Ruminations from a First Year Resident

New Doc Learns the Ropes of Practice Management
Written by Carrie Runde, ND, AANP Board of Directors

In early October I excitedly began a yearlong naturopathic residency at the GW Center for Integrative Medicine (CIM) in Washington, DC. When it opened in 1998, the GW CIM was one of the first complementary and alternative medicine practices in the country to be based at an academic medical center. The CIM is impressive in the diversity of health care providers it employs: there are two nurse practitioners, five holistic medical doctors (two internists, a psychiatrist, a rheumatologist, and a gynecologist), three naturopathic physicians, three acupuncturists, two Reiki practitioners, two psychotherapists, a therapeutic yoga instructor, two massage therapists, a nutritionist, a Trager method practitioner, an IV infusion specialist, and a hypnotherapist! Add the four office staff members and multiple George Washington University allopathic medical students and residents, and you have a crowded house of unique providers.

With so much interesting patient care going on at my workplace, you can imagine that I, like any newly minted doctor, was most excited to start seeing patients. I couldn't wait to apply my naturopathic training autonomously to real patients and witness the outcomes. But, as many new grads learn, seeing patients often happens at a slower pace than we expect. For those that are starting their own private practices, the weeks and months after boards are spent getting a myriad of business logistics squared away before a patient can even walk in the door. For others, the fall is spent creating positions for themselves in places that have never employed naturopathic physicians.

While awaiting the arrival of my medical license, I spent much of October shadowing the providers at CIM and also learning the behind the scenes aspects of private practice. Initially it was a bit daunting having to grasp a whole new system, but I recognized the importance of learning how a busy practice functions. I was able to compare the systems at my residency with the business models that I learned in practice management courses, all the while contemplating how I will run things in my own future practice.

In my time so far at the clinic, I've gained useful exposure to practice management software and electronic medical records. All of the scheduling and billing at GW CIM is done through a program called MindBody. I've benefitted from working with the center's business manager, to learn MindBody's dashboard and bookkeeping abilities, and with the front desk staff, to learn the program's patient scheduling and time of service transactions. The clinic is currently transitioning to electronic charting with Practice Fusion. It will significantly reduce office paper work and administrative tasks, as providers can use it to order and receive labs and message other providers all within the program. However, this program also has limitations, like not being able to integrate with our supplement dispensary or allow for automatic input of data from patient intake forms. I hope to someday have a paperless practice of my own, so learning the ins and outs of an EMR system is invaluable. I am lucky to have entered medicine at a digital turning point and to be learning the ropes as a resident.

Besides the scheduling, billing, and EMR systems, I have also learned the details about working with conventional and specialty labs. From setting up accounts, integrating with EMR, working with local lab reps, learning insurance billing nuances, and calling support staff with clinical questions, there is a great deal more involved than I had realized! As a medical student working in the teaching clinic, most of the business happened behind the scenes. This was in some ways for the good, as we student clinicians had more than enough on our plates. But business is an inevitable part of being in practice and hands-on learning is a perk to being a private practice resident.

While I may not have started seeing my own patients on day one, the non-clinical skills that I have learned are an equally important part of my postgraduate education. I am excited to have an entire year to soak in this experience, learning clinical and business skills. I look forward to sharing more of my observations as a naturopathic resident in future postings!

Thriving in an Unlicensed State

Dos and Don'ts
Written by Rhonda Steinke, ND
Practicing in unlicensed states can be a rewarding experience especially since these areas are lacking integrative healthcare. The key to creating a thriving practice is to plan carefully. The following recommendations on starting a successful career in an unlicensed state are based on my experience.

Holding a License to Practice Naturopathic Medicine is NOT Optional

The Importance of the Naturopathic Medical License
Written by Carrie Runde, ND, AANP Board of Directors

As many reading this know, the road to becoming a physician is long. First, you have to excel in your many pre-med classes as an undergrad or post-bacc student. Once you are accepted into medical school, you complete four or five years of basic sciences, clinical sciences, and clinical rotations totaling over 310 credits. Throughout this process, hundreds of thousands of dollars (plus interest!) are spent on your accredited, doctoral education. When graduation rolls around, excited friends and family travel to AZ, CT, IL, OR, or WA to watch you cross the stage and be called “doctor” for the first time! New graduates and supporters alike are thankful for the completion of this arduous, yet transformative, process.

The new grad's sense of liberation is ephemeral, however, as the reality of the upcoming board exams set in. This is truly the final hurdle between the newly minted naturopathic doctor and his or her ability to practice medicine. A passing score is needed to obtain a medical license in each of the jurisdictions that grant them to NDs. But what about those graduates who plan on working in states that have yet to license naturopathic doctors?  What is the rationale behind holding an out-of-state license?

As we learn in our jurisprudence courses, it is illegal to call ourselves physicians, to diagnose, treat, and prescribe (read: practice medicine) in states that do not license naturopaths.  New docs must remember this in unlicensed states! Just because one holds an Arizona license, for example, does not mean that he or she can practice medicine in an unlicensed state like Texas. This does not mean that NDs in these states should be license-less, however.

Simply put, medical professionals have medical licenses. Naturopathic physicians are medical professionals. The Department of Education recognizes our doctoral degree to be on par with our allopathic and osteopathic peers, which is why we are able to obtain most of the same government-issued educational loans as our conventional colleagues. These doctors, as well as chiropractors, nurses, and physicians' assistants maintain licenses for public safety. Practitioners who hold licenses have received degrees from accredited medical programs, abide by legal and ethical standards, and fulfill yearly continuing education requirements in order to provide optimal patient care. By holding a medical license, you are telling the world you are a naturopath who has received accredited training as a family doctor and who stays current on medical practice as required in the state in which you hold a license.  This distinguishes you from the online, diploma-mill “naturopathic doctors.” Even though your unlicensed state has yet to recognize you as a physician, you are minding the safety of your clients by adhering to the high professional standards associated with maintaining a physician's license.

There are also important reasons related to your state's future licensure. Holding a medical license in another state is proof that you are licensable. This is something that diploma-mill graduates cannot claim. This gives credibility with other medical professionals and legislators. Dr. Carol Rainville, a naturopathic doctor in Massachusetts explains that, “whenever I am educating people about naturopathic medicine I mention that I hold a license in Washington where I went to school. It gives people reassurance that I am the real deal. It's also important for interacting with other professionals. Patients may not realize that you need to go to school and pass the boards to get a license, but other medical professionals do. And if you're going to ask legislators to pass licensing laws, your position is more tenable with a license in your pocket.”

Maintaining your out-of-state license is an obligation to your state's licensing efforts. Naturopathic doctors will be licensed in all 50 states eventually, and it will take effort from all of us to make it happen. An ND working hard on Maryland licensure, Dr. Emily Telfair maintains that, “a naturopathic medical license is one of the strongest legs we have to stand on as our profession establishes itself as a vital and active participant in health care in this country. And while one piece of paper cannot truly explain what it means to be a naturopathic physician, all of the steps that allow us to display that piece of paper in our offices begin to tell that story. There are moments in our story that connect us to other professionals who graduated from accredited medical schools and language within our story that is familiar to legislators who may otherwise question the validity of our request for a license. Holding a naturopathic medical license in an unlicensed state gives me confidence in knowing that what has been achieved in other states can happen where I live as well. Holding a Washington license reminds me that I am a physician and just because I can't advertise myself as such in Maryland does not change who I am, what I know, or how I got here.”

For information about states' licensing requirements, click here.