Editor’s Note: I’m on vacation in London and won’t be doing my regular Monday post this week. In its place, here’s another guest post from Britt Hermes of NaturopathicDiaries.com, about her extraordinary student debt from her abandoned naturopathy career. If you’re in London, join me at the London Skeptics’ Skeptics in the Pub on Monday night at The Monarch Bar at 7:30 PM! I won’t be giving a talk (I am, after all, on vacation), but after being in contact with some London skeptics I decided that this was the best way for me to meet as many SBM readers as possible without disrupting our vacation to the point where my wife would start to become irritated with me. 🙂 ~ Dr. David Gorski
Dr. Nick graduated from Hollywood Upstairs Medical College
This morning, I checked my student loan balance from earning a doctorate in naturopathic medicine from Bastyr University. I owe a little over $333,000. Since graduation, my loans have accumulated interest while I deferred payments during my naturopathic residency and again after I quit practicing naturopathy.
To call this amount daunting or depressing is an understatement.
Since I thought an ND degree meant I’d have job prospects as a real primary care physician, I assumed I’d have no problem paying back my student loans, just like most medical doctors. I also thought I’d be eligible for federal loan repayment programs. I quickly learned, as have my former colleagues, that naturopathic doctors have dismal job prospects and earnings.
The average naturopathic doctor makes $60,000 a year in private practice. To put this in perspective, the average primary care physician income is about $186,000. Despite Bastyr insisting that naturopaths are trained as primary care physicians, their income certainly does not reflect it. (Nor does their training.)
Government loan repayment programs for naturopathic “doctors”
Shortly before I quit practicing naturopathy, I was discussing my student loan situation with an older, financially successful naturopathic “elder” who went to school in the 1990s. He confessed that had I borrowed private loans for naturopathic school, he would have recommended that I claim bankruptcy to erase the loans, just like he did after graduating from the National College of Natural Medicine. He said this was not an uncommon practice for naturopaths graduating from the approved schools a few decades ago.
Private lenders no longer offer loans to naturopathic students (see links 1, 2, 3, 4, and 5). Perhaps private lenders caught onto the bankruptcy declarations, or maybe they realized that based on their incomes, the likelihood of naturopaths repaying their debts is poor.
In the U.S., medical and health professional students are eligible for several loan, scholarship, and repayment programs administered by the Department of Health and Human Services. Unlike other health professionals, naturopaths are not eligible for any of these services, including aid programs specific to primary care.
In some circumstances, naturopaths may be eligible for state-run debt repayment programs. Whether or not a naturopath’s debt qualifies for loan repayment depends on the program. For example, naturopaths working at National College of Natural Medicine in Oregon might qualify for the Public Service Loan Forgiveness program but do not qualify for the Oregon Medicaid Primary Care Loan Repayment Program or the Oregon Partnership State Loan Repayment program. Overall, naturopathic graduates have far fewer opportunities to reduce their student loan debt because they are not considered real physicians.
I consider it a looming financial disaster that naturopathic students are paying hundreds of thousands of dollars to learn pseudoscience, old-timey treatments, magic, and how to convince others it is all bonafide medicine.
Naturopathic education costs an arm and a leg
The Bastyr University website states the average first year tuition for their Doctorate of Naturopathic Medicine Program is $39,589, not including living expenses. In Kenmore, Washingon CollegeData.com estimates living expenses of $15,550 per year. Thus, four years of naturopathic school at Bastyr can easily reach $220,000!
USnews.com reports that graduates from public medical schools average $167,763 in student loan debt, and private medical school graduates typically borrow $190,053. Does the high cost of naturopathic education reflect its legitimacy?
No.
The most important distinction between naturopathic school and medical school is that pseudoscience is essential to the naturopathic curriculum. I took classes in homeopathy, naturopathic manipulation, hydrotherapy, Chinese medicine, botanical medicine, and naturopathic theory and philosophy. Bastyr taught alternative vaccine schedules, and various energy healing cures like Bach flower remedies, as well as therapeutic touch. These classes are part of the standardized naturopathic curriculum as established by the Council on Naturopathic Medical Education.
How much did these classes cost me?
