As I sat in the busy Brazilian restaurant, I had a moment.
It was my birthday. Surrounded by family, energetic servers, and laughter, I had trouble conjuring up a genuine smile. I’m not a vegetarian, but I’m definitely not a huge meat eater. This restaurant wasn’t my choice.
So why did I pick it for my birthday?
I picked it to make somebody else happy – I’ve always been a people-pleaser, consumed with making others feel good, sometimes at my own expense. The guy I was dating was a meat eater and I knew he loved this restaurant. But he didn’t even come to dinner.
This guy had dumped me 3 days before my birthday. He did it via text message.
This was the moment I decided to ‘do me’. To put myself first. This was the moment that I decided to follow my dream and travel.
I was just finishing school …
After passing the NPLEX-2 I packed my bags and headed off to Thailand. As a new grad with no clinical experience and no job lined up, my only tools were determination and a little money put aside.
The worries were there:
“I have NO money saved”
“I don’t speak the language”
“I don’t know anybody, or anything about where I’m going”
After meeting countless travelers these past few years I’m confident in saying that the cost of traveling isn’t what stops most. Many men and women live nomadic lives without a dollar in their bank account, working enough to eat and get to their next destinations. I’m not necessarily recommending you follow their lead but use it as an example to impress upon you the real reason why people don’t travel.
And you know what? I’m still trying to figure it out but I’m working to forge a new path for ND’s to make a living doing what they love and doing it successfully.
So I jumped, but not right away
Every time I compared myself to others or my ideas of social norm I got scared. I hesitated. The voice in my head kept saying, “you’re finally a Naturopathic doctor and you want to travel. Really?”
Fear sucks. It stops me from taking action everyday. Watching Brazilian dancers shake their asses while meat was being thrown in my face gave me the moment of courage. Courage to go against the grain of expectations. Courage to ‘do me’.
Now it’s your turn to ‘do you’.
I tried to plan – it didn’t work
I sent out 100’s of emails to various hotels, resorts, and wellness centers across South East Asia without any success. A couple inquiries and interviews, but no confirmed jobs.
(download my spreadsheet here to see my research)
It was disconcerting but in the end worked to my advantage. If you’ve never traveled to a foreign area it’s hard to know what to expect. It’s also hard to gauge what a fair salary or hourly rate would be. And what about the working and living conditions?
What I found was that there are countless opportunities to work (and volunteer) once you arrive in a foreign country.
Nobody is interested in hiring a student a year from now, especially one who wants to work abroad for a good wage in a tropical paradise working leisure hours. I later found that resorts get a lot of inquires and have learned to tune them out because so few are serious.
I had zero job opportunities before leaving Canada, but once I arrived on the island of Koh Phangan in Thailand I had 2 job offers out of 5 places I contacted (and that was 3 months after I had already traveled).
If you want to travel, commit. Jump.
I’m not saying you shouldn’t try and secure a job ahead of time, heck use my document to contact potential employers. What I’m saying is, don’t to let your insecurities and excuses stop you from trying.
The 10 most important strategies for ND’s to travel and make money
Click on a link to skip ahead if there’s one section that’s of particular interest to you:
- Talk to people who are or have worked abroad
- Pick a place
- Contact people– early
- Visas and salaries
- Sell yourself
- Carry-on bag
- Intake form and charting
- Get to know your online distribution companies
- The follow-up
1. Talk to people who are or have worked abroad.
√ Chec….. Well hold up! This article is a great start, but there are many other NDs who have lots of experiences in various countries and roles.
For example, if you want a long-term clinical position in Dubai, I’m not the person to talk to. The regulations and medical structure in Dubai works very different to Thailand, especially since it is an expensive city to live in with strict health regulations and a unique social atmosphere. The ND I’d send you to is Imane.
