The Role of Naturopathic Medicine In the Broader Healthcare System - Dr. Kristina Conner, Dean of the School of Naturopathic Medicine at Bastyr University

Michael Carrese: Hi, everybody. I'm Michael Carrese, welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and health care.

Due to rising awareness of the importance of nutrition to good health and patient demand for alternatives to so-called Western medicine, the number of medical schools offering naturopathic programs has grown in the past two decades in the United States. 

Well, today on Raise the Line, we're going to learn more about this approach to medicine, the education and training involved and where the field is heading with Dr. Kristina Conner, Dean of the School of Naturopathic Medicine at Bastyr University. 

Dr. Conner earned her Doctorate of Naturopathic Medicine degree from Bastyr and completed a residency at University of Bridgeport College of Naturopathic Medicine. She was one of the founding faculty for the ND program at the National University of Health Sciences and taught there for fifteen years. And we're very happy to have you on the program today. Thanks for coming. 

Dr. Kristina Conner: Yes, thank you, Michael. Honored to be here.

Michael: So, to set the table a little bit, can you define naturopathic medicine for us so we know what we're talking about? 

Dr. Conner: Yeah. Naturopathic medicine is really an approach and is a system towards healthcare and health. We use a lot of elements from both conventional Western medicine as well as many traditional world medicines, as well as a philosophy that really puts the patient's own health and their ability to heal at the center of the healthcare encounter. 

We really emphasize this idea that you use the least invasive treatment or intervention to try to maximize the patient's own ability to heal and then from there, you use things where if you need a higher force intervention, then you use a higher force intervention. Our philosophy is really very all-encompassing of the many ways that people can practice and that can be everything from using very simple things -- like you mentioned nutrition as a primary modality and a way to help people -- all the way up to the use of pharmaceuticals when they're necessary. For most folks, it's really a combination of many of these different things that they use when seeing a naturopathic physician. 

Michael: Is holistic another term that's used interchangeably, or not?

Dr. Conner: Yes, it is. I feel like the term holistic is a little bit harder to define because some people will use that to say it's the whole body and I think that's kind of the way most people use it. Basically, we want to use like a whole person approach. So, we’re not just looking at, you know, kind of a single system at a time. We're really looking at how the body functions overall. That holistic approach, I think, is something that's very ingrained in naturopathic therapeutic and clinical theory. It's something that we use a lot and it's something I think that attracts people to wanting to consult with naturopathic physicians. 

Michael: Absolutely. Are there misconceptions about the field? When you guys all get together, you're like, ‘gee, I wish people didn't think we did this or understood that we did that.’ 

Dr. Conner: I think there are some misconceptions about the training. I think there are some misconceptions about how we can be utilized in the existing healthcare system and there's definitely some equations sometimes of one of our modalities that we use. For instance, botanical medicine...we are not strictly herbalists, although we do use botanical medicine. 

So, I think sometimes there's an equation of one of our modalities or one of our methods for treating with the entire profession and it really does encompass a number of different things besides just nutrition or botanical medicine. 

Michael: So, what first got you interested in this field?

Dr. Conner: Yeah. So, one of the things that I was really drawn to, like many naturopathic doctors, I wanted to get into the healthcare field. It had been an aspiration throughout my academic career and as I was approaching getting closer to applying to medical schools or other programs, I realized that it wasn't entirely in alignment with my own personal philosophy and beliefs. I also really wanted the ability to explore other areas like nutrition. I was very drawn to the use of nutrition and the use of botanical medicines. So, what I found is that there was a better alignment the naturopathic approach with my own personal beliefs and interests.

I’m also really drawn to the inherent logic of our clinical theory. As I mentioned before, the idea that you use the least invasive thing as possible, you know, and that is part of the tenets of our medicine, as it is for most practitioners, which is first do no harm. I'm really drawn to that, the logic within the medicine, the way that we apply it and the effects that it has on people, too.

I've seen really a different, like, level of healing sometimes that people are able to achieve when they are able to kind of delve more deeply into other types of therapies, or delve more deeply into that more holistic approach. 

Michael: What do you mean  different levels of healing? That’s an interesting phrase. 

Dr. Conner: I think so much of our healthcare system, very understandably, is really geared towards sick care. And I think what a lot of people want -- and increasingly, I've seen this certainly throughout my career -- there's interest in getting in sooner and being able to not necessarily just prevent disease, but treat things at an earlier stage before they really get to the point of pathology that you can't reverse. 

I think there's also much more interest among folks to be able to mix things. They understand, you know, ‘maybe I do need to be on this medication for the rest of my life, but what else can I do to enhance my own life, to optimize my day to day life’ and that's a lot of where we can fill in the gaps as naturopathic doctors because we do have a different tool set and a different approach. 

