The residency application process itself felt painstakingly difficult.

gold-starNot because I’m awful at writing or I didn’t have good enough grades, enough clinical experience or a flashy CV. More-so, because the process of answering essay questions and attending interviews forces you to feel comfortable talking about yourself. I become an awkward turtle when I feel that I have to talk about what makes me a more competitive applicant than all the other bright and incredible students who applied. Why? I asked myself that so many times! (Generally, there’s some sort of wisdom brewing underneath my veil of awkward.) Right now, my answer is that in my culture, we don’t boast about our strengths and achievements. We acknowledge them and quietly pat ourselves on the back and then ask, “How can I be better?”

I can imagine many people in our profession have a similar sense of humility, we’re not in it for fame or fortune. I mean, most of the time when I’m at a party and somebody hears I’m going to become a naturopathic doctor, their response is, “Naturo-what?? ..So you do voodoo peyote hippie medicine?” (Hahahaha!!! Of course, after a couple of giggles we proceed to have an invigorating discussion about the benefits of integrative medicine and if solicited, the research that supports it.)

ANYWAY. This aspect of “marketing myself” is something that I realize I’ll have to become very proficient in for the rest of my life. There’s a fine balance between sounding confident vs. sounding like an overconfident rooster (you know what I mean by that). My biggest recommendation as you approach graduation: ask your clinical advisers and secondaries to discuss your strengths and weaknesses with you, if your attending allows it ask patients for feedback and most importantly ask close friends and family, they know you best. Nobody is perfect, it is okay to make mistakes, harness you inner strength and wisdom to learn from them. Fourth year is a crucial time to figure out who you are and how you can give back to our world, whether you apply for residency, start your own practice or join a practice.

Basically, after all this work I am left feeling like even if I don’t match to a residency site, this entire process was all worth it. I’m so grateful that we have opportunities like this.

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Attn ND students: 8 reasons to apply for an CNME approved residency-

Image8. Networking – as a resident you will be granted the ability to dedicate a certain amount of time each week for professional development. During this time, you can network with other healthcare practitioners. Some residents in the past were able to shadow ER docs, gastroenterologists, surgeons, rheumatologists, psychiatrists as well as naturopathic doctors and chiropractic doctors.

7. Mentorship – In a residency you are able to seek mentorship from your residency director if you’re in a private clinic. If you’re in a teaching clinic, you’re able to select from a handful of mentors. As I’ve approached my own graduation, one bit of advice that I’ve heard from many successful naturopathic doctors is that it’s important to have a mentor who can help guide you on your (sometimes difficult) path as an ND.

6. Politics – Currently, Utah is the only state that requires naturopaths to have gone through a residency in order to practice medicine. It is hypothesized that as ND’s become licensed in more states, the number of states requiring residencies will increase.

5. Learn effective medicine – You want to practice medicine that makes your patients better, right? Why not learn from some of the most successful ND’s out there? Many of them are so successful that they are able to dedicate the time and money required to take a resident on. Also, you want to learn from these doctors because they clearly love teaching or they wouldn’t be offering a position for a resident – they want you there.

4. Research – as a resident you will also have a chance to explore research opportunities! You can partake in clinical research, write literature reviews, or find labs to spend time in. If you love research and want to explore the balance between providing patient care as well as research, a residency may be an option to consider.

3. Patients like it – This may sound like a silly reason, but many patients like to know that their doctors have gone through a residency or some sort or another. Part of this is because all MD and DO students are required to go through residency and let’s be real; Many patients don’t know what the difference is between someone who gets an online naturopathic degree vs. someone who goes through a 4 year accredited naturopathic doctorate program that involves extensive clinical training. What patients do know is that their MD and DO’s go through residency, so added bonus if their ND has too.

2. Explore your niche – During residency, you have time to really explore what patient demographic, modality of healing or conditions you enjoy working with. This is important for before you go into private practice.

1. See patients with conditions that you’ve learned about in school but may have never seen in clinic – I imagine this is especially true of private practice clinics from what I experienced during my interview process. Also, you can learn more about the treatment approaches more experienced naturopathic doctors take with cases where the underlying cause is not clear (the “complicated” cases).

I’m not saying residency is the only way to go, or the best thing to do. I simply wanted to list out the benefits of doing a residency. For me, the most important part is being able to have a mentor. While I do feel very comfortable going out into private practice right now, I would like to have a mentor who I could further polish my clinical thinking skills with and bounce cases off of. I also love research and hope to explore research opportunities. Finally, I really want to eventually practice in an integrative medical setting and I feel that the chances to work with other practitioners would be an incredible experience for me, should I get a naturopathic residency.

My fingers are crossed! I find out a little less than 6 days!

At approximately 2:30 PM this past Thursday, I submitted my preference list for the 2013-2014 residencies.