Here’s a list of NDs who have worked in various location around the globe (if you know of any more, please get their permission and send their contact info to Alison@theNDDC.com). These are the critical people who helped reassure and guide me before I headed off on my trip:
|Hong Kong||Adam Friedman, NDfirstname.lastname@example.org
|Ardyce Yik, ND||http://drardyceyik.com|
|China||Colleen Symmes, ND||Colleen.Symmes.ND@gmail.com (www.Natural-Foundations.com)|
|Quatar||Maral Yazdandoost, ND (not currently practicing)||www.DrMaral.com|
|Dubai||Imane Farhat, NDemail@example.com|
|Thailand||Adam Friedman, NDfirstname.lastname@example.org|
|Alexis Shields, NDemail@example.com|
|Alison Chen, ND||info@DrAlisonChen.com (www.DrAlisonChen.com)|
|Laura Kent-Davidson, NDfirstname.lastname@example.org (with her 1 year old daughter non-the-less!)|
|Lily Hoang, NDemail@example.com|
|Maldives||Adam Friedman, NDfirstname.lastname@example.org|
|Nicaragua||Adam Friedman, NDemail@example.com|
|Tabatha Parker, ND||www.ndimed.org|
|Northern Kenya||Ameet Aggarwall, ND||www.fimafrica.org|
|Egypt||Laura Batson, NDfirstname.lastname@example.org (www.laurabatsonnd.com)|
2. Pick a place.
Pick a few specific places you’d like to visit, or decide on a program, clinic or person you are interested in working with and contact them directly. If they don’t reply, still go there and physically introduce yourself. An in-person relationship has much more impact than sending an email or even calling. It also helps to generate other leads in your field of interest.
Finding a place to stay is easy with websites like:
|Cheap (<$10/ night)||Affordable ($10-20)||Moderate ($20+)|
If you want an affordable and spiritual experience, try a Vipassana – a ten day silent meditation retreat.
3. Contact people– early.
If you are going to send out resumes or CVs, contact the potential business early. Include a short bio, head shot and summary of all the services you can provide. If you’d like to offer programs (ie. weight loss, detox, meditation), highlight how they will bring the company more profit and business.
Here’s a general time frame before you arrive to the area:
- 6 months prior: send initial emails of interest
- 4 months prior: confirm Skype or phone interviews
- 2-4 weeks prior: book an in-person interview
*Hint from Dr. Friedman– tell your potential employer that you will be arriving 2-4 weeks prior to your actual date. The employer will be much more willing to book an in-person interview if they know you are already situated in the area.
You can also look into externships (clinical experience abroad that counts towards school credit)or volunteering with various organizations, such as:
ND Externships and Associations
- ND Global Network- ndglobalnetwork.com
- Naturopathic Doctors International (Nicaragua)- ndimed.org
- Naturopathic Physician Volunteer Corp Program
- Unique Global Health Courses
- Health for Every Living Person (Thailand) Foundation – thehelpfoundation.ca
- Child Family Health International- CFHI.org
- Bolivia, Ecuador, India, Mexico, South Africa
- The Foundations for Integrated Medicine in Africa (Northern Kenya)- fimafrica.org
- Naturopaths Without Boarders- naturopathswithoutborders.org
- Haiti, Mexico, Nigeria, northern Thailand
- Naturopathic Medicine For Global Health (Guatemala)- nmghus.org/
4. Visas and salaries.
Depending on where you work, visa requirement will vary. Most companies will partially or even fully cover your work Visa fees if you are hired in advance. Because I didn’t have a position set-up prior to leaving for South East Asia, I didn’t get a work Visa ahead of time. I got a double entry tourist Visa to Thailand, which allowed me to stay up to 6 months (for most volunteer positions all you need is a tourist visa).
If the company wants to hire you on a salary basis, ensure you have a trial period to protect yourself from getting stuck in an unwanted situation. There are different standards, expectations and challenges when working in a foreign country. Give yourself a chance to explore opportunities before committing to a year or longer.
A common wage is anywhere from 50:50 split (including flight transportation or living) to a 70:30 split (without anything included). Have comparable prices but always slightly higher to the other services offered. You are offering premium services, so be confident in charging accordingly.
