The Next Best Past: Looking Back from 2050
David Schleich, PhD
A sure way to slow down and eventually stall the co-option of naturopathic modalities, protocols, and philosophy by the allopaths is to be very, very effective in providing health care. Another, parallel, and sure way to prevent the suppression of naturopathic medicine is to populate the healthcare terrain with 20 000 new naturopathic doctors. We can do this by 2050.
Imagine our grads confidently fanning out across the continent, like the allopaths, osteopaths, nurse practitioners, and pharmacists did before them. Despite the deliberate mischief of the biomedicine industry gingerly appropriating our modalities in their latest market outreach, “integrative medicine,” we will persist in establishing footholds and building strongholds. Three steps to our 34-year mission: 1) a dozen new, accredited academic and clinical programs; 2) a continuously growing volume of transactional research; and 3) licensing in every state and province on the continent. How likely is the program growth part of this 3-pronged effort?
The accumulating track record of our programs and colleges succeeding in the higher education arena is inspiring. We’ve done it before; we can do it again. That inspiring story, though, is not as well known by our newest matriculating cohorts. There is, for example, the story of how Western States Chiropractic College (WSCC) ditched its ND program when Dr W. A. Budden died and Drs Spaulding, Stone, and Bleything started over in 1956, founding NCNM, the “mother ship,” (now in its 60th year, officially assuming university status on July 1, 2016, in the state of Oregon). Nor do those new naturopathic students seem to know a lot about the 1978 founders of John Bastyr College (Dr Bill Mitchell, Sheila Quinn, Dr Joe Pizzorno, Dr Les Griffith) or why JBC branded itself differently than its parent school, NCNM. That JBC deliberately took the shape it did and grew to become a multi-program university in the state of Washington by 1994 is an important legacy to know about and to understand. The year 1978, in fact, as the story goes, proved to be pivotal. The Ontario College of Naturopathic Medicine (OCNM) was started up in Kitchener, Ontario, by Dr Gordon Smith, along with Dr Asa Hersov, Dr John LePlante, and Dr J. Wilson. OCNM became CCNM (Canadian College of Naturopathic Medicine) in 1994, under the leadership of Dr Don Warren. It became degree-granting 2 decades later in 2014.
Perhaps those same incoming ND cohorts would be curious about how Southwest College of Naturopathic Medicine (SCNM) came to be, in 1992 in Tempe, Arizona, founded by Dr Michael Cronin, Dr Kyle Cronin, Dr Konrad Kail, Dr Dana Keaton, Dr Hugh Hawk, and Deborah Mainville-Knight. Also to factor into this saga is the start-up of the College of Naturopathic Medicine at the University of Bridgeport (BU) in 1997 by Dr James Sensenig. And then, just 2 years later, in January 2000, the Boucher Institute of Naturopathic Medicine (BINM) was launched in Vancouver, BC. Along came Dr Fraser Smith, a graduate of CCNM, who was the founding associate dean of the naturopathic program at National University of Health Sciences (NUHS) in Lombard, Illinois, in 2006. Looking ahead, Maryland University of Integrative Medicine (MUIH) hired its founding dean, Dr Beth Pimentel, just this year, and plans to launch its new ND program in 2017. As well, on the other coast, Dr John Scarenge, President of the Southern California University of Health Sciences, has retained Rita Bettenberg, the former Dean of Naturopathic Medicine at NCNM, to guide the building of a new ND program in north Orange County, potentially opening in 2018. In the last 2 decades, much has happened in naturopathic medical education. The next 2 decades will be no less breathtaking.
Where the Next ND Programs Will Emerge
After Flexner (1910) and the demise of dozens of medical schools (among them Lust’s American School of Naturopathy in New York, and Louis Blumer’s ill-fated College of Naturopathy in Connecticut), surviving stand-alone naturopathic programs and others in chiropractic colleges such as NUHS and WSCC went through very tough times. These days, however, we have regained an earlier momentum, albeit on firmer ground. The first 10 modern ND programs will have taken just over 5 decades to stake out and hold territory in the world of accredited higher education. The next 10 will take much less time. They will almost certainly also show up in public-sector institutions this time, surfacing in pairs and clusters in different parts of the country, 1 after another. Given demographics and the nature of regional health policy, especially after the implementation of the US Affordable Care Act, new programs are likely in due course in New York, Florida, Texas, Quebec, Colorado, Pennsylvania, and Georgia.
