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A Few Thoughts About Naturopathic Medical Education Federal Subsidization, Educational Standards, Clinical Experiences, and Continued Adherence to Naturopathic Principles By Alex Vasquez, ND, DC, Editor, Naturopathy Digest AVasquez@NaturopathyDigest.com During my experiences as a student at eight different undergraduate and graduate schools during my 11 years of full-time college attendance, I've had plenty of opportunity to observe differences in institutional infrastructure and educational methods. I've seen programs that work well, and I've seen programs that crush the spirits of teachers and students alike. I've known graduates from elite professional schools who couldn't tie their shoes without getting a second opinion, and I've seen schools with limited resources ignite passion in their students that propels them to greatness. When I think about ways to make naturopathic medical education better, here are a few of the things I think about. Federal Subsidization All allopathic and osteopathic medical schools receive millions of dollars, by direct and indirect subsidization, from federal and/or state governments. The prima facie reason for this is because medical schools make doctors and conduct research, and we need doctors and research to protect and advance public health; therefore, it is in the interest of the government to fund medical schools. Well, I think the time has already arrived for national appreciation of the current and potential contributions that already are and could be made by naturopathic physicians, and I think the profession is overdue not only for accolades, but also for direct subsidization. Americans already spend more of their money and receive more services from non-allopathic and non-osteopathic providers than from these so-called "conventional" providers,1,2 and thus, if "alternative" providers are shouldering more than their share of the national health care load, their institutions and opportunities for professional advancement should receive federal and state support. Increased subsidization of naturopathic colleges will allow these institutions to advance by both qualitative and quantitative measures. More funding would translate to better facilities, more opportunities, better training and, ultimately, better doctors. More funding would allow campus expansion, newer buildings, newer clinics and lowering of tuition for students; all of these would synergize to increase the number of naturopathic medical graduates and to increase the number of doctorate-level health care providers in the U.S. This would improve health care through increased use of safe and effective natural treatments and preventive approaches,3-8 and would increase competition and thus drive down costs of "medical" care. Based on annual salaries, we see that American allopathic doctors charge roughly twice what doctors in other countries charge for the training and same services (e.g., annual salaries: $100,000 for doctors in other countries compared to $200,000 for American doctors). If more competition brings doctor fees down, more Americans and their businesses will be able to afford health care, thus potentially improving national health status. Allopathic/osteopathic colleges receive $3 billion per year in direct payments from federal and state agencies. Even if only a small portion of this money were appropriately diverted to naturopathic colleges, the results would be profound. Continual Higher Educational Standards Naturopathic medical colleges must constantly seek to improve their curricula, not only through qualitative addition of material and opportunities, but also via qualitative measures such as refinement of teaching technique and emphasis upon clinical relevance. Far too many professional schools have blindly adopted the "more is better" approach to teaching, as best exemplified in allopathic medical schools, and they literally crush their students with quantity, while real-world importance and educational efficiency are insufficiently considered. "More" information may be better, but only up to a point, after which students simply get lost in a maze of swirling data points. Naturopathic educators should receive training that not only makes them experts in their fields, but also makes them experts in efficiently and effectively communicating that wisdom to their students. This training would ensure that the students' direction is always aligned with the ultimate goals of fostering healthy individuals, excellent clinicians and innovative researchers. One of the ways we did this when I taught at Bastyr University was to emphasize not merely quantity through required readings, independent study, and guest lectures, but also to emphasize quality through the use of core competencies - key points that had to be learned in order for a student to pass a course. Courses have to provide an abundance of information in order for students, as future professionals, to be familiar with the breadth and depth of the topics they study. The use of core competencies ensures students learn and are tested on the facts that are key to safe and effective clinical practice. With regard to orthopedics and rheumatology, for example, naturopathic clinicians must know how to diagnose and treat conditions such as cauda equina syndrome, acute compartment syndrome, and temporal arteritis in order to practice safely, and educators and colleges have an obligation to ensure that such basics of emergency medicine and outpatient care are memorized by each student prior to graduation. (For more examples of core competencies, click here.) Early and Diverse Clinical Experiences Clinical experiences must begin in the first year of training. Preceptorships, hospital rotations, volunteer experiences, videos and interactive computer programs, clinic observations, and simulated experiences must be woven into the educational programs of all naturopathic colleges. Continual Adherence to Naturopathic Principles We must never lose sight of the importance of helping our students grow to completeness by maintaining and further developing their gifts and individual humanity. Professional programs should be challenging and they should push students to accomplish what they previously thought was impossible; but our programs should never become dehumanizing or "mechanical" to the point that we force our students to relinquish the very health and completeness health care rightly claims to promote and protect. References Eisenberg DM, et al. Unconventional medicine in the United States - Prevalence, costs, and patterns of use. NEJM, January 1993;328(4):246-52. Note: "Americans made an estimated 425 million visits to providers of unconventional therapy. This number exceeds the number of visits to all U.S. primary care physicians (388 million)." Eisenberg DM, et al. Trends in alternative medicine use in the United States, 1990-1997. JAMA, November 1998;280(18):1569-75. Note: "Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations." Goldhamer AC, et al. Medically supervised water-only fasting in the treatment of hypertension. J Manipulative Physiol Ther, June 2001;24(5):335-9. Goldhamer AC, et al. Medically supervised water-only fasting in the treatment of borderline hypertension. J Altern Complement Med, October 2002;8(5):643-50. Goldhamer AC. Initial cost of care results in medically supervised water-only fasting for treating high blood pressure and diabetes. J Altern Complement Med, December 2002;8(6):696-7. Legorreta A, et al. Comparative analysis of individuals with and without chiropractic coverage. Archives of Internal Medicine 2004;164:1985-1992. Note: "Conclusions: Access to managed chiropractic care may reduce overall health care expenditures through several effects, including (1) positive risk selection; (2) substitution of chiropractic for traditional medical care, particularly for spine conditions; (3) more conservative, less invasive treatment profiles; and (4) lower health service costs associated with managed chiropractic care. Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs." Orme-Johnson DW, Herron RE. An innovative approach to reducing medical care utilization and expenditures. AJMC, January 1997;3(1):135-44. www.ajmc.com/Article.cfm?Menu=1&ID=2154. Herron R, et al. Cost-effective hypertension management: Comparison of drug therapies with an alternative program. AJMC 1996;2(4): 427-437. www.ajmc.com/article.cfm?ID=2345.

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