote about in a recent article entitled, Watch Out for Functional Medicine Practitioners', I shared of the unethical business practices of all too many of those practicing "Functional Medicine".

This is exactly what happens when medicine as a healing art & science operates within a capitalistic paradigm of unending exponential gain in addition to both present day and historical exploitation of workers from the ground up; yes, even Physicians and other healthcare professionals.

Not only are unethical business practices and exploitation of workers common place within our capitalistic economy; it also forces fully qualified, trained, and skilled workers through costly barriers-to-entry via state-sanctioned licensure laws.

This is none-the-less true in our current model of healthcare where licensure as a capitalistic paradigm is deeply flawed and outdated for this modern era; especially at a time when people can now easily plug their health condition into artificial intelligence (AI) and receive a treatment plan all without seeing a Physician.

Now, let me be clear, despite my disdain for professional licensure and the entire system being another evil head of capitalism, I would like to emphasize that I am not explicitly against organized oversight and accountability in healthcare.

Obviously, this is important, especially with practitioners offering higher-level interventions like prescribing pharmaceuticals drugs and performing surgical procedures.

Dominantly, however, the vast majority of holistic health and medicine professionals are not operating at this level; most of us operate at the level of what has been deemed lifestyle medicine where clients are encouraged to improve their health through implementation of various lifestyle changes and natural treatment options.

In this article, I will outline the extensive problems I see with existing licensure models and my own vision for moving holistic health and medicine forward in a way that is more congruent with the shared holistic philosophies we espouse across the professions of naturopathic medicine, chiropractic, herbalism, yoga therapy/Ayurveda, acupuncture/Chinese medicine, health coaching, and the like.

Should We Be Pursuing Licensure?

Firstly, licensure is a deeply complex issue given history, legal precedent, century old paradigms, and cultural beliefs surrounding professional licensure itself. Whereas one singular article may be ineffective in evolving our existing paradigm, my hope is that it plants seeds of reflection among those within holistic health and medicine professions, especially within those in current leadership roles.

To start, I'll begin this exploration by discussing some recent dialogue going on within the yoga therapy world. In November 2024, I was invited to be a guest on a colleagues podcast called Working In Yoga where the host Rebecca Sebastian offers a space for yoga teachers and therapists to discuss the good, bad, and ugly of being a professional within the multi-billion dollar industry that is the Western yoga profession.

This podcast invitation came at the height of disputes within the yoga therapy profession due to changes our professional governing body made without consideration of its membership. This dispute only reinforced the top-down hierarchies that perpetuate and encourage power, domination, and authority within our broader economic structure of capitalism.

The crux of the issue was that the International Association of Yoga Therapists (IAYT) approved a 300-hour yoga therapy curriculum for already licensed healthcare professionals to pursue a pathway to becoming a yoga therapist-ish. This 300-hour training is at a fraction of the hours required by those that had spent years studying in IAYT-accredited programs that essentially are the equivalent to Master's level training programs of 1-2 years and 800-1000+ hours.

Needless to say, already credentialed yoga therapists (C-IAYT) were not having this. Many within the profession felt betrayed and as if their livelihoods were going to be destroyed due to the decision of a handful of leaders within IAYT. The gut-punch for most of the profession was that IAYT threw this decision on their membership and expected us to comply with it. What they received was a firestorm of backlash among credentialed yoga therapists and a fundamental questioning of the role of those in positions of leadership within the organization.

This prompted deep conversations within the profession about the future of yoga therapy as an emerging profession not only within the world of holistic health and medicine but also within the world of conventional medicine.

This brought up foundational questions about the profession including:

Will we actually loose our livelihoods if medical professionals are allowed to take over our profession?

In order to gain credibility among the dominant medical professions, are yoga therapists going to have to go the route of acupuncturists and seek state licensure?

Do yoga therapists even have a role in our existing system of healthcare?

If we do integrate into the conventional healthcare system, will we loose the breadth and depth of a 6,000 year old practice with origins in Vedic India?

These questions are a tiny sliver of what was discussed; one of the bigger topics of which was professional licensure and the future of yoga therapy as a profession.

Some portion of yoga therapists, mainly those that have never been in a licensed health profession see professional licensure as our golden ticket into modern healthcare which they perceive would offer a steady flow of job availability and stable income.