Such growth, of course, will have to contend with the very high cost of starting modern post-secondary programs. Start-ups are not for the faint of heart. Hough (1992), in this connection, wrote persuasively almost 30 years ago about the financing of higher education, pointing out that those who would support emerging professions and vocations would have to find the money to “keep pace with trends in student interests and numbers” (p.1353). Two years before Dr Michael Cronin launched SCNM, Hufner (1991) was adding to the higher-education literature about college finances by reminding academic leaders about another feature of financing colleges and universities, namely the growing “claim for accountability” regarding public financing (for the private and not-for-profit sector, this means Title IV and Stafford student loans). These important trends were never lost on our early, prescient leaders. Spaulding, Pizzorno, Cronin, Warren, Wang, Sensenig, Smith, Vitale, and Scaringe never once expected state and other public money subsidies of the kind which have given mainstream medical schools their huge leg up. They were aware, too, that private-sector schools would be nipping at the gates to the post-secondary city, especially in terms of training allied health providers in “natural” modalities to complement allied healthcare services.
While building the first 10 stable naturopathic programs decades after the heady, early years of the 20th century when pioneers such as Lust and Lindlahr were so active, the later champions had to contend with not only the vulnerable state of educational finances in support of professional formation, but also parallel and persistent expectations that the colleges would stay accountable to the profession. In addition, there is the accumulating concern that our modalities, and with them chunks of our identity, are in danger of being sideswiped by integrative medicine programs and fellowships appearing with market precision out of the biomedicine complex.
Financing post-secondary education is a delicate, high art
In those same corners of the literature about the financing of higher education, there is an accompanying conversation about the difficult challenges of advancement and fundraising as key revenue-generators for the higher-education sector, including our corner of it (Fisher, 1989; Clark, 1998; Duderstadt, 2000). Duderstadt, for example, explains, “It has been suggested that some universities, from a financial perspective, look more like banks than educational institutions, since their most significant economic activity involves managing their endowment investments and capital expansion” (p.171). Many ND leaders have been hard at work building advancement capacity, including choreographing modest endowment funds. Significant progress has been made since the early 90s at BINM, CCNM, BU, NCNM, and SCNM regarding plant and property developments, which have involved exactly such advancement efforts.
Also darting around the prospects for growing the profession is literature about the enormous impact of information technology, not only as it relates to related instructional costs and management and learning information systems, but also to the larger issue of funding those capital costs to sustain key instructional, operational and research strategies (Hanna, 2000). Our “millennial” students learn differently than the passionate pilgrims of naturopathic medical education who assembled in Kansas in the mid-70s, longing for a campus of their own. The yearning for naturopathic medical education is as strong as ever and growing; the methodologies for delivery are transforming at breakneck speed.
In addition to considerations of finance, the literature of higher education articulates a taxonomy of accountability across more than money matters. Hufner’s “level-specific” and “function-specific” accountability model is quite useful for those of us in the naturopathic medical education sector (Table 1). Hufner has written a lot about the essential characteristics of higher education, alongside lots of other descriptions and discussions pointing us at important variables that we have to keep in mind if we intend to start a new ND program somewhere, anywhere.
Table 1. Comparison of Early-Accountability Expectations for New Programming
|Accountability to the Profession: Starting a New Program of Naturopathic Medicine|
|· Measured against the standards of recruitment and performance set out in the professional competency standards espoused by the AANMC
· Measured against the credentials essential for faculty appointments as medical academics by the CNME accreditation body
· Level of research activity, measured by publications and by percentage of the profession participation
· Reliability of curriculum outcomes as preparation, not only for medical practice, but also for entry to practice via external licensing exams.
