Naturopathic Residencies

Kirsten West, ND

Third-year students, it’s time to worry.

What will you be doing a year from now? Wondering how to repay your student loans or packing to start an exciting residency? If you’d like it to be the latter or haven’t even given it a thought, now is the time to think about it. With summer break coming up, here is some information about naturopathic residencies that might help you make a decision and get you inspired to start your application process.

My Credentials

Let me start by confessing that while I was a naturopathic student I was obsessed with getting a residency. For me, it was the logical next step in my education and I was determined to secure a place in a clinic or hospital. As I entered the last year of my naturopathic education I developed a passion for oncology. My quest for the perfect residency was narrowed, and I charted a path.

During my last year at Southwest College of Naturopathic Medicine I visited and was a preceptee for a week at the Center for Cancer Care in Goshen, Indiana and at the Cancer Treatment Centers of America (CTCA) in Philadelphia, PA, Zion, IL, and Tulsa, OK. I also visited the Riverwalk Natural Health Clinic in Edwards, Colorado. My obsession has left me knowledgeable about how the process works and the residencies available. [I now serve as the ‘resident’ board member of the Naturopathic Post Graduate Association (NPGA).]

Why Seek a Residency?

What type of student will be better off going into a residency rather than straight into practice? In my opinion, a residency allows a gradual transition of roles from student to doctor. Residency is not for the student with business plan in hand and a signed office space lease agreement. Nor is it for the student weary of over the shoulder supervision. It is for the student who is committed to a continuation of supervised education and a desire to continue their clinical training. Obviously a residency is advantageous for those with a desire to specialize in a particular area of naturopathic medicine. A fitting quote I recall hearing in my first year of school: “What happens in these next 4 years will teach you how to be a safe doctor. What happens afterwards determines whether you will be a good doctor.” Residency helps you become a good doctor.

Specialization is a strong reason to pursue residency. Although much of what we learned in the classroom encompasses the practice of general medicine, there are a growing number of naturopathic practices devoted to specific areas of health care. These specializations include treatment of autoimmune diseases, women’s and men’s health, oncology, sports medicine, cardiology, and others. Knowledge in these fields is growing exponentially. These kinds of specialty practices are ideal settings in which to continue one’s education and to gain clinical skills and theoretical knowledge that may have taken the lead practitioners years to develop. Residency programs and specialized residencies have the opportunity to offer catalytic growth for the individual and profession as a whole.

Residency Availability

So, what residencies are offered? The number and choices of residencies available to new graduates grows appreciably each year. Many residencies now offer a range of general and specialized medical practices including hospital-based, dual programs (ND, LAc), and those under the supervision of an MD. This growth in opportunities is a promising measure of our profession’s growth. There are currently 29 CNME (Council on Naturopathic Medical Education) accredited residencies. Some of these offer 2-6 placements, making the total number of residency placements 48. (Approximately 350 students graduate from naturopathic colleges each year). The majority of the placements come from the naturopathic schools themselves, offering residents the chance to learn from not only attending physicians but also to teach, in a student-based environment. Southwest College, National College, and Bastyr offer yearly accredited residencies. There has also been a growth of hospital-based residencies. Examples of these include the Goshen Center for Cancer Care, Integrated Health Department at Clifton Springs Hospital in Clifton Springs, New York, and CTCA.

Some of these residencies groom the young physician for a career at the designated site post-training, while others simply provide the learning ground before being unleashed into the world as a “honed” naturopathic physician. For example, most school-based residencies prepare the resident for building their own practice or joining a set practice after training. While others, such as CTCA, are tailored to train residents to become part of their naturopathic team. Other residencies are at rapidly growing clinics that offer the possibility of a permanent position for the doctor post residency completion.

One cannot be picky when choosing a residency, but location and pay are still important considerations. It may be a continuation of clinical training, but a residency is still a job. New doctors will suddenly have to factor in student loan repayments that start after graduation into their balance sheets. Annual income will vary from residency to residency. None will pay as well as an allopathic residency. Most naturopathic residencies will pay from $27,000 – $35,000 per year. Second-year residents receive slightly more. Although some might say the pay is relatively low, completing a residency, at least in theory, affords the ability to make a higher income later.

Residency programs are offered in locations that are geographically diverse; think of the difference between living in Hawaii or Alaska. This makes not only the type of practice, but also its location, a factor to consider. While there is a tendency for naturopathic physicians to sequester in licensed states, it is important to note that several residencies exist in unlicensed states, speaking volumes for what may be possible once licensing is widespread.