This was countered by many existing licensed healthcare professionals who are also credentialed yoga therapists that offered a stark reality check to those seeing professional licensure as a panacea to our current struggles as a profession; especially given all that licensed healthcare professionals face in their daily careers.

Through these conversations, I was asked by Rebecca Sebastian to share my thoughts about licensure on her podcast which was released November 25, 2024, entitled, The Full License, A Deep Dive with Stevie Inghram.

Nervously, for the first time publicly, I spoke about all of the thoughts I had swirling around in my mind over the years regarding professional licensure within the holistic health and medicine space. In short, I am of the view that yoga therapy should not become a licensed profession, and this is not because I do not want to see yoga therapy as a profession succeed.

What I do think the yoga therapy profession needs to do is deeply sit with whether yogic practice and philosophy is ethically congruent with our existing structures of power, domination, and authority within this current capitalistic paradigm. Furthermore, we need to sincerely ask ourselves whether we wish to uphold these hierarchies professionally.

If we seek to assimilate into these existing systems, our collective priorities as a profession will be abundantly clear.

Needless to say, I came to Rebecca's podcast episode having done thorough research on these interesections over multiple years and curated a large document of facts and data at the ready for that conversation, some of which I’ll be sharing here.

At this point, you may be thinking that I’m only against licensure for yoga therapists.

To be clear, I’m against existing unlicensed professions assimilating into our current systems that prioritize and uphold power, authority, and hierarchy; all of which are common place within the Western world.

I realize that's a very bold statement. Further, I recognize the weight and gravity of that within our existing capitalistic system that favors professional licensure and the multi-billion dollar industry that profits by state licensure boards who enforce state licensure laws.

Sadly, I seem to be one of few voices in the abyss of this licensure conversation willing to publicly challenge the existing narratives surrounding professional licensure. Hats off to long time Yoga Educator Leslie Kaminoff for sharing some of my perspectives on this.

Beyond yoga therapy, the chiropractic profession is equally having discussions regarding their professions assimilation into healthcare since the 1970's. Out of any of the holistic health & medicine professions, chiropractic has deep insight into how assimilation has destroyed the profession from the inside out.

Currently, a new organizing group has recently formed called Chiropractic Freedom Coalition (CFC) of which is a movement to bring Chiropractic back to its roots by breaking the monopoly that has been formed by the Council on Chiropractic Education (CCE) and the National Board of Chiropractic Examiners (NBCE) of which has led Chiropractic as a profession far away from its origins.

This is what assimilation risks in all of the holistic health and medicine professions; this is nonetheless true among Osteopathic Physicians (DOs) who fought tooth and nail against the American Medical Association for the better part of 75 years to assimilate into the conventional medical system. This too, has stripped them of their original roots and philosophy.

Despite these histories and the current challenges our professions face against existing structures of power, I do recognize for the professions that are already licensed, Naturopathic Physicians (ND/NMD), Chiropractors (DC), Acupuncturists (LAc), etcetera; there are pathways for these professions to become more equitable in their approach to licensure as we progress towards more egalitarian/ horizontally structured organizations and credentialing systems that do not uphold existing licensure laws and the structures of power they are enmeshed within.

Current State of Licensure in Holistic Health & Medicine

Currently, within the United States, Naturopathic Physicians (ND/NMD) are licensed in about 25 states and continue to seek licensure in the remaining 25. However, NDs only have legal rights as primary care physicians within a small number of the already licensed states which allows them to practice the totality of our naturopathic therapies in addition to having state-sanctioned authority to prescribe pharmaceutical drugs.

In the Ayurvedic profession, at the behest of the National Ayurvedic Medical Association (NAMA), Ayurvedic professionals began seeking professional licensure within the state of Colorado in 2019. In the Sunrise Review submitted to the CO Department of Regulatory Affairs, Ayurvedic professionals made their case for the state granting them licensure primarily based on the premise that granting licensure, "...would enable Ayurveda to be wholly integrated into the U.S. health-care system."

That's a pretty astronomical claim considering that Naturopathic Physicians are already licensed in approximately 25 states and are really no more "integrated" into the U.S. healthcare system than NDs practicing in states without licensure.