· Financial solvency and reinvestment resources of the host institution
|Hufner’s Function-Specific Accountability Model (Hufner, 1991, p.49)|
|· Teaching accountability
· Research accountability
· Consulting (public service) accountability
· Learning accountability
· Administrative, including fiscal, accountability
Against this complex backdrop of planning and expectations, how can we generate a dozen new programs on this continent fast enough to hold our position in the emerging models of care? Because of the formidable and unforgiving cost, the length of time between announcing a program and attracting the first class, and between being eligible for candidacy and getting candidacy, starting new programs poised to solve these problems is tougher than it used to be back in 1956, 1978, 1992, 1997, and 2006, even though that is exactly what we must do, and quickly. Today, as outlined earlier, we have 8 programs operating in various frameworks in North America: Vancouver, Toronto, Lombard, Bridgeport, Seattle, Portland, Tempe, and San Diego, and 2 imminent new ones in Laurel and Whittier. We need a dozen more before 2050 rolls around.
Those programs are unlikely to be the stand-alone, single-program colleges we have been familiar with. Rather, they will be programs within existing post-secondary institutions, perhaps non-profit and even for-profit. In this regard, the Association of Accredited Naturopathic Medical Colleges (AANMC) may well wish to promote program growth with equal enthusiasm in all 3 sectors – non-profit, for-profit, and public sector – as conversations grow about start-up modeling. There is the growing clout of the for-profit educators still in the game, despite recent federal review of organizations such as the Corinthian Colleges group. Those for-profit enterprises (such as the Apollo Group, Argosy, and others) have their antennae aimed at the natural medicine industry and sense profits in meeting the demand for training.
We worry that these for-profit, private-sector incubators of naturopathic medical programming will inadvertently or even deliberately intrude into the content and clinical skills of CNME-quality naturopathic doctors nationwide, diluting protocols, modalities, and the entire profession into the bargain. It is not diploma mills (like the former Clayton College in Birmingham, Alabama, or the American Academy of Quantum Medicine in Las Vegas, Nevada, a subset of the American Naturopathic Medical Certification and Accreditation Board) we will have to worry about for full-degree programming, enabling graduates to take NPLEX. This latter group has no affiliation with the Department of Education or the CNME, but nevertheless offers attractive certification programming to lay and professional students alike, such as “Quantum Medicine Certification” [CQM] and “Quorum Nutrition Certification” [CQN] to MDs, DOs, DCs, DDSs, PhDs, NDs, OMDs and IMDs, in addition to their outreach to massage therapists, acupuncturists, nutritional counselors, certified nutritionists, registered nurses, and dieticians. A crowded, clouded landscape can confuse the health consumer as well as the legislators from whom we seek legitimacy.
There are more than 1700 organizations in North America loosely described as “corporate universities,” some of which definitely have an eye on many professional and vocational preparation program opportunities, including the rich, specialized market of “natural medicine education,” ranging from the professional doctorate credential to quick allied healthcare certificates. These private-sector learning entrepreneurs are setting a new pace in post-secondary transformation (www.corpu.com). Jeanne Meister, president of Corporate University Xchange [CUX], predicted over a decade and a half ago that private educational “institutes for learning” would actually outnumber traditional universities by the year 2010 (Morrison, 2000). The great recession of 2008 and the Gainful Employment legislation of 2014 stalled that growth, but there is evidence that it has a renewed vigor in the more resilient economy of 2016. Indeed, the overall growth in doctoral programs in the health professions and related programs since 2008 has risen slowly but steadily from 51 675 to 64 195 (Table 324.10, Digest of Education Statistics, National Center for Educational Statistics, 2014). Equally impressively, in bachelor’s and master’s degree programs in the same sector, growth has risen from 111 478 to 181 144 for bachelor’s programs, and from 58 120 to 90 931 for master’s programs (Table 325.60, Digest of Educational Statistics, National Center for Educational Statistics, 2014).
Let’s not rule out corporate universities quite yet
Corporate universities do not seem to want their primary function to only be the granting of degrees, though. Rather, they also know they have to “partner with universities to provide customized programs for major job families, usually within their organizations” (Morrison, 2000). However, it is in the interactivity, along those points where the public and the private meet, that influence is sharply felt and anxieties run high. Old certitudes continue to be nudged by new patterns. It is where the nudges are strongest that a naturopathic medical program will pop up. It is highly probable that the Council on Naturopathic Medical Education (CNME) will be asked to review its preference for non-profit entities, not unlike the Medical Association’s Liaison Committee on Medical Education (LCME)’s having been challenged to accept early for-profit DO colleges, such as Rocky Vista University College of Osteopathic Medicine (RVUCOM) in Parker, CO, near Denver. That school was founded and is owned by Yife Tien, COO, of the American University of the Caribbean (AUC) in St Maarten, itself a for-profit, higher education entity. Ross University operates an LCME-accredited medical program in the Caribbean and has been successful in attracting high-profile medical educational professionals, including – some years back – the former Dean of Naturopathic Medicine from Bastyr University.
