It’s been almost two years since the last time I posted. I should explain why it’s been so long and why I’m posting now.
I started this blog because in June of 2016 Britt Hermes started a Change.org petition against naturopathic doctors. In that petition she grossly misrepresented naturopathic medicine. I showed how she was being intentionally misleading here and here. The strongest data about naturopathic medicine shows that that seeing naturopathic doctors improves health outcomes and saves both patients and insurers money.
I decided to publish anonymously because Mrs. Hermes was publicly harassing NDs. In our current online world there are unfortunately few consequences for this harassment and anyone that has a public persona, especially a physician, is at a real risk of having their business affected by things like fake reviews or fake complaints to the medical board. In the end this has a chilling effect on people speaking out. Her twitter account includes many examples of this harassment:
Beyond misrepresenting the science and literature about naturopathic medicine, Ms. Hermes has misrepresented and in some cases outright lied about her education. How do I know this? I went to the same school she did, had many of the same teachers, and may or may not have known her (I am choosing not to say).
You’re here because you’re either trying to learn more about naturopathic medicine or considering a career as a naturopathic doctor. It’s important that potential students and the general public get an accurate view of naturopathic medical school.
I’m going fact check the points that Mrs. Hermes makes in her article “Should I go to naturopathic medical school” individually, but I want to first answer the question directly that this article makes: “Should I go to naturopathic school?”
My answer to that question: It depends.
Becoming a physician is hard work. If you’re not ready to commit to four difficult years of school, then medicine shouldn’t be a career path for you – naturopathic or conventional.
The next question you should ask is what kind of doctor do you want to be? Do you want to triage acute injuries in an ER setting, or do primarily surgery? If that answer is yes, then a conventional route is the best one for you.
Do you want to be an expert on a body system, specialize in women’s health or do general primary care? Do you want to specialize in pediatrics or help mainly patients that have failed conventional therapy?
If you answered yes, a naturopathic medical degree would give you the most comprehensive set of tools to help people in these categories.
What do I mean by tools?
In medicine, the tools you have are the things you use to help people get better. Most of medicine can roughly be divided into two categories – diagnosis and treatment. Diagnosis is finding out what the problem is. Treatment is how that problem is going to be solved, how you’re going to help that patient get better.
80% of solving a case is in the interview (in medicine we call this the Subjective), the rest is in objective findings – either though doing physical exam or testing. These skills are taught in great detail at Bastyr and other naturopathic medical programs.
The second piece of medicine is your toolset. Once the problem has been figured out (diagnosed), how are you going to solve it? How are you going to get the patient better? This is really the area where naturopathic medicine and a naturopathic medical education excels. We have lots of data/research, most amassed over the past 40 years, that shows the profound effect of diet, nutrition, vitamins, herbal medicine, and exercise on health. The naturopathic medical education covers all of these comprehensively. It’s puzzling to me how limited a conventional education is on these topics. Generally pharmaceuticals and surgery are well covered in a conventional education, but diet, nutrition, vitamins, herbal medicine, and exercise are not. If they are, it’s usually in the form of a single optional elective. In a naturopathic medical education each of these topics has multiple classes, spanning multiple quarters. The details of each intervention are covered in great depth. An example of class notes from a Diet and Nutrient Therapy class at Bastyr, part of the old core curriculum.
A quick note on terms: when I refer to naturopathic medical school or naturopathic school, I’m referring to schools that are accredited by the CNME and part of the AANMC coalition of schools. Graduation from one of these school, plus passing board exams, allows one to be eligible for licensure in states that regulate NDs. There are online schools that call themselves naturopathic doctor programs that don’t have the rigor of these accredited programs and don’t allow one to be licensed to practice medicine in any state or province.
Fact Check – Naturopathic education lacks medical training
A discussion of insurance rates and malpractice claims might sound like a strange place to start this discussion, maybe even a dodge, but I hope to make it should be clear why I start here after the following paragraph.
Insurance companies set rates based on what their expected loss will be while maintaining a certain profit margin for themselves. NCMIC is one of the leading malpractice insurers for naturopathic doctors. They also insure chiropractors and medical doctors. As of 2017 their insurance rates for NDs were $3,802 and their rates for medical doctors were $18,646. This is almost 5 times higher than for NDs. If NDs were poorly trained then it would follow there would be more malpractice claims per practitioner (on average) and rates would be higher. The reality is that claims are almost 5 times less on a monetary basis.
In Oregon and Washington naturopathic doctors act as primary care providers and have full prescribing rights, yet they maintain insurance rates lower then medical doctors. This suggests that on average, naturopathic doctors have better medical training then conventional doctors. If they didn’t, they would be making more errors, and it would be reflected in the malpractice insurance rates they pay.