Concluding this review, the CO Department of Regulatory Affairs recommended, "Do not regulate Ayurvedic professionals in Colorado" based upon The Colorado Natural Health Consumer Protection Act that already grants holistic health professionals safeguards for practicing in the state without a license. At the end of the day, they determined that there was not enough evidence to prove that Ayurvedic professionals are practicing unsafely; therefore, no need for licensure. I'm of the belief that this logic could be applied to the vast majority of holistic health and medicine professions.

Historically, stories like these are common place within our professions whether it be Chiropractic, Naturopathic, Osteopathic, Homeopathic, Chinese Medicine, Yoga, Ayurveda, or others.

At some point, we as holistic health and medicine professionals have got to ask ourselves, is this licensure paradigm genuinely serving us or are we seeking to achieve licensure based upon the mired of flawed fallacies that have been perpetuated about licensure over the last century?

Sadly, I don’t think many of us within these professions have critically thought about the complexity of this issue at the intersection of these power structures because we're starry eyed over the golden ticket of greater recognition of our professions within the broader conventional healthcare system. History, however, may provide a different perspective that would be useful for us to reflect upon.

Historical Perspectives

As we are seeing currently play out in the world, if we don't study history to inform our present or future, we're likely to repeat it.

Let me walk you through some of the history of medicine.

Prior to 1910, medicine in North America was open, eclectic, pluralistic, and decentralized. There were no unified standards, no singular definition of what constituted medicine, nor were there any national licensure examinations or medical boards.

Essentially, medicine was an open marketplace, similar to a farmer's market; where you had the ability to choose which healthcare professional you wanted to establish care with. This consumer-driven market incentivized competition among doctors and created an environment where their reputation, affordability, accessibility, and philosophy directly influenced their practice and the care they provided.

At this time, all physicians were on equal footing regardless of the specific form of medicine they were trained in; thus, patients were the primary regulators of physicians in practice. Patients decided who was trustworthy, what kind of medicine to pursue, and how much they were willing to pay for medical services.

This approach gave the public access to diverse approaches to healing, many of which were rooted in cultural, ancestral, or community knowledge which in turn lead to lower cost of entry to practice; of which also allowed working class people, women, and persons' of color to enter the field of their desire. Innovation truly thrived as new professions like Chiropractic and Osteopathic Medicine both emerged in this environment.

Despite this decentralized form of medicine in the early 20th century, billionaires salivated at the opportunity to bring greater "authority" to conventional medicine.

The Flexner Report

Notwithstanding all of the good that came from this period in medicine prior to 1910, sweeping shifts toward professional monopoly began early in the 20th century compelled by The Flexner Report of which was commissioned by the Carnegie Foundation and funded by industrial capitalists like Andrew Carnegie and John D. Rockefeller.

This commissioned report sought to upend the entire pluralistic nature of medicine by hiring educational reformer Abraham Flexner, who was not a physician. The goal of Flexner's work was to establish scientific rigor and standardization within medical education which contrasted medical schools of the time which were often proprietary institutions privately owned by physicians.

During the years prior to Flexner, there were approximately 150-160 medical schools that existed by the late 1800s. The totality of these schools were a mix of conventional (allopathic) medical schools, homeopathic schools, naturopathic schools, chiropractic schools, osteopathic schools, and even medical schools dedicated to training black and female physicians.

Flexner's job was to travel to each of these medical schools and conduct on-site visits, comparing the curriculum at each of these schools with the gold standard of medical education which was the curriculum at Johns Hopkins University School of Medicine. The more aligned a medical school's curriculum was to Johns Hopkins, the better its chances were at remaining open.

Needless to say, what ended up happening is that nearly all of the allopathic medical schools were allowed to remain open while the holistic and eclectic medical schools were forced to close their doors; including the majority of schools dedicated to training black and female physicians. This was done to incentivize the biomedical model of medicine and to centralize/monopolize medical practice of which solidified conventional medicine as the dominant and exclusive form of state recognized medical care.

Thus, power, hierarchy, authority and billionaire co-sponosors have been embedded into the institution of medicine for well over one century.

Some of you by now may be thinking that what I have stated here is conspiracy theory and conjecture but this is indeed a real historical account of medicine within North America in the 20th century; of which continues to have ripple effects into the 21st century. Anyone looking to investigate this history further, please research Flexner's 1910 Report, "Medical Education in the United States and Canada".