Dr. Friendman’s advice is to be hired as a ‘visiting practitioner/ consultant’ rather than a ‘glorified concierge’. Avoid being pigeon-holed into shuttling clients to other therapists and not utilizing your skills. Be confident. Don’t be afraid to charge what you are worth, relative to the patient population and social-economic status.
5. Sell yourself.
Along with having a solid resume or CV, you need to be able to sell yourself as a package. People outside of North America don’t really know what Naturopathic medicine is. Get them interested. Contrary to North America, being able to offer a variety of skills is more appealing than being able to treat a lot of medical conditions. Go as far as making a menu of services to paints a clear picture of what you have to offer:
- Massage, lymph drainage, abdominal massage or chi nei tsang
- Acupuncture and auricular medicine
- Chiropractic adjustments
- Nutrition and lifestyle counseling
- Herbal medicine (Western, TCM, Ayurvedic)
- Facial rejuvenation
- Pain management
- Detox and weight loss programming
- Exercise training and rehabilitation
- Yoga instructor
- First Aid training
Giving away free information sessions, leading group meditation classes, or doing some ‘tongue and pulse’ readings make for great leads. It gives people immediate value and allows them to get comfortable and curious with you. If there are detox/ Yoga/ Pilates groups in your community, create a meet and greet during group times to help bring up common health issues and concerns. Don’t be afraid to shmooze with guests and find out their health concerns or goals.
A form of testing is a great selling point. Especially one that gives patients something physical to see and repeat later on for comparison. Lab testing is ideal but not always available.
Here are some tests (excluding labs) you can include:
- Applied kinesiology muscle testing
- Food sensitivity tests
- Iridology imaging
- Blood pressure
- Insulin tests
- Urinalysis or dipstick
- Before and after photographs with facial rejuvenation or body composition
- Tape measuring
- Vega testing
- Dark Field Microscopy
Side note: I also recommend giving back to the local area to build a strong community. Set aside time to offer free visits to other staff members or locals who may not be able to afford your services. Learn the basic local language and respect the culture.
If you choose to create a program or provide a service that requires physical tools, be sure you bring them or know how to order them. For example, I ordered acupuncture needles and tacks from Korea but I brought my own homeopathic remedies.
The wellness centre had Ayurvedic herbs that I learned to use and got a small percentage from each sale. If I went back to the wellness centre, I’d consider buying some supplements to bring over since they were difficult to find and order.
These are the general formulas to consider (for a full list, click HERE):
- Sleep and anxiety
- Heart health and cholesterol
- Brain and cognitive support
- Candida, parasite and fungal infections
- Detox and weight management
- Menstrual and menopausal support
- Skin health (sunburn, allergy, autoimmune) ▪ Anemia (Iron, B12)
- Pain and inflammation
- Addiction and depression
If you decide to bring text books because the internet may be unreliable, be selective. Those textbooks can really add up and weight down your bags.
- Clinical Naturopathy: An evidence-based guide to practice, 1e by Jerome Sarris and Jon Wardle
- Desktop Guide: To Keynotes and Confirmatory Symptoms by Roger Morrison
- Acupuncture Desk Reference by David Kuoch (it has a surprising amount of great references outside of TCM)
- The Ultimate Herbal Compendium: A Desktop Guide for Herbal Prescribers by Kerry Bone
Lighten your load by carrying only your laptop. All your tools can be found within 1 document and 1 program:
- Online NPLEX-2 Study Guide– for a quick reference for conditions, signs and symptoms, pertinent labs, sequelae and treatments in chart format (available to download for free here). Download it and save it onto your computer.
- Natural Health Product Assist (NHP Assist) and ND Assist– an online tool designed to help select the most appropriate professional grade natural health products. ND Assist has the added benefit of including herbal monographs, acupuncture points and actions, pathologies and lab testing definitions.
