Your Comments: Income Influences for Naturopathic Physicians

Summary:  The article and analysis on the survey from the Association of Accredited Naturopathic Medical Colleges provoked an array of perspectives on naturopathic physician income (Income for Naturopathic Physicians: Data from AANMC Survey, February 5, 2007). Subjects range from the low response rate to the "confidence gene" to the life-style choices of the mostly female work force to work fewer hours, especially faced with student loan debt over $100,000. Commentators are Michael Traub, ND, past president of the American Association of Naturopathic Physicians; Guru Sandesh Khalsa, ND, naturopathic medicine dean at the University of Bridgeport; Robert May, ND, a consultant and former executive with a managed complementary medicine firm Alternare; and Erik Goldman, the co-founder and editor of Holistic Primary Care.

1.   "Marketing Gene" or "Confidence Gene" the Major Influence?

Commentator Michael Traub, ND

Commentator Michael Traub, ND has served in various leadership positions in both naturopathic medicine and integrative medicine for 20 years. His experience includes service as a past president of the American Association of Naturopathic Physicians and was the leader of the integrative medicine team at the pioneering North Hawaii Community Hospital.

"Good article.  You wrote about the 81% non respondents:  'Did busy doctors not take the time, thus skewing the data downward?'
This is very possible.  When one has a full schedule, one must pick and choose which surveys to respond to.

"You wrote 'Or, more likely, what of the graduates who don't have the marketing gene and despite possibly excellent clinical potential to help patients, left the field?'

"I don't think grads fail because they lack the marketing gene if they have excellent clinical potential - my experience, having had many students preceptor with me over the years, is that the ones who succeed do so because they demonstrate that they are confident (real or through acting like they are), and those who struggle are the ones who lack this 'confidence' gene.

"I also think that it makes a huge difference if one is willing to work a full 40 hour week, rather than try to get by with 3.5 - 4 days/week.  And also that it makes a huge difference if you value your services sufficiently to charge fees that not only keep you in business, but give you a cushion, a retirement plan, and money to take vacations to recharge your batteries

"As for marketing, I think it's become far more simple these days, with websites and email newsletters.  This can be done even by people who are otherwise genetically deficient in marketing. Thanks for sharing this with us."

Michael Traub, ND
Kailua Kona, Hawaii

"I believe that Michael's comments are generally correct.  I believe that confidence is probably the most important factor for success, although without competence it is certainly misplaced.  And I have known a number of very successful practitioners who did little in the way of conventional marketing (although I would not say that marketing is not important, especially in certain environments).

"The 81% who did not fill it out are probably a mix that includes those who are very busy, who gave up or are otherwise  no longer involved, and some in between.  It is speculation as to who they are and what their affect on the number would be if they filled one out."

Guru Sandesh Khalsa, ND, Dean
Bridgeport, Connecticut

Commentator Robert May, ND

Robert May, ND is a past executive with pioneering complementary managed care firm Alternare. He is presently a member of the board of the Washington Association of Naturopathic Physicians (WANP). He made clear that his views are his own and that he wasn't speaking on behalf of WANP.

"Nice article on the ND incomes.  A big question for the profession related to the 81% non-responders is what is/will be the default rate on the huge loans that students graduate with.  Significant default rates could potentially threaten availability of financial aid, and thus threaten the schools. 

"It’s overwhelming to think of students coming out with over $100K in debt and the cost of starting a practice.  The schools may be doing well, but time will tell if it is sustainable – and I’m concerned that prospective students don’t hear that income data is based on a less than 20% response rate.

"A related area that concerns me is the current ND political strategy, at least in WA, to go mainstream, i.e. fight for primary care status, expanded prescriptive authority, and access to Medicare and Medicaid programs.  The goal is to increase access to patients and billable services, but some of these programs will bring increased liability, increased costs, and questionable patient populations – with a resulting dilution of original naturopathic perspective and practice.  

"Are NDs racing to get into a party that others are racing to get out of?  (An MD colleague) suggested that perspective to me a few years ago about the CPT system, and I think it’s quite accurate.  The mainstream system is sick, and is the problem, in many ways.  Do NDs really need to become more part of it?

"What I’d like to see is at least a commensurate strategic focus on clarifying the unique elements of naturopathic medicine, and then identification of a way for new docs to market that and make good living.  This would address the issue of the missing 81% of ND respondents.  It also is the best insurance policy for naturopathic medicine, whereas becoming more mainstream could reduce the raison d’etre for NDs over the long term.   The Foundations of Naturopathic Medicine Project that Pam Snider, ND and others are working on is very important, but it needs to be tied to real world application in the market place – something that doesn’t sell out the soul of naturopathy for inclusion in the predominant dysfunctional paradigm.

"I’ve been thinking about this a fair bit lately, and thought I’d share it with you.  Maybe there will be some threads to pick up for future examination in your work."

Robert May, ND
Seattle, WA

Eric Goldman is co-founder of Holistic Primary Care

Erik Goldman, co-founder and editor of Holistic Primary Care has followed the naturopathic medical profession for years, covering its action and  sometimes employing its writers (including Traub).

"Nice work on that AANMC income survey story. I'm not quite sure how to 'read' the meaning though..... Is it a hopeful sign that NDs can make 80K? That amount, five years out, isn't exactly a whole lot of money. Here in NYC, 80k is barely middle class. On the other hand, 80K- if you're in your early 30s, you're only working part-time and your mate/spouse/whatever also works, is a decent living by national standards. If factored against a debt of 100K or more, though, it doesn't go very far. At least they're happy (but then again, there's that poverty mentality thing.......)

"I've talked with (an ND colleague) at length, and he paints a pretty dire picture----at best only 20% or so of the total ND/NMD universe is making what he calls a 'real adult living' practicing medicine. The situation is somewhat better for holistic MDs, but they have their own set of economic struggles. We're still a long way away from healthcare valhalla, that's for sure.

"I'm curious just how much of a slice the revenue on formularies comprises for NDs who make a real living in practice. I'm also wondering just how many practitioners out there (MDs, ND/NMDs, DCs) dispense  from their offices. Ever come across meaningful data on this?

"So a lot of NDs don't 'feel emotionally right' at 40 hours? Is that
because 70% of 'em are young reproductive aged women who've just had or are just having kids?) I can tell you that a lot of MDs (female or male, kids or no) definitely do not 'feel right' working 80!!  I wonder how many NDs are in full-time vs part-time practice and whether that's by choice. It's hard to interpret the AANMC findings if we don't know how many hours, on average, the folks are working.

"It would be really interesting to chart hourly revenue (gross & net) for various practitioner groups: conventional MDs, holistic MDs, NDs/ NMDs, Chiros, and look at it along gender, age and regional lines.  Could also look at overhead vs. take-home, which I think would be  very instructive to those naturos who dream of feeding freely at insurance/managed care troughs. It's really not so great making $250K a year if you have to pay half of that to billing clerks to manage your practice. Anyway.....ideas are easy, finding time and money to work on 'em is  another story."

Erik Goldman
New York City