After the release of Flexner's report, this empowered state monopolization of medicine through licensing boards to enforce these new standards. Unsurprisingly, these medical boards were often entirely composed of conventional physicians (MDs) which further ensured the legalization of their form of medicine. By the 1930s, medical licensure was mandatory in all 48 states at the time which lead to the criminalization of those "practicing medicine without a license;" this relegated holistically trained physicians, midwives, herbalist, and indigenous healers to the status of "quackery" and "folk medicine".

Undeniably, the Flexner Report improved scientific rigor all while enforcing a narrow colonial definition of legitimate medicine that cemented this field as a racist, classist, sexist, and capitalistic paradigm; which is still par for the course to this day.

When we talk about professional licensure within healthcare, especially within holistic health and medicine, it is these oppressive systems and histories that we risk upholding.

There is not a single part of me that can fathom upholding these harms all to give ourselves more legitimacy and acceptance within the system that has perpetuated these harms for the better part of one century; especially when accounting for the fact that many of the tools, practices, and paradigms found within holistic health and medicine come directly from black, brown, and indigenous cultures/traditions globally.

By upholding these colonial, patriarchal, and authoritarian systems, we're not only selling ourselves out but also selling out the people actively upholding theses ancient traditions and lineages in the cultures of which they originally arose.

Some within these holistic professions may not care about being sellouts, but my own personal ethics compels me to care. I hope many of you reading this feel this way, too.

Either we're on the side of biomedical sciences being the sole medical epistemology in the world or we're on the side of a much more expansive, decolonial, and anti-capitalist epistemology which is at the root of many of the holistic health and medicine professions.

Here in 2025, we are allowed to hold two truths simultaneously, one that recognizes the amazing advancements within the biomedical sciences that benefit every single one of us on the planet; all while holding space for a medicine that is more holistic, more trauma-informed, more community-centered, more personalized, and offers liberatory frameworks of care oriented around health justice, abolition, and feminism; in addition to queer, trans, and disabled perspectives.

I am ardently of the belief that the holistic health and medicine can begin shifting these paradigms of medicine by providing care that does not further marginalize and stigmatize the most vulnerable among us but we have to decide whether operating within the existing system allows us to do that.

I do not believe it does and that is my entire argument against our current trajectories; especially given the history of Flexner and its continued monopolization of medicine that has reverberated deep within the foundations of all holistic health and medicine professions to this day. So, what can we do to pave a new path?

Shifting Licensure Paradigms

Move from Gatekeeping to Democratization

Despite all of the training holistic health & medicine professionals often receive and given the fact that being a healing professional is a lifelong practice like any other career; none of this matters in a licensure only system.

Licensure by its very nature is government sanctioned gatekeeping as if holistic health professionals did not receive proper foundational training and skills throughout the entire length of their education.

Not only is licensure a method of gatekeeping professional entrance to practice, it is a structural tool of marginalization that turns licensed professionals into an extension of state violence.

There is abundant evidence that licensure requirements create economic barriers disproportionately excluding those that are black and brown, indigenous, persons' of color, disabled, LGBTQIA+, immigrant, neurodivergent, and working class people from entering professional practice just as it did in the 20th century.

Thus, state licensure upholds white supremacy, colonialism, domination, hierarchy, and elitist models of care that are far less responsive to the needs of diverse populations including diverse professionals themselves.

So, despite practitioners of marginalized identities often displaying higher levels of psycho-emotional maturity, health and medical competence, empathy, bed-side manner, and ethical behavior; our current system prioritizes granting licensure to those that are able to finance and pass meaningless licensure exams that prove nothing other than ones ability to regurgitate information for an exam. Once licensure is granted to these "professionals," there remains little oversight from licensing boards and unethical behavior of licensed professionals can persist for years or even decades without accountability.

Why are we insistent on maintaining a system that has perpetuated so much harm?

Further, how can we democratize professional practice so that we maintain a proper balance between ethical accountability/patient safety all while allowing holistic health and medicine professions to have long prosperous livelihoods without obstruction from state governments?

Democratizing Professional Practice

Firstly, democratization must acknowledge the history of which I've outlined here and vow to not repeat it; this is the only way we can move forward and create new paradigms that right so many historical wrongs.

As both a queer/transgender person, as someone living with a chronic health condition, and as a soon-to-be Naturopathic Physician (ND), I do not have the luxury of separating my personal politics from my professional practice; writing this article is a call for other holistic health professionals to align themselves in this way, too. This is where we must start.