I took an average of 25 credits per semester while at Bastyr University from 2007 to 2011. I calculated an average cost of $427 per credit for my studies across all four years.
I tallied the credit numbers for the following courses from my transcript:
- 17.5 credits in hydrotherapy, naturopathic manipulation and myofascial analysis
- 11.0 credits in botanical medicine
- 7.0 credits in homeopathy
- 8.0 credits in naturopathic theory
- 4.0 credits traditional Chinese medicine
TOTAL: 47.5 credits
COST: $20,282.50
I spent over $20,000 directly on subjects that are widely regarded by the medical community to be ineffective, unscientific, and in some cases, dangerous.
Much more of my total tuition expenses were spent on courses that included some real medicine but also had packed in a lot of fake medicine and mystical philosophy. I learned about herbal remedies in the clinical courses, such as using solid hawthorn extract in cases of hypertension or the use of demulcent herbs for acute respiratory conditions. The bottom line is that a basic sciences course at a naturopathic school is not the same thing as a class at a real medical school. Pediatrics at Bastyr University is not pediatrics at Harvard.
I spent about another $20,000 for my clinical training in Bastyr University’s teaching clinic, where the pseudoscience was put into practice.
My patient care shifts were superficial medical training, at best, predominately caring for the worried well. Naturopathic students have no clinical training in emergency departments or urgent care settings. Naturopathic training simply does not and cannot produce competent physicians.
Is there a “doctor” on board? Comic by Brian Kent, Menso.
Not employable and in-debt
There are serious career challenges for a naturopath.
Aside from working at one of the naturopathic schools or in a private practice, there are not many job opportunities. Naturopaths do not have hospital admitting privileges and are therefore not eligible for hospital-based positions. Although some NDs claim to work in hospitals, these positions provide adjunctive care usually with nutritional and lifestyle advice.
In a private practice setting, it can be very difficult to make naturopathic services affordable and accessible to patients. One issue is not all states accept insurance for naturopathic services, let alone license NDs. When naturopathic services are covered by insurance, the reimbursement is usually comparable to what is reimbursed for the services of a nurse and does not cover the naturopathic-y treatments like IV therapies and bogus blood tests.
Another major drawback to the ND degree is limited state licensure. Currently, naturopaths are only licensed to practice in 20 U.S. states and territories. Within these 20 jurisdictions, the legal scope of practice differs widely. Some states and territories permit naturopaths to order exams and write prescriptions. Others strictly limit the scope to nutrition and lifestyle advice. Practicing in an unlicensed state may be tricky for liability and legal reasons and is a risk not many accept.
Unlike the MD/DO degree, the naturopathic doctorate does not qualify an individual to work for major government or medical organizations like the Centers for Disease Control, the Food and Drug Administration, or the World Health Organization. In order to work in the fields of public health or health policy, one usually needs a PhD in a relevant field or to have earned a medical degree, completed a medical residency, and hold an active medical license.
On a global scale, the naturopathic degree does not easily translate in other countries. Despite homeopathic medicine being widely practiced in Germany, I cannot practice naturopathy with my ND degree here. I once had a brief email exchange with a Canadian ND who runs a private practice in Singapore. She is only legally allowed to make nutritional, lifestyle, and homeopathic recommendations. In the U.K., naturopathy is unregulated, and Australia seems to be engaged in a public debate about the future of NDs.
Overall, a naturopathic doctoral degree will not provide good career opportunities in the fields of health policy, research, and medicine. A career in naturopathy will provide a constant flow of patient experiences that reinforce beliefs in pseudoscience, not a prosperous financial future as a “doctor.”
But maybe money and stability do not matter to naturopaths. I have never met a naturopath who stated they are in it for the money. For many, the choice of a naturopathic school over a medical school is a choice about personal values. It is an emotional decision, not a rational one.
Fearful but still delusional?
Many students who contact me are afraid that medical school will turn them into harried, pill pushing, uncaring doctors. In contrast, they believe a naturopathic education will cultivate empathy, open-mindedness, and compassion. (Things medicine presumably lack.) Neither assumptions are true, but I can relate to each.
