What’s It Really Like Out There?

As every naturopathic physician knows, natural medicine is also known these days as “holistic” or “integrative” or “functional.” Some estimates put the aggregate population of active licensed/registered/certified (by civil authority) traditional naturopathic providers at 5000 nationwide. Many mainstream allopathic health-education institutions, we must remember, have pushed into this market in recent years, borrowing the lingo and terminology but not the philosophy or the coordinated practice of a spry network of universities and colleges around America that has been dedicated to natural medicine for decades. That small group of fewer than 10 programs has faced detractors and political opposition the whole way. The latecomers (eg, mainstream integrative medicine programs) have not usually benefited from knowing the history of natural medicine that has persisted for at least a century in America. Their general assumption is that mainstream biomedicine is gravitating toward more holistic approaches in response to market demand, rather than the shift emanating from a more philosophical center, notwithstanding the epistemology and track record of its disease-centered paradigm.

Let’s have a look at the top 10 characteristics of this robust network of institutions whose members have held the place for preventive, lifelong wellness medicine for decades.

Top 10 Market Realities Naturopathic Institutions Face

Natural medicine is a tiny but necessary (and growing) piece of a massive healthcare market.A handful of colleges and universities in America continue to add modestly each year to the number of natural medicine providers. Contrasted with fewer than 5000 in the licensed naturopathic sector, as cited above, the broader biomedicine terrain consists of approximately 1.3 million MDs and DOs in the United States. The actively licensed biomedicine/allopathic physician population in the United States is growing and slightly aging, with an increasing ratio of female to male physicians in the younger age groups. The number of biomedicine physicians holding an osteopathic medical degree is also growing significantly (28% in 2010-2016). There are 287 allopathic physicians per 100 000 population. As well, there are currently 136 073 nurse practitioners and 98 470 physician assistants in primary and subspecialty care in America.¹
Despite the steady strengthening of the historical naturopathic medicine education institutions, allopathic/biomedicine is capturing and dominating the growth of integrative medicine. In the post-Patient Protection and Affordable Care Act (PPACA) healthcare landscape, society is mainstreaming “integrative and functional medicine.” The Academic Consortium for Integrative Medicine & Health now has over 75 members (academic institutions and health systems), which are focused on the tripartite service mission of education, research, and clinical services. Specialty certification is growing (eg, AIHM, NCIPH, OCCAM, NCCIH, Cochrane Complementary Medicine, and more), as are numerous conferences and professional development activities and mentorship activity. Further, there is an escalating number of established practices in integrative medicine employing our graduates. These integrative medicine alliances and networks are targeting certain cohorts through aggressive platforms such as the Institute for Functional Medicine and “Integrated Connections.” Significantly, the naturopathic and Chinese medicine professions have yet to consolidate professional identity; gain nationwide licensing, certification or registration; and are rarely recognized in the general public as “integrative” specialists. The allopathic professions are incorporating “holistic” modalities and practice into their biomedicine platforms.
Despite the hegemony of the biomedicine professional education complex, external stakeholders increasingly recognize the specialized colleges and universities of naturopathic medicine (eg, National University of Natural Medicine, Bastyr University, Southern California University of Health Sciences, National University of Health Sciences, Bridgeport University, and the Southwest College of Naturopathic Medicine, as well as the Canadian College of Naturopathic Medicine and the Boucher Institute of Naturopathic Medicine in Canada) as the voices of natural medicine. Response by employers, health systems and multidiscipline clinic venues to the applied skills of the graduates of such institutions is inextricably linked to presence in the healthcare workforce and also in the healthcare services market. The “Integrative Medicine” market routinely attracts naturopathic and Chinese medicine graduates in licensed and unlicensed states. Professional “identity” is inconsistent and often lacking among the public. Patients are not sure what “holistic” means, nor do their reimbursers treat even licensed natural medicine providers equitably or equally. Even so, more such insurers are paying attention to patient demand and checking out the natural medicine sector more carefully these days.