Image This year, there were approximately 43 residency sites with around 65 first-year positions available. My fiancé is attending MD school and over the past few months we’ve discussed the similarities and differences between our residency programs. Here are some of the similarities we noticed*:

  • There is a long application process that includes writing numerous essays, a CV, obtaining letters of recommendations and more. Sites will select which residents they would like to interview and will send out invitations. The interviewing process can take weeks to complete based on the number of interviews granted and the amount of traveling that must be done for interviews.
  • They go through the same matching process. This means that the applicant will rank the sites that they were asked to interview for in order of most desired to least desired. Each residency site will do the same for their applicants. Then the applicants will be matched to the sites based on this complex mathematical process that’s really hard for me to wrap my head around. I don’t think mathematically and I’m terrible with spatial reasoning. When I think about who goes about matching, or who designed the computer program to match, I get a little bit overwhelmed.
  • In teaching clinics, residents help support and teach naturopathic medical students as they go through their rotations. They also approve chart notes. The residents are always supported by attending physicians but they are also expected to eventually make clinical decisions on their own. Some teaching clinics require residents to have their own rotations.
  • Professional development is important and residents are encourages to pursue research opportunities and rotate with other practitioners including MD’s and DO’s.
  • They are paid between $30,000-40,000 a year (ie: work way more than they’re paid).
  • The residents can see their own patients.

Here are some differences we noticed*:

  • ND’s are not required to complete a residency in order to go out in practice. This is because we are trained primarily in general medicine and primary care and it is not required for us to specialize the way MD’s and DO’s do.
  • Most naturopathic residencies are focused on primary care. Some are more focused on oncology and integrative medicine. The residency director at each site may have his/her own speciality or focus but a certain amount of time must be focused on general practice to diversify the clinical experience of the resident.
  • There are extremely limited residency opportunities compared to the amount of ND’s that graduate every year.
  • Our residencies are typically only a year long with the potential for a second or third year residency as opposed to MD residencies which can be up to 7 years long.
  • There are three main types of residencies: Oncology focused residencies, teaching clinic residencies and private practice residencies. Each residency has its advantages. At the teaching sites, a resident is able oversee the care of a large number of patients which helps diversify their training (as in: they can sit in on sports medicine rotations, pediatrics rotations, environmental medicine rotations, etc..), and develop their teaching skills.  At a private practice, a resident is able to learn more the business side of things: practice management, bookkeeping, marketing and work closely with the attending physician in developing clinical skills. Oftentimes, an applicant will select a private clinic site based on how their interests match up to the focus of the doctors at each site. For example, one site is very focused on providing integrative medical care to women while another site is more focused on sports medicine, dermatology and oncology.
  • We must apply for residencies while we are still doing rotations. This can make the entire process much more stressful (speaking from experience..)

* These are the similarities and differences as I perceived them. There are many different types of naturopathic residencies and many of these comparisons are very generalized.

Why in the world would someone dedicate their winter break to writing essays and applying for a naturopathic residency? ESPECIALLY if said residency is not required? Who in their right mind would spend hundreds of dollars flying out to interviews for a position that, in the end, is highly competitive and not guaranteed??

…..What a great topic for another blog post, hahaha… No really, the answers on its way!

Bringing Empowerment Back to the Patient

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You hear about it all the time, whether it’s eavesdropping in on a conversation at the check out line of the grocery store or at a family gathering, it’s something we’ve all faced at one point or another: a sense of powerlessness in determining our own health. You may not even realize it’s something you’ve experienced, so I’ll give you an example: A woman goes to her doctor complaining that she is menstruating for over half the month with very heavy bleeding. She is assessed and eventually (almost always) given oral contraceptives and is told, “Here, these will regulate your menses.” Yet it is in sickness that we have the most potential for change and many of us go to the doctors seeking information to get well, not medications to suppress our symptoms. What if we want to know what caused the illness in the first place? Was it our diet? Was it our lifestyle? Was it hereditary? Was it stress related? What exactly is stress? Are medications really necessary? Is there any other non drug treatment option? Oftentimes, office visits with primary care doctors are curtailed due to the immense pressure to see more patients placed on doctors by insurance companies. Patients are left seeking answers from Google search engines and supplement store employees.

For me, I always knew I wanted to be a doctor who had time to educate and provide more than just prescription drugs for a patient to achieve wellness.

During my medical education, this is precisely what I have learned! It is called patient centered care. What this means is that at every office visit, a patient is given information on how we (a team of doctors and medical students) perceive their current state of health based on a combination of subjectively what the patient reports, objectively what we see has changed, labs, imaging and any other indicated diagnostic tools. Afterwards, we give them options for treatment, ask if they have any questions and determine a treatment plan with the patients input.

The amazing thing about being able to have a say in your treatment options, is that all of a sudden, you play an active role in your health. There is a shift from the doctor being an authoritative figure to the doctor working collaboratively with you, actively listening and responding to your concerns and questions.

I am so happy that I learned this in my medical program, mainly because I want my patients to view me as a support system and guiding force in rediscovering their health. I think it is essential that a primary care doctor have these skills, since it is at the level of primary care that preventative medicine is most effective. I will have the information on what herb, diet, pharmaceutical, acupuncture protocol will help my patients get better, but in the end, true healing potential resides in hands of the patient.