Beyond this, rather than maintaining the status quo, we must collectively gather together to envision bold and progressive changes to upend these legacies of harm.

With this intention, I will share several ideas that I see as potential pathways for holistic health and medical professions to pursue. What I write here should not be seen as our only options but those that facilitate conversation and dialogue within the broader world of holistic health and healing.

Pursing this path will take much more of a collective vision than that of a singular person; as moving away from the long-engrained state-licensure model will require the creation of entirely new horizontally led structures that simultaneously prioritize community, accountability, accessibility, and ethical practice without further instilling the gatekeeping and systemic inequities of this existing system.

Given this framing, what is the core philosophy of this new approach and what options do we have in building more equitable structures?

Summary of Core Philosophy

• Decolonialism- This is number one. We must emphatically challenge the notion that state-sanctioned licensure laws are the only pathway to confer "expertise" and that licensed practitioners are the only ones that can legally hold the knowledge of clinical practice; especially knowledge at the intersection of the sciences and indigenous, ancestral, and community-based traditions.
• Patient Accountability over State-Sanction- We must shift the lotus of legitimacy from that of government control to both trained professionals and the communities of which they serve.
• Cooperation Over Competition- We must build true networks and organizations that are not only egalitarian and horizontally led but that also serve as inter-professional cooperatives and resource sharing instead of stifling entrance to practice via competitive licensure exams that limit professional access to practice, especially among those most marginalized within society.
• Radical Accessibility & Professional Accountability- We must actively work to make training and entrance to practice both financially and culturally accessible; along with professional organizations prioritizing true practitioner accountability when patients are harmed.
• Shifting From Exchange-Value to Use-Value- State sanctioned licensure signals to the market (employers) that a professional is legally transactable in an exchange-value system. This means practitioners' themselves become a commodifiable good that serves the interests of exponential capital gain. This is how capitalism works via worker exploitation. Use-value, however, counters this by assessing whether the practitioner is actually effective, ethical, and responsive to the needs of their clients and community. Ultimately, the difference here is that the use-model prioritizes the value and quality of the practitioner-client relationship over the exchange model of which prioritizes state authorization and market certification.

Stating this core philosophy does not negate the need for professions that are already licensed to move toward more equitable access to professional practice; this should not be seen as an end goal but one that serves as a transition into more egalitarian structures. I am under no delusion given our current system that we can automatically switch from one system to the other; there does need to be a transition period. However, for professions that are already unlicensed, they should be striving to work toward and create egalitarian horizontal structures rather than pursuing licensure. What does all of this look like?

Equitable Structure Models

Model 1- Portfolio Review & Preceptorships for Licensed Professions

As explained ad nauseam throughout this article, existing licensure models gate-keep professional entrance to practice via licensure exams; whereas some may favor licensure exams they should never be used as the sole approach to obtaining professional licensure, especially among professions that have a high debt-to-income ratio.

On average, holistic health and medicine professions currently have a 585% debt-to-income ratio; meaning the amount of debt students go into in order to enter professional practice is 585% higher than the income of which they make in practice. This is not only unsustainable but it is entirely unethical and immoral to gate-keep entrance to practice with this kind of debt burden. Remember the exponential growth within a capitalist system that I spoke of previously?

Not only is debt something that should arouse suspicion about our current paradigms but all of the inequities previously mentioned that block those most marginalized from entering professional practice due to all of the structural forces that keep them marginalized in the first place.

Given these existing inequities, the law profession, after having published a study at the 2022 Bar Exam National Conference confirmed that the Bar Exam disproportionately and adversely affects law candidates from systemically disadvantaged backgrounds including those within black and brown communities, those from low socioeconomic backgrounds, and those that are first generation law students; thus acting as a significant barrier to practice.

Given this research, the legal profession decided to create an additional pathway to professional practice . Not only did the law profession keep the Bar Exam for those that wish to become licensed via standardized testing but they provided an additional pathway to becoming licensed via a portfolio/preceptorship based model of which has been implemented in a multitude of states including Utah, Oregon, Washington, Minnesota, and several others.

Not only does this diversify the legal profession, reduce debt burden, and address attorney shortages/legal deserts, but it provides an innovative and equitable pathway to professional licensure.

