In a marked shift from the past, today’s naturopathic graduates tend to be more interested in working in integrative group practices rather than in the old-school model of solo independent practice, Patterson told Holistic Primary Care.
In large part, this reflects the economic realities of modern clinical practice which, everyone interviewed agrees, can be harsh for recent grads.
“The economics of my student loan are a huge challenge for me,” says Freggiaro. “I paid almost the same amount to attend Bastyr that an MD student at UW would pay, but they have a guaranteed salary at the end of that tunnel. I don’t.
“There are lots of very successful NDs out there, but you have to be creative, find your niche. It is one of our greatest challenges as a profession. My MD counterpart gets paid for a 7-10 minute office visit. That’s not medicine to me.
How do we hold true to the roots of our philosophy and practice, and still become mainstream enough, accessible enough in this day and age?”
Cathy Rogers, whose clinical career spanned the indie practice era, says that few of today’s young naturopaths would ever be able to get out of debt via the old time “classical” naturopathic practice model. The cost of the training is high, but the earning potential has not kept up. Good naturopathic practice is inherently time-intensive.
While she sees the profession’s movement from margin to mainstream as a positive one for patients, it does carry some risk: in trying to adapt themselves to the clinical and fiscal demands of a highly dysfunctional healthcare system, naturopaths could find themselves compromising the core principles that make their profession unique.
“The schools definitely chose to go the family practice / primary care approach as the main focus. That’s what the schools are teaching. My worry is that the students are not getting exposure to the older ways of working with modalities that support the body’s ways of healing.” Rogers’ concerns are shared by many in the field.
As president of Bastyr, Patterson is well aware of all of these issues.
“We do have the problem that we’re not on insurance par with MD services. We have to fix that over time. By working in integrative settings, the patients and the other practitioners will start to demand coverage in the package of insurance. The integration of that viewpoint into insurance plans will happen more quickly with greater inside advocacy.”
But after decades working within mainstream hospital systems, Patterson has no illusions about health insurance plans or their motives.
“We don’t want to be treated exactly like family medicine MDs in insurance. That’s not what we want to be going for. We have to figure out how were going to get an insurance company that supports practitioners in getting people healthy.” Ultimately, this is not about joining a broken system, but helping to recreate a system that is more supportive of keeping people healthy.”
Does integration inevitably mean compromise for naturopathic medicine? Patterson thinks not.
“My point of view is that you don’t really have to sacrifice your principles at all. You shouldn’t. It’s not about naturopaths becoming like other providers, it’s about bringing your philosophy and skill set in there. You don’t ignore the existence of conventional medicine, acute care, drugs, and surgery. It’s a part of reality, and it is sometimes the appropriate approach. But we need to think from the patients’ point of view, we need to think about the whole, and think about therapeutic order--choose the lowest level of intervention first.”
An Enduring Legacy
Bastyr University, and the people who built it, have endured much over the last 40 years, and they have also contributed much to the broader field of holistic medicine.
John Weeks points out that a number of the Institute for Functional Medicine’s key educators—including IFM’s Assistant Director of Medical Education, Dan Luckazer—are Bastyr graduates. Sheila Quinn, who edited the Textbook of Functional Medicine along with IFM founder David Jones, MD, brought more than a decade’s worth of experience with naturopathy at Bastyr into her work in functional medicine.
Tabatha Parker, ND, currently the interim executive director of the Academy of Integrative Health and Medicine (AIHM) was previously on the faculty at Bastyr.
“I see the mark of the NDs in so many places,” says Weeks, who believes that the naturopathic curriculum developed at Bastyr provided a framework for a number of the holistic and integrative training programs for allopathic doctors, including the University of Arizona’s highly influential fellowship.
“The ‘naturos’ have laid down a foundation that many others have borrowed from, Weeks told Holistic Primary Care. “The naturopathic model begins with respect for a holistic healing perspective as its base. I don’t think that naturos fully get this, that their 4-year residential training program will be the reference standard for decades to come.”
Patterson sees an organic convergence between naturopathic and functional medicine that will only increase in the coming years.
“I definitely see that (functional medicine) as synergistic. We’re trying to create a bigger tent here, and they are also trying to create a bigger tent. We have quite a number of conventionally trained healthcare professionals—MDs, PAs, nurses, who are frustrated with the conventional system and the limitations it imposes.
“There’s an opportunity here to bring these people in via functional medicine,” says Patterson. “We’ve done that as one-offs at Bastyr. They come to Bastyr to get an ND and move forward. We are thinking about maybe creating an intentional pathway for those kinds of folks. That’s really what the functional medicine folks are doing. The functional medicine approach is not identical, but it is much more aligned with naturopathy than the conventional approach, especially in primary care.”
Looking toward the future, Pizzorno sees two major challenges facing the naturopathic profession: The need for greater training in nature-based primary care, and the need for replicable models of financially viable naturopathic clinics.
“We really need more year-long residencies in primary care, to fine tune skills. Only about 50% of naturopathic grads get residencies because there’s no funding.” Like Patterson, Pizzorno sees collaborative MD-ND practices as increasingly important for the future of the field.
Looking back through the decades to the earliest days of the school he founded, Pizzorno is hopeful for the future. “We’ve made huge advances. We now have financial aid, federally-funded research, federally-funded post doc opportunities. Eventually the salaries will go up too. The people who are drawn to the profession believe in what we’re doing. More and more people see it as a viable profession. It used to be because it was “alternative,” it was a counterculture thing. Now it’s just because it’s good medicine.”
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