Michael: You know, I said at the beginning that there's been a growth and interest in this. Why don't you address that...what are you seeing in terms of growth and interest, and where do you think it's coming from? 

Dr. Conner: I think a lot of it really is patient driven. We've seen this even in the way that conventional medicine has changed over the years to start to talk about things like determinants of health. That is something that naturopathic philosophy has always contained... the concept of determinants of health and that being such a foundational, important piece for every single person, regardless of their health status. So, I've seen some of that philosophy just kind of creep in to conventional care too. 

A lot of that has been because patients have asked for that. They feel like that's an important piece that they might be missing and it's something that they really want. At the same time, I think practitioners are more interested, too, whether that's because their patients are interested, or whether they personally are interested.

Interestingly, like many forms of healthcare, what eventually drives people into the office sometimes is a personal experience or a family member or a friend who's had a positive experience with some aspect of naturopathic care. I think all of that really factors into this increased interest throughout the field and it extends beyond just naturopathic medicine. People are looking for alternatives of all kinds. 

Michael: Yeah, I agree with that. So, let's talk about the education and training involved. What's the sort of thumbnail sketch of that and how it may differ from what people are accustomed to thinking about in terms of medical education?

Dr. Conner: Mm-hmm. Yeah. So there are probably more similarities between conventional training at a physician, or a first contact level. Many of the things that we study are very similar to what other healthcare practitioners study, such as basic sciences. Of course, that's the foundation. You have to have that before you can move on to clinical sciences. We are postgraduate, meaning that our entering students already have an undergraduate degree. Most of them have followed some sort of their pre-med track, and maybe have even considered, or at one point were thinking about, applying to an MD or a DO school or nurse practitioner school. 

So, our training starts out very similarly in that we complete basic sciences, clinical sciences, and then a clinical practicum component. All of those elements are still there. Now, of course, basic sciences doesn't really change, although we do try to incorporate more about understanding about the naturopathic approach, as well as start to mix in some of these other modalities, which are not usually covered in conventional care. 

Then we'll move into clinical sciences, and that does start to look a little bit different because we will of course have some different therapeutics that students are going to learn about and gain some level of proficiency in, and then they're also going to learn how to mix the two, like I mentioned before. So, how do you deal with a complex patient who's coming in, who's already on maybe some medications, and they've done some things on their own as far as changing their lifestyle? How do we mix those two together and make sure that they're still safely and effectively being treated? So, that's a lot of what we go over in the clinical sciences.

Then, of course, clinical practicum is putting that all together. Probably the biggest differences in clinical practicum, particularly compared to a medical doctor or an osteopathic doctor, is that we primarily train in outpatient settings and that's where almost all NDs practice. So, we really do focus on outpatient care from a generalist standpoint. 

One of the things that may be a little bit different from the conventional medical system is that we don't have a lot of specialties right now. People do have areas of interest, of course. They may gain additional training in certain areas, but we really only have a couple set specialties and it's certainly not the level of training postgraduate that a medical doctor or an osteopathic doctor would complete. We do, for the most part, practice as generalists, so our clinical practicum reflects the way that the profession is operating right now. 

Michael: What are the specialties that you mentioned?

Dr. Conner: So, there is a specialty in oncology right now. One of the more recent developments -- there's a couple in development right now -- but there also is a specialty in naturopathic gastroenterology. That's been a relatively recent one. And we do have some other ones where there are a number of naturopathic doctors, for instance, who might also be midwives, they’re trained in midwifery, so natural childbirth is also a specialty. There are some other ones in development, for instance, psychiatric and mental health. That's one that's currently being developed right now. 

Michael: Very interesting. So, talk about the program there specifically at Bastyr University. What do you think is interesting about it or sets it apart?

Dr. Conner: Yeah. I think our curriculum really helps students prepare for that generalist practice and it gives them exposure to a lot of different modalities. We have wonderful faculty, many of whom have very deep knowledge in those areas, and so we're able to share that with the students. We also have what we call a spiral curriculum, meaning that in their first year, for instance, as students are learning basic sciences, they learn by system. The first year curriculum, of course, is going to contain the cardiovascular system and the respiratory system and endocrine and so forth. In their second year, they learn it again and then they pick up more of the pathology. First year is kind of normal function. Second year is pathology. Then in the third year, they start to incorporate in going over that system. Again, they start to incorporate the therapeutics and the more specific diagnostics for those.

Michael: So, there's kind of a refresh going on as you add. 