New programs expand the smaller, specialized natural medicine university’s participation in the growth of integrative medicine. The trajectory of program development in the university insinuates their graduates into more and more elements of the US healthcare workforce and policy agencies in terms of service imbued with natural medicine modalities, principles, and products. Nutrition, Sports Medicine, Integrative Mental Health and Behavioral Health, and Expressive Arts move graduates from these unique universities and their skills into mainstream career options. When the alignment of these natural medicine and related health sciences career competencies is consistently with the “healing power of nature,” the presence of these universities in the higher-education and health-services sectors is strengthened.
The small network of natural and holistic medicine universities and colleges in America has become increasingly financially stable, and contributed/donated revenue and in-kind gifts are on the rise; however, their cash reserves remain small. These universities are aggressively catching up in terms of plant and property capital, human resources capital, diversified revenue streams (eg, doubling of its program mix, enhanced delivery of educational and health products, fundraising, health centers, continuing education, and publishing). These examples of the institutions’ current 5-year plans show a remarkably consistent trend; that is, they are invariably aiming at committing a minimum of 5% of its aggregate top-line earnings each fiscal year to a reserve capital fund.
The fixed costs of these example institutions are still growing. The juxtaposition of enhancing capacity (physical, intellectual, proprietary products, healthcare services) with rapidly addressing debt ratio is a medium-term challenge for these universities. The drivers of these increasing fixed costs are physical facilities, equipment costs, startup costs, and rising personnel costs. The rate of increase of fixed costs will slow as efficiencies become possible through online scaling, more efficient utilization of personnel across the curriculum, strengthening of managerial and leadership resources, and the confident growth in participation in the mainstream of higher education and healthcare services.
The core programs of these universities and colleges are generally quite healthy financially. However, single-program institutions in this group remain vulnerable to enrollment fluctuations that cannot be easily ameliorated by growth in other, allied programs. These universities’ core programs are stable, reflecting fluctuations common to the larger, higher-education sector; however, the field is slowly growing and each of the example institutions shows strong commitment to building a larger applicant pool overall as part of an ongoing strategy. The attraction of their core programs is strong when their nature and potential are understood and valued. The descriptors about how natural medicine systems contribute to the healthcare delivery and effectiveness crisis, though, need to be reinforced by data and clear statements of value proposition.
The new programs showing up in the mix of these universities are invariably enhancing the health of these institutions.New degrees and certificates that diversify their program mixes are also being synchronized with a demonstrable and sustained service reputation for the professions these universities serve. The data show that each offering has had in recent years an ROI that is financial, philosophical, and brand enhancing. Additionally, as these organizations differentiate their credential positioning locations in serving professions (eg, MBA in Integrative Health Administration, Integrative Mental Health), they are strengthening the overall identity and brand of their core programs.
There is a least common denominator among these university examples of dramatic physical growth that has remained highly utilized in recent years. Plant and property acquisition, redeployment or repurposing enable instructional and related learning spaces to be developed. As these universities expand their footprint and improve their facilities, physical assets are increasingly being accompanied by technological progress in parallel, particularly in online presence. The data show that fill-rates for physical space routinely optimize evening, weekend, and low-season programming. New facilities tend to be information-technology-rich.
These small holistic medicine universities have strong foundations and reputations to support growth. The essential elements of protracted, secure growth are present and strengthening year over year. Campus footprint (room to grow), physical assets (buildings, equipment, classroom and clinic configuration), human resources, programming with highly visible outcomes in a growing health workforce market, research capacity, capable and visionary leadership, a growing residential and online student body, and participation in healthcare delivery in the integrative channel are all extant.

References:

Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2013 to 2025 – Final Report. March 2015. IHS Inc, Washington, D.C., 2015. AAMC Web site. https://www.aamc.org/download/426242/data/ihsreportdownload.pdf?cm_mmc=AAMC-_-ScientificAffairs-_-PDF-_-ihsreport. Accessed January 2, 2018.

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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).