I‘VE WORKED AS A NATUROPATHIC DOCTOR in various clinical settings- everything from ND clinics to a big box gym. I found both good and bad attributes for each. Depending on the vision for your career, this article will help you decide what type of clinic you should work in.
1. Working with another Naturopathic doctor
The first clinic I started with was owned and run by a Naturopathic doctor. It was important to me to work with a mentor and someone I could learn from. When working with another Naturopathic doctor, make sure he or she is willing to let you preceptor.
This is the best way to see them in action and to pick up the subtle things like:
- How to greet the patient
- How to handle talkative patients
- How to prioritize the treatment plan
- How to divide the visit into intake and physical exam
- How to encourage the patient to change their diet and lifestyle
- How to end the visit (on time)
These are all things that we not taught in school. It takes practice to master these skills.
Unfortunately, in my experience NDs are not always open to preceptors. Of course most NDs want to support new practitioners to be successful and build strong relationships with their patients, but a third observer can interrupt a visit. Some patients may not feel as comfortable sharing in the visit, as the relationship has yet to be built with the third party. If patient rapport suffers, so does the quality of care and their compliance.
Pros of working in a Naturopathic clinic
- The other ND can act as a mentor allowing you to collaborate on difficult patient cases.
- The Naturopathic doctor will be more empathetic to your needs as a practitioner as well as support you when you are struggling or burning out. She can provide valuable tips based on her own experiences.
- You learn a lot about how to run a (successful) Naturopathic business, while balancing your personal life.
- Marketing is already done for the clinic. Patients who find us online or via advertising are already aware of who NDs are and what to generally expect.
- The clinic is set up and ready to accept Naturopathic patients with a receptionist that understands the needs of a ND and a full dispensary. This allows your costs to be greatly reduced.
Cons of working in a Naturopathic clinic
(Note: these cons could apply to any clinic setting)
- They weren’t willing to let me preceptor, which was my main attraction to working with other NDs.
- There wasn’t enough time set aside to have regular meetings. If mentorship and collaboration on difficult cases is important to you, make sure it is evident in your contract or agreement with the other ND.
- They found it difficult to run a business. I felt a sense of competition since we were all NDs. I was never introduced to their patients and the receptionist did not mention that I was even part of the clinic.
- They didn’t support my growth. Listen to your gut. Does the owner or practitioners truly want to see you busy or do they see you as competition? Or worse yet, are you just a way to subsidize a slow clinic?
- Preceptor with a mentor or peer. Even if the clinic you work at doesn’t allow it, make an effort to look outside for opportunities to learn the soft skills of being an ND and business owner.
- The practice should be full and thriving. When working for another Naturopathic doctor, ideally he/ she should have a waiting list that you can fill and get busy right away.
- You should feel like family. Make sure you are introduced to the patients, receptionists and other practitioners so that the clinic runs like a well-lubricated machine.
- Make sure that new patients go to the newest ND first. If the primary ND is fully booked, it makes sense for the associated to take on the overflow. The receptionist should be good at talking up the newest ND so that patient feel comfortable seeing them instead. This will allow your practice to grow faster.
- The clinic owner should know what a win-win contract looks like. Once your practice takes off and you are paying more than your fair share, it’s time to renegotiate.
- Take over a maternity leave. This will allow you to increase your experience, have a mentor and give you deeper pockets when you are starting out.
2. An Integrative Clinic
Working in an integrative clinic can be quite rewarding if the other practitioners are willing to cross-refer. Otherwise, it’s just like working on your own. Collaborating on client cases with various practitioners will give a more thorough and comprehensive care to them, if you can work cohesively.
Pros of working in an integrative clinic
- You can discuss client cases among other practitioners that are also treating them. With a different approach another practitioner may be able to see something that you are missing.
- Clients will feel like they are well taken care of and they don’t need to visit multiple clinics.
- You have a greater chance to receive new patients if the other practitioners are willing to talk about your services to their clients.
Cons of working in an integrative clinic
- Other practitioners might not understand what you do, it’ll be difficult to receive referrals.
- Clients might be used to a “quick fix” often provided by many manual practitioners and unless the practitioner does a good job explaining what to expect, they can often be disappointed by Naturopathic medical care (ie lifestyle changes).
- Competition for the same clients can occur, so make sure your receptionists are well versed in the types of conditions and patient populations you treat. If you are the newbie in the clinic and there’s a walk-in, the receptionists may refer to older practitioners if they are unsure of what you do.
- Provide free care to everyone that works there. This includes any receptionists, staff and practitioners. It’s the only way they can see for themselves what you have to offer making them more inclined to talk positively about you to their clients.
