Blueprint for Expansion: The Right Plan at the Right Time
David J. Schleich, PhD
Building the profession is a many layered enterprise, with education at the core.
As the second decade of a new century zooms toward the third, we are increasingly finding our place in the mainstream higher education sector. National College of Naturopathic Medicine’s rebranding as National University of Natural Medicine is a recent case in point. National University of Health Sciences, in Lombard, Illinois, added naturopathic medicine to its program mix over a decade ago and University of Bridgeport did the same a decade before that. The inclusion of the naturopathic doctorate within the program family of Maryland University of Integrative Health in 2018 and Southern California University of Health Sciences soon after that are also part of this trend. Thus, by 2020 we will have 10 accredited clinical doctorates in play on the continent with several more on the horizon between 2021 and 2029.
For the past 20 years, finding ways to locate our schools as institutions within civil society has been helped by the increasing number of states offering licensure (California, Colorado, North Dakota, Minnesota, Maryland and Pennsylvania have been added to the list since 2004). During this same period there has been growing interest in scholarly literature about what is known as the “social economy.” In this regard, we need to work out exactly what our programs and institutions are in the context of the higher education sector. That discussion is vital because the very nature of our naturopathic educational platforms dramatically affects how we are seen in mainstream higher education. The broadly cherished goal of growing the profession requires powerful coordination of understanding of these complex interrelationships.
The Multifaceted Landscape
Several factors are simultaneously at work here. At the program level, the preferences, skills, knowledge, and priorities of professors and Deans, Council on Naturopathic Medical Education (CNME) commissioners, and state volunteers on licensing boards significantly influence content and outcomes. The NDs who serve in these capacities make decisions that impact everything from learning outcomes to numbers of credits based on their understanding of the most important knowledge and skills our graduates will need in the nation’s transforming healthcare landscape. Affecting these same elements are the regulations and public policy that determine scopes of practice for graduates in states and provinces. Making sense of what often are perceived as contrary imperatives is paramount to the continuing safe expansion of the naturopathic profession.
Contributing to this complex interplay are the economic sectors in America and Canada, most often demarcated as the for-profit, not-for-profit (non-profit), and public sectors. A muddle of terminology accompanies these categories. It is worthwhile to sort out the labels while becoming clear about how the nonprofit sector, in particular, operates in the mixed economies of North America and beyond. Equally vital is that we see where our higher education programs fit into these intersecting economic venues.
We have much to learn in our naturopathic community about how the evolution of the nonprofit entity in America has shaped our institutions. In this regard, the works of Salamon (1995) and Hirschhorn (1997) call attention to the “dearth of conceptual and theoretical frameworks for studying nonprofits.” It is illuminating to review the scholarship about the “economie sociale,” (Snaith, 1991; DeFourny and Monzon Campos, 1992) which provides a lens for understanding this remarkable and highly useful sector. To better understand the distinctions between nonprofits and public sector organizations, contemplating the nonprofit sector as a “buffer between the state and the individual,” (Richmond, 1999) or a “commons,” (Lohman, 1992) is a good path for us. We also need to develop a better understanding of the limits of public policy (Weisbrod, 1988) and how they have contributed to the emergence and growth of nonprofits such as Bastyr University, National University of Natural Medicine, Canadian College of Naturopathic Medicine, National University of Health Sciences, University of Bridgeport, Boucher Institute of Naturopathic Medicine, Southwest College of Naturopathic Medicine, Maryland University of Integrative Health, and Southern California University of Health Sciences. When ND programs become ensconced in multi-program institutions, the nature of these institutions influence the purpose, nature and vision of the naturopathic profession as it scrambles to compete in the shifting terrain of integrative medicine.
As 1 of many programs in an institution with competing needs and shifting pressures from a wide variety of stakeholders, ND programs can experience a blurring of identity. Contributing to the complexity is the somewhat confusing role the private market plays in the generation of nonprofits (Hansman, 1986). James (1987) flips the perspective on this relationship from the demand side to the supply side, suggesting that we sometimes have to figure out where the market is headed and get ready for it, often long before demand suggests and assures us that we should. And, just as these complexities begin to settle into a helpful framework, Salamon points out “neither consumer demands nor government and private sector failures to supply them account for the large and publicly-subsidized role of nonprofits in the provision of public services.” (1995, p.57) Into this interesting fray comes Samuel Martin’s (1985) phrase “humanistic sector” and his neat narrative on the 4 classes of humanistic service “[moving] through the 4 stages of delivery at different speeds.” Martin (1985) reflects back to 1937, just when the grip of the Great Depression began to loosen, to examine the origins of resource allocation, and guides the reader through a tour of historical Japanese, Chinese, western European (including British), and eastern European stages of “humanistic service.” What Martin’s work teaches us is that when we began to realign our naturopathic schools with the mainstream, the profession’s chances for growth improved and thus our mandate of providing natural medicine options for society gathered momentum. By the mid-1970s, we were back in the game.
The Mutual Nonprofit Model of Naturopathic Education
Alessandrini (2002), on the other hand, developed a typology of nonprofit human service organizations like our naturopathic medical schools, classifying them as mutual nonprofits. As mutual nonprofits, we share a common goal and work toward this goal as nonprofit organizations. This typology seems to capture the nature of our schools and programs. Alessandrini identified 6 organizational types “along a continuum characterized by increasing sophistication and distance from the traditional model, itself characterized by altruism, voluntarism and mutuality.” (2002, p.5)
Alessandrini (2002, pp.3-4) observed that “the further organizations [are] from the traditional model [of the nonprofit], the greater their orientation to the market, in both their delivery of services and their funding sources.” He developed a classification system using 5 levels of nongovernment nonprofits based on the degree and nature of their market orientation. At first glance, our schools seem to fit most comfortably at the quasi-commercial end of the continuum, most similar to commercial businesses.
