Income for Naturopathic Physicians: Data from AANMC Survey
Written by John Weeks
Income for Naturopathic Physicians: Data from AANMC Survey
Summary: The Association of Accredited Naturopathic Medical Colleges (AANMC) recently released data from a 2004 survey of the roughly 3068 licensed naturopathic physicians then practicing in North America. The AANMC attributed the wide spectrum of net incomesto "personal choice and values/priorities." Still, 98% of respondents showed satisfaction with their career choices.Most NDs do not have the opportunity to be employed and must develop their practice from scratch. An increasing number are in multi-disciplinary settings. A major short-coming of the portrait, however, is the response rate. Only 583 (19%) took part. How many of the non-responders couldn't make the shift from medical student to self-marketer and dropped out, despite student loan debt frequently at $100,000+? The Integrator compares this data with those on MD income published by the Medical Group Management Association.
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Paul Mittman, ND, AANMC president
The Association of Accredited Naturopathic Medical Colleges (AANMC) recently reported in its newsletter the results of a 2004 survey of naturopathic practices. The AANMC represents the six North American naturopathic medical programs (see list and links below) which are accredited through the US Department of Education-recognized accrediting agency, the Council on Naturopathic Medical Education.
The survey found a great disparity in income among respondents. A nearly unanimous (98%) set, however, expressed satisfaction with their chosen profession. In fact, 78% of respondents reported that they "love the work." Notably, a 2003 studyof conventional family practice doctors found that 18% of respondents expressed dissatisfaction, despite incomes typically at least double those of the naturopathic doctors (see chart at bottom).
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AANMC Survey Findings at a Glance
2004
Respondents to Survey 19% response rate on
3068 surveyed
Finding
Income Related
Income (net) of individual starting out
$20,000-$30,000
Income (net) of those in "large, busy practices"
$80,000-$90,000
Minority group of high producers
Over $200,000
Satisfied with income at 2 years
57%
Satisfied with income at 5 years
83%
Satisfied with career choice
98%
Respondents who "love the work"
78%
Conditions Most Frequently Seen#
Fatigue
63%
Menstruation/hormonal issues
62%
Allergies
41%
Depression/insomnia
35%
Thyroid
32%
Weight/appetite
21%
Cholesterol
19%
Headaches/migraines
17%
Blood pressure
14%
Fibromyalgia
14%
Information from AANMC 2004
* % who ranked the condition in the top 3 of those they most frequently see.
_______________________________
Karen Howard, AANMC executive director
The key income-related finding toward which these individuals could hitch their dreams was that respondents "who run or partner in a large,
busy practice" can net $80,000-$90,000 annually. However, respondents just
starting out or in college residencies may net as little as
$20,000-$30,000 per year. Then again, a subset reported incomes over $200,000. Sales of natural pharmacy was often a component of income for higher producers.
The AANMC site
which houses the report data is directed toward educating, and attracting, prospective naturopathic medical students.
An introductory comment to the report underscores that money is not typically the driver among individuals who enter the naturopathic medical profession. It states:
"While income may not be the most important factor in your decision to
choose a career in naturopathic medicine, it is no doubt a concern. Of
our naturopathic physician survey respondents, 71% reported
satisfaction with their incomes."
Not surprisingly, satisfaction with income went up with years in practice. By five years out, 83% of respondents expressed satisfaction with their income level.
The survey also captured a variety of additional information about the practice. A list of top conditions seen put fatigue, menstruation and hormonal issues, allergies, depression/insomnia and thyroid in the top five (see chart, above).
Responses also showed that a growing number of new naturopathic doctors are in multi-disciplinary practices. The accompanying text indicated that massage therapists and acupuncturists were the disciplines with which they are most often combining. The report states: "This emerging collaborative care model provides numerous opportunities and benefits – to practitioners and patients alike." Comment: Many graduates of naturopathic
medical programs are entering practice with well over $100,000 in
medical school debt. Mainstream health care still offers very few
employment opportunities. New doctors must switch focus from medicine
to marketing and develop their practices from scratch. The very low
income found in the first few years of practice is about what a $15/hour laborer makes.
These twin realities have caused me to joke
more than once to colleagues in the naturopathic field that their
profession has gained enough acceptance to go into debt. The problem is, they just don't have enough acceptance yet to get out of it. (Sick joke, yes, but I married the right to tell it.)
Yet
this survey suggests that those who hang in there, choose to work a
full clinical week and find
the patients to fill their schedules can make what most of the universe would consider a good living. The media is still only half of what a family practice MD makes (see chart below). Yet with
frugality, these new naturopathic physicians should be able to pay off their first mortgage - the one that bought them their education.
What of the Non-Respondent 81%?
The problem with this data - especially for
prospective students who are evaluating a career - is the low response
rate of 19%. What of the other 81% of licensees? Who filled out the survey and who round-filed it?
Medical Group Management
Association, Physician Compensation
and Production Report: 2004
Did busy doctors not take the time, thus skewing the data downward?
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?
Can one reasonably assume that those who dropped out or are feeling beaten down with the challenge were harder to locate and less likely to respond?
And how long is the typical journey from $30,000/year to $80,000/year?
More specifically, what about naturopathic clinicians who find that for the human-intensive, whole-person, patient-centered care they prefer that 3-4 clinical days is all the spirit allows? Does this then limit income to $50,000-$60,000 for this set? These questions about the survey outcomes are significant.
The good news for the naturopathic medical schools is that those drawn to the profession tend to be drawn as a calling, rather than with an anticipated income in mind. To date, the calling seems to be reaching a growing number of ears. As noted in an earlier Integrator article, the size of the licensed profession doubled from 2001 to 2006, with the number now over 4,000. And if the profession can manage to push back AMA opposition and expand licensing into the high-population states where campaigns are currently under way - Illinois, New York, Florida and Massachusetts - the income-earning opportunities of new graduates will rapidly expand.
Who knows, perhaps one day the US health care system - and particularly the community health and public health sectors where naturopathic physicians could be employed as chronic disease and lifestyle change physicians -- may open opportunities for general practice naturopathic doctors for whom income considerations are second fiddle to their desire to help their patients toward health. But for now, the prospective student would be served to spend at least a little time meditating on the non-respondent 80% and the struggle to create a practice niche.
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