This portfolio/preceptor based model requires that after graduation from law school, graduates that pursue this pathway are required to do supervised legal work upwards of 500-1000 hours post graduation, accumulate legal documents to create a portfolio that demonstrates their competency, and undergo structured mentorship. Ultimately, the goal is for these preceptors to submit their hours and portfolios to the state Bar Association to obtain full legal licensure thereafter.

This model is something that I strongly believe existing licensed holistic healthcare professions should be working towards if we truly want to move toward more equitable and eventually more egalitarian ways of professional organization.

The additional pathways suggested below are those that unlicensed professions can establish in order to build more equitable and egalitarian futures.

Model 2- Professional Membership Association with Voluntary Certification & Registry Model

This model prioritizes an independent, non-state run organization that establishes professional competencies, educational standards, code of ethics, scope of practice, pathways for disciplinary action, and post-certification standards for professional practice. This idea has already been utilized in many non-licensed holistic health professions and is the exact model of a multitude of professions including yoga teachers, yoga therapists, Ayurvedic professionals, and many others.

IAYT for example, the organization credentialing yoga therapists is run as a 501c3 non-profit organization of which in its legal structuring does not allow for members of that organization to make decisions about the future of the governing body or the profession; this model further instills existing top-down non-egalitarian hierarchies making change only possible by a select few in positions of power.

Ultimately, professions looking to create voluntary certification and registry models would most benefit from a 501c6 designation of which disperses governance and voting rights to its membership rather than delegating it to a central board of a select few people who often benefit from maintaining their roles of authority. A membership based governing model would allow members to control the organizations various agendas in a horizontal manner rather than via a top-down one.

Professional membership associations like these could also provide its associates with model contracts, informed consent forms, insurance, continuing education, and low-cost mediation services for client-practitioner disputes all while maintaining a public directory and having a transparent process for investigating ethical complaints whether it is those within accredited training programs or those within professional practice.

The core strengths of this model goes beyond mere academic achievement to a focus on building an ethical framework for practice and professional conduct given that the entire organizations reputation rests on the integrity and ethics of its membership. This model also helps reduce administrative burden and the legal vulnerabilities often associated with solo practice; all while providing a clear and accessible path for addressing grievances outside of the costly legal system.

Model 3- Integrated Peer Review/Portfolio Model

After completion of a professional training program whether via formal education or via apprenticeship models, graduates would apply to a cohort of diversely experienced peer-practitioners; along with seniors within the profession and submit a credentialing portfolio of which would be a living portfolio of one's existing practice.

Over a period of 1-2 years, applicants would provide detailed narratives about each clinical case, explanation of their clinical decision making process, address any challenges and/or ethical dilemmas that arose and how those were overcome, and provide outcomes the client has achieved as a result of working with the practitioner. With each client's consent, excerpts from these sessions could be added to the portfolio for review; in addition to including feedback from the each client themselves.

At the end of each case, applicants would provide a self-reflective journal analyzing their own growth, bias, and philosophy of practice.

Peer review sessions would be held at designated periods to provide space for clarifying questions, debate, observations, sharing of relevant experience, and offering alternative perspectives.

Final assessment would be mapped according to the competencies created for applicants; these categories could transverse therapeutic relationship skills, ethical reasoning, clinical skill proficiency, cultural humility, trauma-informed practice, and any other standards the profession deems important for professional competence and practice. At the end of each peer review cycle, both senior and experienced practitioners would collaboratively recommend the applicant for credentialing and thus grant entrance to professional practice.

Model 4- Community-Based Credentialing & Apprenticeship Based Model

Combining apprenticeship and community based credentialing would serve as a decentralized form of credentialing within particular communities whether geographic, cultural, or via professional designations. In this model, a local council of elders, master practitioners, and community members could all work to design apprenticeships. An example of this would be that communities design a pathway to transmit their traditional knowledge to newer generations of those within their communities interested in becoming healers/herbalists. This apprenticeship based model would not only include the technical skills needed to safely and appropriately apply the knowledge within their community but would also include cultural protocols, framing of these practices within a historical context, and specific community service hours to achieve the requirements and standards of the apprenticeship.

Not only does this model protect cultural sovereignty and relevance that mainstream licensure models erase, practitioners are directly accountable to the people they serve rather than some distant bureaucratic board that has zero relationship with the practitioner or community members. Beyond these benefits, community-based credentialing and the training therein is tailored to the specific health needs of a particular community all while embedding values of community service, cultural humility, and indigenous/community-centered knowledge from the start.