With so many options, narrowing the residency search is important. Hopefully by the time students are in their fourth year, they will have some sense of where their interests are focused and what sort of practice environment will suit them. However, for the student weighing options, questions still exist. A preceptorship allows one to narrow the search by visiting sites of interest. Most naturopathic schools now allow for off-site rotations. This offers the chance to check out residencies of interest while completing clinical credits.

In my case it also gave me the chance to see parts of the country I had not visited before. Hauling my luggage onto the “L” in Chicago was a new experience for me. I thought I had seen snow before, but nothing in my Colorado experience prepared me for the gigantic snowflakes, what they call “lake effect snow,” in Goshen, Indiana. More importantly, being a preceptee at residency sites enables the student to meet and get to know the people they may be working with and allows a greater understanding of the program, its dynamics, and goals. These are things that are hard to ascertain from a 1-day, on-site residency interview. In the end, it is just as much about the student choosing the site as it is about the site choosing the student, an invaluable lesson I picked up along the way.

Qualities Desired in an Applicant

There are several characteristics residencies look for in an applicant; they may differ from site to site. However, one thing became evident to me that all the residencies are seeking, and that is dedication. This lies at the foundation of all medical programs and includes dedication to the naturopathic profession, education, and the specific residency specialty. For example, it makes sense that a student applying to be a CTCA resident be a student member of the OncANP.

Dedication to residency comes well before the actual time of applications. It is integral to the process because it involves planning.

  • What sites should I visit?
  • What doctors should I work with beforehand?
  • What else can I do to show who I am and what I will be to a residency?

Passion is equally as important. A student of naturopathy must believe in what he/she does. Residencies look for those with this belief and the passion to make a difference. The number of naturopathic physicians is small relative to the allopathic world. The number of residencies is even smaller. Therefore, it is the student who strongly aligns with the residency, its goals, and values who is most sought after. Being familiar with the residency cannot be overemphasized. Obviously, past achievements and grade point average also hold weight, but it is the student exhibiting dedication, passion, and understanding of the residency program who holds the advantage. When dedication and achievements match, residency is not far off.

Applications

The application process itself is both daunting and tedious. It requires work done well before the actual application submission.

Last year in 2009, application materials were released in November and then due in January. The timing may change, so get on this early. Completing the application will take more time than you think and recall that you are supposed to still be in school attending classes, clinic, studying, etc.

Begin early and plan ahead. Essay writing takes time to do well; this is the applicant’s chance to state their case for residency. Up to 4 “general” essays must be written as outlined in the application packet. Commonly, an essay or essays written specific to each site chosen are included. The applications require suitable references, and often clinic attending physicians who are asked to judge the applicant in several areas of performance. All of this is confidential, making for a nerve-racking experience. It is these ratings, in sealed envelopes complete with the attending’s signature along the seal, that must be turned in. A “blind” process, the applicant hopes will be favorable, rather than the demise of their application. Letters of recommendation may also be included, either because they are required or because the applicant desires them to be a part. Finally, with the application fee included, the entire packet must be sealed and mailed by the designated date. The next 3 steps in the process are wait, interview, and then wait some more.

The best time to start thinking about a residency is late spring in your third year of naturopathic medical school. The idea that there might be life after school begins to sound possible. Take it from me, the last year goes by fast; the seemingly Herculean task of collecting clinic check-offs, studying for and passing clinical board exams, and all those other things happen before you know it. If you don’t get an early start on this process, it is a sure way not to get a residency. Look at the fourth-year students now; the ones with residencies are the ones smiling.

In my view, residency is a rite of passage. It is the next step in education, one taken as a doctor. It is not for all, and yet it is the best choice for some. In the future, I believe completing a residency should be the first step for all naturopathic graduates. The Naturopathic Post Graduate Association aspires toward this goal. Until that time, it is imperative that students and graduates understand the nature of residency, why it is so valuable, and what it yields to the profession. If I may be but one voice, one who was immersed in the process, I hope I may help those coming after me and those not completely clear as to this whole “residency business.” We are growing as a profession. It is exciting, promising, and full of opportunity. Residency is just one of these advancements.

To get more information on residencies, go to the CNME’s website that lists individual accredited naturopathic programs. Follow the link to each school that offers residency opportunities: http://www.cnme.org/programs.html.


West_KKirsten West, ND is a first year resident at Cancer Treatment Centers of America in Philadelphia and the current Resident Board Member of the Naturopathic Post Graduate Association (NPGA). Dr. West completed her medical degree at SCNM in June 2009. Dr. West’s interests include integrative oncology, the facilitation of hospital-based naturopathic practices, and the expansion of residency opportunities for new graduates.

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