Alessandrini further differentiated nonprofit organizations into 6 types, manifesting varying aspects of the 5 levels of market orientation: simple, single factor, non-hierarchical, semiprofessional defined client, complex managerial entrepreneurial, and pseudo market entrepreneurial. Although the pseudo market entrepreneurial category captures many of the characteristics of our schools, it appears that none of these types perfectly describes our educational institutions. For example, whereas the simple type has a voluntary board, it has low levels of management proficiency and low staffing numbers. The pseudo market entrepreneurial classification includes a management description in which the players are highly professional and financial management is highly complex.
Ultimately, we need to maintain an agenda that grows our professional training presence in all sectors of American society. One valuable tool for strategic planning is the US Census, which provides demographic data by region. For example, the Pacific region holds 17% of the nation’s population and has 3 (soon to be 4) naturopathic medical programs. A quarter-century strategy could be to become proportionally present in each region. If we embrace this strategy, based on the most recent census data, we will need at least 1 more training program in each of the West North Central, East South Central, and Middle Atlantic regions, and at least 3 more in each of the East North Central, Middle Atlantic and South Atlantic regions. In other words, we will need 12 new programs at a minimum to match population densities before the middle of this century. We have managed 4 new programs since 1978. The pace quickens.
Regional Population Distribution (US Census Bureau, 2010) and Current Naturopathic Training Programs:
- Pacific: WA, OR, CA, HI, AK (17%) [BU, NUNM, SCUHS]
- Mountain: ID, MT, WY, NV, UT, CO, AZ, NM (6%) [SCNM]
- West North Central: ND, SD, MN, NE, IA, KS, MO ((6%) 
- West South Central: OK, AR, TX, LA (10%) 
- East North Central: WI, MI, IL, IN, OH (15%) [NUHS]
- East South Central: KY, TN, MS, AL (5%) 
- New England: ME, VT, NH, MA, CT, RI (6%) [UB]
- Middle Atlantic: NY, PA, NJ (16%) 
- South Atlantic: WV, MD, DE, VA, NC, SC, GA, FL (19%) 
With such a strategy in mind, we will want to install new, full-time programs into existing institutions in those regions. A national task force, utilizing the resources of the American Association of Naturopathic Physicians (AANP), state associations, and the American Association of Naturopathic Medical Colleges (AANMC) could prioritize this vision and strike a plan that begins in earnest no later than the end of our current decade. We will want to keep in mind the best practices and values of both the mutual non-profit sector and the non-profit sector as a whole in the process of finding partners in the higher education world to accomplish this grand vision. Public sector universities are subject to regulatory policies and planning cycles that are highly politicized and instantly responsive to changes in public funding. A fast track would be possible, though, if 1 or more public sector institutions were to embrace the concept and take action. This is more likely than ever now that more states are validating naturopathic medicine through licensure. It is also of interest to people all over America who want more NDs in their communities.
Alessandrini, M. (2002, October). A fourth sector: the impact of neo-liberalism on non-profit organizations. Refereed paper presented at the Jubilee Conference of the Australasian Political Studies Association, Australian National University, Canberra, Australia.
Defourny, J. (1992). The origins, forms and roles of a third major sector. In J. Defourny & J. L. Monzon Campos (Eds.), The Third Sector: Cooperative, Mutual and Nonprofit Organizations (pp. 27-50). Brussels, Belgium: CIRIEC, DeBoeck University.
Defourny, J., & Monzon Campos, J. L. (Eds.). (1992). The third sector: Cooperative, mutual and nonprofit organizations. Brussels, Belgium: CIRIEC, DeBoeck University.
Hansman, H. (1986). The role of the nonprofit enterprise. In S. Rose-Ackerman (Ed.), The Economies of Nonprofit Institutions. New York, New York: Oxford University Press.
Hirshhorn, R. (Ed.). (1997). The emerging sector: In search of a frame work. Canadian Policy Research Networks, Inc. Retrieved from http://rcrpp.ca/documents/25944_en.pdf.
James, E. (1987). The nonprofit sector in comparative perspective. In W. W. Powell (Ed.), The Nonprofit Sector: A Research Handbook (pp. 397-415). New Haven, Connecticut: Yale University Press.
Lohmann, R. (1992). The Commons: New perspectives on nonprofit organization and voluntary action. San Francisco, California: Jossey-Bass Publishers.
Martin, S. A. (1985). An Essential Grace: Funding Canada’s Health Care, Education, Welfare, Religion and Culture. Toronto, Canada: McClelland and Stewart.
Richmond, B. J. (1999). Counting on Each Other: A Social Audit Model to Assess the Impact of Nonprofit Organizations (Unpublished doctoral thesis). University of Toronto, Department of Adult Education, Community Development, and Counseling Psychology, Toronto, Canada.
Salamon, L. (1995). Partners in public service: government – nonprofit relations in the modern welfare state. Baltimore, Maryland: The Johns Hopkins University Press.
Snaith, I. (1991). The Economie Sociale in the New Europe. In Yearbook of Co-operative Enterprise. (pp. 61-75). London, England; Plunkett Foundation for Cooperative Studies, 1988–1993.
United States Census Bureau. (2010). 2010 Census Data. Retrieved from http://www.census.gov/2010census/data/.
Weisbrod, B.A. (1988). The Nonprofit Economy. Cambridge, Massachussettes: Harvard University Press.
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).