Model 5- Client-Centered Legal Structures: Informed Consent & Contract Law

This model is one for those that are already in professional practice seeking a robust, and plain-language contract for the client-practitioner relationship of which would explicitly explain and define the non-medical, complementary nature of the services being rendered. An additional goal would be to create a gold-standard informed consent protocol that details not only the theory or practice but the potential risks, benefits, limitations, and the practitioner's specific training background.

Ideally, in a model like this, practitioners would already be trained in ethical transparency which means they are actively documenting all client interactions and conversations regarding written or vocalized informed consent conversations.

This model enforces legal liability through clear contractual boundaries and professional liability insurance rather than via the state licensure model of which in turn empowers client's of practitioners to have greater autonomy and partnership as the relationship becomes one of collaboration and shared-decision making. Additionally, well-crafted contracts reduce legal risk for practitioners by setting clearly understandable expectations which minimize future disputes.

Incidentally, this contract and informed consent based model would easily integrate well with any of the models proposed here.

Model 6- Collective & Cooperative Practice Structures

This model would center worker-owned cooperatives or a multi-modality collective where credentialing is internalized via establishment of their own training and credentialing criteria, peer-review process for new members, and probationary periods due to client disputes with practitioners; in turn the collective has a direct stake in the competence and ethics of each member practitioner which leads to strong internal accountability.

On the client facing side, clients would contact the collective directly then the collective would offer them a choice of practitioners to work with. One of the most beneficial aspects of this model is that the collective shares resources, administrative tasks, and liability all while having a democratic governance model of one member equals one vote.

Further, a cooperative reduces the legal risk of solo practice all while promoting economic justice and stability by profit sharing with member practitioners; in turn reducing the income disparities often present within the professions of holistic health & medicine. This model also naturally fosters interdisciplinary collaboration and client referrals within the collective which in turn creates a sustainable and supportive container for practice by mitigating the burnout often associated with solo practice.

A Multifaceted/Blended Approach

Taking a multifaceted/blended approach is not necessarily a model as outlined above; however, what it does provide is a credentialing ecosystem where each of these proposed models serve different functions within the communities and contexts of which they are created. In turn, this creates an environment of resilience and redundancy as having a multitude of credentialing models confers greater safety; if one model falters, another model can provide structure, adaptation, and progress. These multifaceted approaches also meet a diversity of needs whether it be those of a new practitioner, one starting out on their educational journey, a traditional community healer, or a research-scientist; all of whom can find a path and organization that uniquely meets their needs. Not only does a blended approach support practitioners but as these organizations evolve and weaker models fade, innovative ones can emerge in a decentralized/non-hierarchical environment that breeds collective collaboration and growth.

Addressing Criticisms of Democratized/Egalitarian Models & Consumer Protection

A lot of the concerns of more democratized/egalitarian structures point back to rhetoric regarding state-sanctioned licensure laws, mainly the belief that licensure protects the public. What has been outlined within this article is that licensure often protects unethical practitioners all while upholding existing systems of hierarchy and dominance that gate-keep professional entrance into practice.

Criticism 1- Risk to Public Safety & Inconsistent Standards

Concern- Creating a patchwork of professional standards means there is no reliable minimum competency for professional practice and communities/peer circles could lower standards for their fellow professionals in turn exposing the public to harm from under-qualified practitioners.

Solution- Create a National Framework of Core Competencies with Local Implementation

Instead of pushing often biased and inequitable standardized testing/national exams, establish an open-source framework of core competencies for professional practice within each profession. Local professional organizations, collectives, guilds, or peer networks could then become accredited based upon their compliance to these competencies. Methods within these organizations such as using the peer-reveiew model, or using an apprenticeship based model may vary from organization to organization; however, their outcomes must demonstrate commitment to the established framework. This model would create consistency in ends rather than means. Additionally, an independent auditing organization of credentialed practitioners could ensure adherence.

Criticism 2- Erosion of Professional Cohesion & Identity

Concern- Fragmented organizing structures weakens professional advocacy, mobility, and social credibility; without a unified title, the profession makes negligible progress.

Solution- Establishing a National Membership Alliance

Decentralized nodes of various cooperatives, collectives, and organizations would join a national membership alliance of which would help maintain the public facing brand of the profession. This organization would serve as the collective advocacy and PR voice for various professions, all while negotiating the needs of its membership with state and local governments of which forms a united force representing many localized nodes.