7. Carry-on bag.
If you plan on doing a lot of moving around, I’d recommend bringing only a carry-on. I know it seems ridiculous to live out of a backpack for 9 months, but I did it and don’t regret it. Depending on where you are traveling to, modes of transportation can be tricky— gravel paths, crammed buses, small taxis and expensive check-in luggage prices. To see the full list of what I brought, click here. The essentials:
- Clothes: Underwear, bras, socks
- Running shoes, flip flops, closed toed pair
- 2 casual tops, 2 formal tops
- 1 sweater/ scarf, 1 rain jacket
- 2 shorts, 1 legging, 1 long pant and/or skirt
- Toiletries: contacts, solution, toothbrush, toothpaste, deodorant, wet naps, sunscreen, feminine hygiene products (Diva cup), quick-dry full-size travel towel, detergent, nail clippers
- Eye mask, ear plugs, water bottle, hand sanitizer
- Electronics: laptop, unlocked phone, camera and chargers
- Universal plug, flash light, USB stick, head phones, lock
- Medical equipment: stethoscope, BP cuff, thermometer, ophthalmoscope (don’t forget covers, tips and slips! They can be surprisingly difficult to find)
- Parasite formula (Berberis, black walnut, grapefruit seed extract, heat-stable probiotics, etc)
- First aid kit, homeopathics, Traumeel (if you can still find it) and electrolytes
- Critical documents: Passport with proper visas if necessary, credit cards, debit card (with plus symbol), health card, travel insurance, driver’s license, extra passport size photos
- Photocopy of all important documents
- Some local currency and US $ for easy money exchange
Utilizing online intake forms and electronic medical records (EMRs) are ideal for traveling to limit the weight of carrying patient files. That being said, if you are visiting an area with unreliable internet (like I was), you will want to have a back up.
You can create online consent forms with programs like eSignature but again, I would recommend printing off hard copies once you start seeing patients. It’s nice to leave them with the receptionist so that your patients can fill them out prior to their visit.
A generic intake form will suffice, but make sure it is concise. The last thing you want is to carry around a binder full of heavy intake forms for the next 10 years. Also ensure you have a well-written email consent. Most of your follow-up correspondence will be via email and you will want to set them up on an email marketing service (find out more below or download the “Start a Naturopathic Blog Blueprint” and read page 29).
Take a look at my intake form HERE, which includes an email consent and practitioner disclaimer.
EMRs like Practice Fusion, ClinicND, Whole MedX, Charm and the new SmartND have a great reputation from other NDs. I personally didn’t invest in an EMR program since my internet was not reliable on the island. I decided to create a Word doc SOAP template that I secured. It wasn’t ideal but since I was working in an unlicensed country I had a bit more flexibility. I was also not willing to lug around a 100 patient files in my backpack.
9. Get to know your online distribution companies.
Depending on where you will be practicing, get in touch with the supplement companies that ship to your area but also worldwide. Your patients will most likely be coming from all around the world and prescribing a supplement will be difficult if you don’t know the reliable brands.
If you choose companies like Amazon and IHerb, get their affiliate links so that you can receive a small percentage of any product your patient purchases via your link, but make sure to have a full disclosure clause to inform your patients.
Below is a list of a few that I’ve found, however I haven’t used all of them. If you have more please send them to me and I’ll add them to the list (Alison@theNDDC.com):
- Drop shipments with individual companies (create a relationship before hand) -locations available depend on the supplement company
- Amazon– Worldwide
- IHerb– Worldwide
- Practitioner Dispensary (botanicals)- Australia
- Natural Dispensary– UK, International options
- Health Wave– Canada, USA
- Vita Shop– Canada
- Naturally Northern– Canada (esp Northwest Territories, Yukon, Nunavut)
- The Dispensary Online– Canada, USA, Puerto Rico
This was the trickiest part of practicing in a holiday location. Unless people are specifically traveling to see you, most likely you will have 1 or at most 2 sessions with your patient. Most are on holiday for 1-2 weeks, looking to relax but interested in this ‘Natural Medicine thing’ that they’ve never heard of.