This doesn’t suggest that naturopathic doctors are perfect however. The cases where naturopathic doctors have made mistakes or are guilty of malpractice are sensationalized by Mrs. Hermes and others to score political points, not from any sense of objectivity.
To look at this point from another angle – The National Practitioner Data Bank keeps a complete record of malpractice claims that are sortable by practitioner type. Over a 20 year period, from 1990 to 2010, there were 254,380 malpractice claims against medical doctors and 16 against naturopathic physicians.
To be fair, there are many more medical doctors then naturopathic doctors so it makes sense to find the number of malpractice claims per doctor. In 2010 there were 839,351 medical doctors with active licenses. There are around 6,000 naturopathic doctors practicing in the US currently (in 2018). There were less in 2010, but those numbers aren’t available. Conservatively I’ll estimate 4,000 in 2010. Doing a little math shows that medical doctors are on average 75 times more likely to have a malpractice claim filed against them when compared with naturopathic physicians.
My final counterpoint to the claim that naturopathic doctors lack medical training is to include some class notes taken from the current curriculum at Bastyr. Make a judgement for yourself about whether or not these come from a school that provides “medical training”. I think they speak for themselves.
Integrated Cardiovascular System
Integrated Cardiovascular and Immune System
Naturopathic Clinical Diagnosis
Integrated Nervous System
I’ve looked at the claim that a naturopathic education lacks medical training from three perspectives – insurance rates for naturopathic doctors, malpractice claims by practitioner type, and examples from class notes. These all show Mrs. Hermes claim to be naturopathic doctors lack medical training as patently false.
Fact check – The cost of naturopathic education is overpriced
Medical school is expensive, whether it’s a naturopathic medical education or a conventional one. There is no way around it. It’s an investment of both time and money. I have no regrets for taking on the debt I did or for the time spent getting my education.
I get to set my own hours, and am paid very well for the work I do. My schedule is flexible. I get to schedule my work around family time and not the other way around. This is a luxury that most people don’t get and it’s hard to overstate how much this independence improves your quality of life. Most conventional doctors are in large group practices that are constantly consolidating. The focus on these large practices tends to be on the bottom line and not quality of life for the doctor, leading to physician burnout.
In 2016, 51% of medical doctors experienced burnout. Those numbers get worse every year. Burnout is defined as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. I’m sure they are out there, but I’ve never meant an ND that would fit that description.
There are student loan payment plans that keep repayment at 10-15% of take home income, so the debt I had to incur to go to naturopathic medical school, while large never felt burdensome or overwhelming.
The majority of naturopathic doctors I know make six figure incomes per year; the ones that don’t have chosen to work part time to focus on family or are in their 1st or 2nd year out from medical school.
To address Mrs. Hermes claims directly that she spent money of “fake medical courses” and she had “patient care shifts with scant medical training” – look back over the previous section. If naturopathic doctors were poorly trained with “fake medical courses” and “patient care shifts with scant medical training” they would commit more medical errors and have more malpractice claims against them – their malpractice insurance rates would be high. The opposite is true – they have 75 times less malpractice claims on average, and have lower malpractice insurance rates.
To her 2nd point –The idea that NDs aren’t eligible for student loan forgiveness or that the options are very limited is a complete falsehood. Naturopathic Doctors ARE eligible for federal student loan forgiveness. When you work for an eligible non-profit full time, which is considered 30 or more hours, your student loans are forgiven after 10 years. Many NDs are currently taking this route.
Fact Check – Job Prospects for naturopaths are limited
Your naturopathic education will train you to be a primary care provider and a specialist in integrative medicine. There are currently 23 states that regulate naturopathic doctors. In states without licensure many people choose to practice as a consultant. The scope of practice varies in each state. In at least Oregon, Washington, and Vermont naturopathic doctors are licensed as primary care doctors, are covered by insurance, and have a full prescription formulary.
Jobs are available at private clinics, there are also jobs at the Universities, and one can start their own practice. Wellness centers are increasingly developed that employ NDs.
At Yale a naturopathic doctor was the director integrative medicine and taught pediatrics at their medical school.
Some graduates work for supplement companies as formula consultants or in other aspects of the nutraceutical industry.
Some go into research, or get jobs in public health.
I can’t speak as to what motivated Ms. Hermes to publish her blog. I think it’s clear from this and previous posts how she is being intentionally misleading on what naturopathic medicine is and what her education was like.
I went through the exact same classes that she did, with many of the same teachers. Somehow I’ve become a good doctor, make a good income, and have a good quality of life. I get to spend a lot of time with my patients, hear their stories, and give quality care. I’ve seen cases cured that the conventional system had run of ideas for. I’ve been told I saved a life by grateful parents.