Criticism 3- Increased Liability & Legal Vulnerability

Concern- Ambiguous practice standards increase malpractice risk and insurance costs.

Solution- Member nodes with the national alliance adopt formal practice protocols for informed consent, practitioner documentation responsibilities, emergencies, and referral networks as the de facto standard for practice of which provides legal clarity and thus greater protection. This national alliance could also actively negotiate the groups liability/malpractice insurance policies for all members thus leveraging collective buying power which intern reinforces safety and reduced insurance premiums for its membership.

Criticism 4- Potential for Exploitation & Internal Inequity

Concern- Decentralized models can replicate oppression without state-level due process including mentor exploitation and peer-reviewer bias.

Solution- Emedded Design & Independent Ombuds

Governance of each membership organization would include designated seats for community members and early career practitioners on all credentialing and review panels. Peer review processes as often as possible should use blinded protocols and rotate cohorts of reviewers to mitigate ongoing bias. Additionally, funding an operationally separate ombudsperson to provide a confidential external avenue for grievances related to exploitation or bias within any member node would provide an unbiased third party to assess the claims and seek non-legal routes for conflict resolution.

Criticism 5- Consumer Confusion & Weakened Trust

Concern- A multitude of credentials confuses the public and allows bad actors to create fake certifications.

Solution- A Public, Verifiable Registry of Transparency

Firstly, as stated within this article, this is already occurring within the context of "Functional Medicine" and many other areas of holistic health and medicine to this day. The solution here is for the proposed national alliance to maintain a single, searchable public registry of all practitioners credentialed by various accredited nodes including information on the credential, the node of origin, a log of complete peer-review hours, and any ethical complaints against the practitioner. Ultimately, this shifts trust from obtaining a singular license to ongoing transparency throughout the duration of one's professional life. Additionally, this would enable the national alliance to protect their credential and legally prosecute its unauthorized use.

Criticism 6- Sustainably Funding Voluntary Models

Concern- Voluntary models are unstable and will be under-resourced for serious oversight.

Solution- Tiered Membership & Service-Based Revenue

Funding in this model would need to be diversified including membership dues within each local node, practitioner fees for registry, listing, and insurance/liability; in addition to fees-for-service to the national alliance from local nodes for auditing, technology, and verification processes. This would be structured as a cooperative non-profit utility where nodes are member-owners; thus sustainability and viability of each node is tied to the value of the services provided by the national alliance including liability reduction, credentialing, client referrals, practitioner registry, etcetera.

Criticism 7- Accountability for Serious Practitioner Violations

Concern- This voluntary model is meaningless if practitioners can just join another node of which is not equivalent to a state-wide license revocation.

Solution- National Alliance as the Ultimate Enforcement Tool

When it comes to public safety, access to information about an unethical professional should not be underestimated. A practitioner expelled from an accredited node for ethical violations will be removed from the national public registry and thus would face legal prosecution if they maintained unauthorized use of the professional credential. Additionally, the national alliance would establish mandatory reporting rules for serious violations of professional practice. A confirmed violation would lead to a mandatory red flag on the practitioners profile for a set period of time (1 year, 5 years, etc.) of which would be visible to any prospective client or institution that searches for them. Rather than sole discretion centering licensure boards and licensure revocation processes, this model creates a powerful market-based deterrent thus allowing for a greater level of public transparency and accountability in contrast to lackadaisical disciplinary actions from state licensure boards.

Summary & Conclusion

Overall, this democratized model shifts professional practice from the paradigm of, "The state guarantees this practitioner is safe" to a transparent ecosystem that makes a practitioners entire history of competency and conduct publicly visible which allows the community to continue to support and trust them in an ongoing manner. This ongoing trust and support is what is missing from existing state-sanctioned licensure models given the structures of power, hierarchy, and authority they are presently and historically contained within.

The question remains for the entire field of holistic health and medicine including all of the aforementioned professions:

Do we as holistic health professionals wish to maintain these hierarchies of harm or do we as holistically minded professionals seek to create long-lasting and sustainable solutions that truly merge our shared philosophies and histories with the complexities of modern ethical clinical practice?

The answer is clear me but are we collectively up for the challenge of co-creating a new paradigm?