During the visit you may be able to show them that they could really benefit from a hypo-allergenic diet along with taking an adaptogen and joining a local dance class, but the implementation is what actually matters.
What I found was that when people are out of their natural environment they are relaxed and eager to change their habits and start living a healthier life! GREAT! But then they fly back home, touch down to the gloomy weather and start stressing over the traffic, pollution, dinner parties, family gatherings, going back to a massive project at work and then life gets too busy to review your protocol, let alone go visit their health food store.
They may never even get to start your protocol (which you spent 3 hours perfecting) because life got in the way. Sometimes a friendly hello, reminder, or follow-up appointment is what they need to get going. Other times re-evaluating their progress will require a new strategy. Being kept in the dark about how well or poorly your patient is doing is the worst.
Follow-up strategies are key! I developed 3 main options that eliminate unwanted back-and-forth emailing while still providing one-on-one support.
1. Membership program
This is something Jonathan Goodman and I collaborated on to create. It is an efficient way to give one-on-one support to a large number of people on an ongoing basis for a reasonable cost.
My patients log into Skype messenger during Office Hours that I set and make available on my website (ie. Fridays from 8-10am EST). They are able to ask me questions about their protocol and I will respond as the questions come in. I set very clear instructions on how to ask questions so that I am not getting long-winded updates on irrelevant information. If their question is complex we can easily jump on a Skype call to clarify any details.
People living in different parts of the world can make scheduling appropriate “Office Hours” difficult. Therefore the membership program allows people to write down their questions at their own convenience knowing that I will only respond during office hours. To see how I created my sales page, see here.
I offer reoccurring monthly billing or an annual option that is discounted. The first month after their appointment is free to allow the patient to get comfortable in using the membership program and asking questions. I linked the squeeze page to a Paypal button, which then directs them to a welcome page with my Skype ID and all the common FAQs.
2. Skype or phone consultation
This is a typical 1-hour follow-up appointment where I speak with the patient via phone or Skype. Skype-to-Skype is best since it is free. There are potentially high long distance charges if you are calling from your phone, so I’d recommend Skype-to-phone if your patient isn’t able to use Skype. Adding credit to your Skype account allows you to call anywhere in the world at a reasonable rate.
To set up online payment options and appointment scheduling I use Paypal and TimeTrade, respectively. Once the patient clicks on the Paypal link and pays for a session, a TimeTrade calendar will pop up with all of the times still available in my schedule (I set this up ahead of time with reoccurring hours).
Once a time is selected I will receive an email from TimeTrade with the patient’s name and booking info. It automatically adjusts for the varying time zones, so you don’t need to do the math and worry about missing the appointment.
3. Email marketing
Using email marketing is an ideal way to stay on top of your patient’s mind if they opt to not follow-up right away. It reminds them of how valuable you are. Any new article you write or seasonal tip will be one more way to remind your patient that you are still there for them.
Email marketing also allows you to schedule emails ahead of time so that you can plan them out at your convenience. To learn more about email marketing read page 29 from ‘Start a Naturopathic Blog Blueprint’. It walks you through setting up email marketing but also creating a squeeze page to sell your follow-up online visits and linking payment options and appointment scheduling.
Live the dream. Don’t be jealous of it.
With the right determination, creativity and courage, you can also take off. Trust me, a clinic back home will always be there for you. And it’s not a walk in the park. Building a patient list takes time, a lot of marketing, getting yourself out into the community, and TIME. Hopefully, that won’t always be the case (if I have anything to do with it!).
I’m not any more special than you. If you can realistically set aside $1000 per month (including transportation) you will live comfortably in South East Asia without working. If you are creative and start networking now, you will be surprised what kind of opportunities will make themselves available. It may not be the inter-disciplinary state-of-the-art technology clinic you’ve been dreaming of, but I guarantee that you will learn a lot, both clinically and personally.