3. The Big Box Gym Health Centre
While I was trying to grow my practice, I was presented with the opportunity to work at a big-box gym as an ND. This gym was expanding and already had 13,000 members!
It was an appealing opportunity. People who go to the gym must have their health as a priority, right?
I worked there part-time for almost two years.
How I Got New Patients
- Free talks – The most effective way I was able to generate new patients was to put on free monthly talks. I had a large white board near the front desk with a sign up sheet and pen attached. I advertised my talks on the board with a quick and effective call to action. Members could sign up for the talk and I’d be able to estimate the number of attendees.
- Free Samples– I also had a “juice bar” with free samples to encourage members to ask me questions, taste a healthy snack and walk away with a free recipe with my contact information on it.
A year later, the fitness club changed their rules and no one could advertise in the club unless it was in a plastic sleeve in the bathroom stalls.
Needless to say, this made it very difficult to announce my talks and services to members and I was constantly fighting for advertisement space with the personal trainers.
The gym expected me to walk around the club and solicit my services. This system did not work for me and I felt unsupported by the big box gym.
Pros to working in a big box gym
- People recognized the brand of the gym and thus its location and where to find me.
- There were a lot of potential new clients. 13,000 health-conscious leads!
- They provided all the medical supplies: computer, a printer, a hydraulic table and medical equipment (ie Welch Allyn wall mount set and body composition machine). They also provided linens and acupuncture needles.
- Referrals were great once I built rapport with a few personal trainers. A trainer-client relationship is intimate. When a client has health concerns that the trainer is unable to support, your referral will be a huge lead.
- Health practitioners are hired as employees, which means you collect a commission on your services instead of a split and thus you collect EI, benefits and don’t have to worry about HST.
- As a staff member, you got a free gym membership valid in all locations.
- Health practitioners are advertised on their website and they provided an online booking system.
Cons of working for a big box gym
- Front desk staff rotated often and could not keep up with the needs of the health centre.
- The health centre was not supported or mentioned on their own TV station and audio advertisements in the club. They also disallowed any advertisement like posters and white boards. Approaching members that were working out was more of a nuisance.
- They did not have a collaborative health approach, like a program between the personal trainers and the health centre. The gym staff were not educated about the needs we could meet as health care providers.
- Ironically, often times the referrals from personal trainers were people who wanted a quick fix and did not want to spend any money.
- The split did not have a cap so there was not any incentive to grow and be busy.
- There was no health centre manager on site that could help with daily promotional events. The manager was off site and could not always relate to the struggles with the local gym.
- There was no receptionist. You had to check out and book all the patients yourself.
After almost 2 years, my practice did not grow as much as I would have liked. Working 3 part-time days a week (4-6 hrs/day), I averaged 6 patients a week.
It was a combination of how the gym was run but also my inability to be outgoing and to speak to every member no matter what they were doing. I realized that my strengths lie in building referral networks and relationships with colleagues of different professions like massage therapists, chiropractors, osteopaths, hypnotherapists and nutritionists. I also enjoy giving talks in the community.
It is important when evaluating existing practice locations to be clear about what services they are going to provide for the rent or split you are remitting to them.
As a Naturopathic doctor, patient visits alone can be very draining and it is important to have adequate support in your practice. Having help with patient booking, follow-ups, checkouts, providing patient referrals, advertising and other administrative tasks should not be overlooked.
When I was paying almost half of my earnings to a business that was not concerned with these things, I realized that it was not a good long-term fit.
The bottom line is that if you are paying a lot to a business owner, you should be getting a lot. This means an excellent front desk staff that does all of your bookings and can answer your patient’s basic questions so that you aren’t spending valuable time fixing booking mistakes or doing admin work that is much below your pay rate.
Tasks that the front desk staff should be able to handle:
- Patient bookings and handling calls in a professional manner.
- Reminder of appointment calls.
- Following up with patients if they cancel and do not re-book right away. (It’s hard to keep track of everyone and so having a receptionist that is on top of this, is very helpful.)
- Faxing “Release of Records” to the patient’s doctor and then making sure the results come in before their follow-up appointment.
- Creating and managing a waiting list.
Despite the obstacles that I encountered, I learned so much from the process. Although it has been challenging, the relationships I have established with friends and colleagues along the way have all been rewarding and we continue to learn from each other.
Figuring out where and with whom to practice is part of the journey to being a Naturopathic doctor and entrepreneur. Take every experience, good or bad as an opportunity to grow as a person and as a practitioner.