You've probably heard of the credentials M.D. and R.N., and maybe N.P. The people using those letters are doctors, registered nurses and nurse practitioners. But what about PSC.D or D.PSc? Those letters refer to someone who practices pastoral medicine — or "Bible-based" health care.

It's a relatively new title being used by some alternative health practitioners. The Texas-based Pastoral Medical Association gives out "pastoral provider licenses" in all 50 states and 30 countries. Some providers call themselves doctors of pastoral medicine. But these licenses are not medical degrees. That has watchdog organizations concerned that some patients may not understand what this certification really means.

That includes patients like 60-year-old Mark Sarchioto, who lives just outside Dallas. Sarchioto has crippling neuropathy and has been searching for a treatment for decades. One leg is numb, and as he shifts from his walker to the couch, he holds out his left hand.

"It feels like somebody is puncturing it with needles," he says. "Right now it's cold and I can't keep it warm."

In 2013, he and his wife, Joan Sarchioto, heard an ad for a breakthrough therapy for neuropathy at HealthCore Center in Richardson, Texas. They jumped at the chance for a free evaluation. But it didn't take long to realize the free evaluation was going to cost them.

"We get in and the [medical assistant] or whoever takes the vitals and they go, 'We need to go take your X-rays and there's an evaluation fee of $35.' And I said, 'But I thought this was free,' " Joan Sarchioto says. "When they start ordering tests, I know what's BS — and I know what's not."

The founder of HealthCore Center is Karl Jawhari. He is a chiropractor, but says he practices "functional medicine" under his license from the Pastoral Medical Association.

HealthCore Center advertises natural weight loss, help for hypothyroidism and diabetes programs — and on its website it touts its employees as doctors of pastoral medicine. Jawhari's office walls are lined with framed certificates, and there's a Bible on his desk.

"We've seen people with an array of issues: thyroid issues, diabetes, blood pressure, cholesterol," Jawhari says. "We work with a lot of people to reduce their weight and so forth and we've had great success with that."

Jawhari hasn't always had success with state regulators. Last August, he was fined $2,500 by the Texas Board of Chiropractic Examiners for deceptive advertising. In June, the Texas Medical Board — which licenses, regulates and disciplines physicians, physician assistants and other practitioners — issued a cease and desist order demanding that Jawhari stop offering to treat conditions beyond his chiropractic training.

He says he's done that.

There may be people who take advantage of the pastoral license, he says, but he's not one of them.

"I've heard of a few people that are practicing that aren't even doctors," he says. "It's up to the consumer to do due diligence and figure out is this practitioner — does this doctor know what he's doing?"

In recent years, the Texas Medical Board has sent about a dozen cease and desist orders to people using the pastoral medicine certification. Some hawk dubious supplements like colloidal silver, promise extreme weight loss, treat thyroid disorders and discourage vaccine use.

The Texas Medical Board has just become aware of the term pastoral medicine in the past couple of years, says Mari Robinson, the board's president.

"Folks are purporting to treat and diagnose illness using that term," she says. "It's not a degree; it's not a license."

At least not a license recognized by the Texas Medical Board. NPR reached out to several other people in North Texas who have licenses from the Pastoral Medical Association. None agreed to talk.

Many of the practitioners who highlight their pastoral medical degrees have slick websites touting patient success stories.

Robinson says anyone in the United States who wants to create a website can do so, but it is illegal to diagnose what is wrong with someone, treat them, or offer to treat them without the appropriate training and licensing.

The Pastoral Medical Association didn't respond to several attempts to connect by phone. It did send a statement by email explaining it was founded by a group of Christians concerned with the increase in chronic illness. The association says it seeks to protect "the Almighty's Health Care workers."

According to the association's website, to obtain a license, applicants must pass "rigid standards" that the group wouldn't share. Members also have to pay processing and annual fees that can range from a few hundred dollars to a few thousand.

So, why might someone join?

People may feel they are more marketable if they get some credentials, says Stephen Barrett, a retired psychiatrist and founder of the consumer protection site Quackwatch.org.

"There are lots of credentials you can buy," he says, "and this is just one of many."

Barrett says the Pastoral Medical Association functions like a private club. Patients sign confidentiality agreements, pay out of pocket and are prohibited from suing if they're unhappy with the care they receive. Any disputes are handled by an ecclesiastical tribunal.

"They're claiming that 'Any advice we give you is pastoral in nature,' " Barrett says. "In other words, 'If I give you health advice that's not health advice, that's pastoral advice.' "

These practices do have supporters. Toni McElhaney of Plano, Texas, found out about HealthCore through a flier advertising a free thyroid seminar. She'd been taking medication for hypothyroidism but still felt exhausted.

She says she paid $300 for initial testing and $4,500 for a six-month treatment plan. None of her treatment is covered by health insurance.

McElhaney thinks the heavy metal detox, special diet and herbal supplements helped her lose weight and gain energy. So, does it matter to her that the woman she sees isn't actually a licensed doctor or nurse?

"No," she says. "It doesn't matter to me. I feel like she knows her stuff, and I have responded better to her treatment than I would have just going to an endocrinologist alone."

Sometimes traditional medicine doesn't have all the answers, and navigating what's legit in the world of alternative medicine can be tough. The key, according to Mari Robinson of the Texas Medical Board, is to really understand the qualifications of the person you are seeing. Just because someone puts doctor in front of their name doesn't mean they are medically qualified.

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