And, there is another variation in the private post-secondary arena, with some relevance for naturopathic medical education. Geoffrey Cox wrote years ago, enthusiastically, about the “promising signs” that online instruction, in fact entire online university programs, [were] doable “with quality and integrity” (Cox, 2000). He and his colleagues at Unext predicted, long before Facebook and Learning Management Systems, the imminent strength of “technologies that emphasize the best pedagogical theories, such as asynchronous, on-demand learning.” Unext and Cardean are for-profit, private institutions. Cox insisted 15 years ago, “There is nothing inherent about a for-profit structure that limits an institution’s ability to provide quality education” (Cox, 2000).
It can be quite useful to explore this growing recognition of private higher education as a “central element” (Altbach, 1999, vii) of post-secondary educational systems. Private higher education is well funded, agile, and aggressive. There are numerous very successful operations that have added capacity in some natural medicine modalities already; some high-profile, international, private examples include INSEAD in Paris, Waseda or Keio in Japan, Yale in America, Ateneo de Manilla in the Philippines, and Javieriana University in Columbia. There is also a new holistic/naturopathic college in Manila, its funding coming directly from a for-profit, multi-discipline, allopathic enterprise called TotalMed. Happily, this latter company is committed to spinning off its new school into a non-profit, and inviting the CNME to consider generating standards for international school clients.
We might be alarmed at these intrusions into higher education by business. Our inclination is to embrace the social good which our schools can do, and to eschew any idea of accruing equity for any individual or group from the naturopathic community. Earlier, Clark (1983) outlined a useful typology of 3 basic value sets (specifically, social justice, competence, liberty… and perhaps loyalty) that help to position colleges and programs like ours in society. These value sets are frequently cited as the debate emerges about the “social good” (or lack of it) that accompanies private universities, particularly of the for-profit kind. This values-typology is enhanced even further by Clark’s now-famous “triangular model,” outlined a decade later in the landmark study, Places of Inquiry, in which he contemplates the strain within academia generated by conflicting pressures among the sometimes contrary imperatives of education for the professions, general liberal education, and research training and practice (1995).
As well, Janet Knowles’ discussion about the “emerging entrepreneurship” within colleges (in terms of their response to the very private-sector-like impacts of markets and revenue) is another handy tool for a closer look at the manifesting of private higher education in our world. The goal is to understand those forces which are driving what Altbach has described as “the logic of today’s market economies and an ideology of privatization” (1999, p.2).
Naturopathic Education & the Social Good
The responsibilities of private higher education (that is, the complex conversation about public and private good) are very much part of the parameters of private higher education. Gorostiaga (1999, p.192), as a case in point, argues that public, social good is not a commodity. Buchbinder (1993) states that “the objectives of higher education that are expressed as the production and transmission of knowledge as a social good are being replaced by an emphasis on the production of knowledge as a market good, a salable commodity” (p.143). Whatever impact this tension is eventually shown to have on academic autonomy and collegiality, the tremendous differentiation in private higher education, being witnessed by students of higher education as a global phenomenon, could find very precise manifestation in one of our proposed corners of America as a potential launch pad for the half-dozen new programs we think we might need in place by 2050. We have our work cut out for us. Looking back, though, may be less scary than looking ahead.
David J. Schleich, PhD, is president and CEO of the National University of Natural Medicine (NUNM), former president of Truestar Health, and former CEO and president of CCNM, where he served from 1996 to 2003. Previous posts have included appointments as vice president academic of Niagara College, and administrative and teaching positions at St. Lawrence College, Swinburne University (Australia) and the University of Alberta. His academic credentials have been earned from the University of Western Ontario (BA), the University of Alberta (MA), Queen’s University (BEd), and the University of Toronto (PhD).