I went to naturopathic school in hopes of finding a better medical system than the one I experienced. I wanted to change health policy and improve the way medicine is practiced all over the world. This brave new world of naturopathy included the foundations of health that seemingly get neglected in the doctor’s office, like diet, spirituality, stress management, and exercise. Medicine needed to be more than just a prescription. Naturopathy seemed to address all aspects of the patient. It seemed so simple and commonsensical.
I think that in order to believe naturopathic medicine was the future, I also needed to accept fictitious notions:
- All pharmaceutical companies are corrupt
- Medical doctors do not know anything about nutrition
- Medical doctors do not care to discuss lifestyle changes in an appointment because prescribing pills is much faster and easier
- Not all vaccines are safe or effective
- Children receive more vaccines than needed
- Diet can help treat any chronic disease
- Pharmaceutical medication makes people sicker and is part of a larger, complex scheme by pharmaceutical companies to make people dependent on medication
- GMOs are bad
- Organic is good
It is very difficult to explain, even to non-judgemental listeners like my husband, how I came to these beliefs. I know one thing’s for sure, though. Much like the idea that naturopathy is better than medicine, these are not rational beliefs.
I still find myself susceptible to these bogus thoughts. I tend to gravitate towards the organic produce section in the market. I get worried when my Dad tells me he is starting a new medication for his cholesterol. I just told my husband that the Rotavirus vaccine still scares me because of the risk of intussusception (stated in conversation about vaccinating future children).
How can these thoughts still pop into my head after all this time spent promoting science-based medicine and debunking naturopathic medicine?
A currently-practicing naturopath who emailed me this morning may explain it best:
While studying at the college you are living in a naturopathic bubble…and you just get brainwashed into believing things that are not there. Once you start, it is difficult to stop on this path.
When I am confronted with situations that would have evoked fear, like my Dad’s health or my unborn children getting sick, I have to work very hard to remind myself that I trust science and the dedicated physicians who practice medicine. I do not believe in conspiracy theories.
With the privilege of hindsight, I now know my investment in a naturopathic education did not make me open-minded or provide me with the tools to be a good physician. Instead, my naturopathic education impaired my independent and critical thinking skills, and it gave me a false sense of self. I thought I was a real primary care doctor. In reality, I was someone who paid a lot of money for a degree in pseudoscience; I was tricked into believing I could diagnose and treat patients competently. Fortunately, I came out of the fog.
Dr. Evil and I are both “doctors.”
ND = Not Debtworthy
A Facebook-er who graduated from Bastyr recently posted that she feels she will never be able to pay back her naturopathic student loans within her lifetime. She even went so far as to say that if given the choice, she would not “do it over again.” The assumption on my part is that she wouldn’t attend naturopathic school due to the high cost of education and poor earning potential.
Around the same time on Facebook, another naturopath from Bastyr linked to an article discussing the Whitehouse’s “cracking down” on for-profit colleges. He posted that he wondered how naturopathic schools would be affected by the new U.S. Department of Education regulations, as there “are plenty of us that don’t meet the income requirements to justify our loans.”
Schools are now required to provide information on the earnings of graduates. With the new federal regulations, annual loan repayments cannot exceed 20% of a graduate’s discretionary income or 8% of total earnings. If student debt exceeds these limits, the school risks losing federal funding.
Though Bastyr is a not-for-profit college, the same rules apply. Students are being overcharged and graduates are (rightfully) underpaid for degrees that don’t qualify them as real doctors. I believe it is just a matter of time before the Department of Education realizes this looming crisis.
Eventually, I learned that naturopathic medicine is unscientific, unethical, and dangerous. This awareness, coupled with the moral implications of continuing to practice, drove me to leave the profession forever.
Naturopathy is a fear-mongering ideology that promotes dangerous and unsound therapies under the ironic mantra of “First, do no harm.”
Since my departure from naturopathy, I have had an important realization. I would not have turned into a stressed and indifferent drug-peddling doctor had I gone to medical school. I would have become the doctor I always wanted to be.
Naturopathic medicine is not just a bad health decision. It is a terrible financial decision.
I no longer fear for the patients of medical doctors. I fear for the patients of naturopaths.