Dr. Conner: Yeah. It continues to review the material, but with some additional material mixed in there.  That repetition, I think, is very helpful for students, and it really gives them a very comprehensive view of how the body works by the time they've finished. 

Michael:  Are there any changes going on in naturopathic education in the last couple years, or trends? I’m thinking about the impact of artificial intelligence or other, you know, forces, whatever they may be. What's happening in that respect?

Dr. Conner: Yeah, absolutely. Just as in conventional medicine, AI is shaking up the naturopathic world as well and I really think, as many people have predicted, it is going to change the way medicine is practiced across the board in the next few years. 

A lot of those changes I see as being very positive. What I hope for us as naturopathic physicians -- and I think this is where a lot of the discussion is centered within our profession -- is we've long been known for being a very high touch profession where people have a very strong relationship with their physician, with their practitioner. I think we can still do that using more modern tools and still maintain a very strong relationship with patients. That’s our challenge right now is to figure out how to do that. 

Many of the AI tools that we're already seeing come into place, like some of the charting tools around coding and billing and many of the other areas around that, those are areas that I think will -- if we can use the efficiencies that we gain from some of these new technologies -- will allow us to more effectively focus on maintaining that strong doctor patient relationship. 

I think that’s one of the things we've learned in the past in the past few years with the big move towards telehealth that has also affected the profession. One of the silver linings that we found is that, you know, we can still effectively meet with patients, even in a telehealth setting. We're not losing things as far as our relationship with patients, we're gaining something else. Hopefully, all of those positive changes within the medical system in general, and within medical education training, will allow us to more effectively focus on the things that really make us unique and really help us serve patients best.

Michael: Yeah, and there's a lot of talk that AI will reduce the priority on memorization and put a premium on interpersonal skills, listening skills, all of that. So, it seems to me that probably is a benefit for you folks.

Dr. Conner: Right. Yes, that is an area that I feel like we've been very strong in all along and now it's just a matter of how we use some of the newer tools to enhance that relationship and not look at it as just something that's taking away.

Michael: Right. I was having actually a hard time, as I was getting ready to talk to you today, getting a feel for what the penetration is of naturopathic medicine in the healthcare landscape and it may be something that's just very difficult to measure or quantify, but give us your view on that and what you think both the opportunities are and the challenges are in expanding that footprint.

Dr. Conner: So, we're a small but mighty profession, I'd say. We've had a much bigger impact than the numbers that we have. I think a part of that has been because some of the early practitioners for naturopathic medicine, and kind of its revision since the 70s and 80s, have gone out and done really outscale things to just being a private practitioner. They've written books and they've had more influence on policy and in the development of even some other professions that we're seeing -- such as integrated medicine and functional medicine -- which really do share a lot of commonality with naturopathic medicine. Many of the people who have pioneered in those fields have also been involved in the naturopathic profession in some way.

So, one of the things that I think we're seeing now is that there's better understanding about naturopathic physicians ourselves and our level of training and the role that we can play within the healthcare system, which is really kind of bridging the gap between some of the conventional care and more natural and holistic therapies because people are increasingly using things from all over the spectrum. 

I think what we're going to see is an increased need for either naturopathic physicians or practitioners like us who can kind of bridge that gap. So, I see a lot of demand, even if it's not specific for naturopathic physicians, but more for that role that we can play there, and because of that, you know, I think there will be some expansion of the profession to help with that need.

Michael: Do you see that happening, for example, by having a traditional medical practice embed a naturopathic provider in their practice, or do you see it as creating more of a parallel system of solo practices?

Dr. Conner: Yeah, I think it will probably be some of both, and really over the past couple of decades, that's what we've seen. We've seen both more integration with other providers as well as an increasing kind of solo and parallel, like you say, practices. I think ultimately -- because our landscape of healthcare is so different throughout the country and throughout different regions -- if you're in a rural community, maybe it doesn't make sense for you to be a standalone practitioner when there's kind of a ‘one-doc-shop’ in town. Maybe it makes more sense there to have some alignment and be right alongside other colleagues. Whereas in a more urban or suburban environment, I can see that just like you’ll find more specialists in those types of areas, you'll find more naturopathic physicians who are working more as specialists more than providing kind of frontline care.

Michael: That makes sense. As you know, we're a teaching company and we love to ask our guests to fill knowledge gaps for us. So, is there something in particular that you care about or are interested in -- it doesn't necessarily need to be related to naturopathic medicine, but I'm guessing it might be -- where you would say, "Osmosis, I would love to see a video on this or have you guys develop a course on this.” What would it be? 

Dr. Conner: I think what I would love to see more of in kind of the media that's available, particularly to students and newer practitioners, is how do they work with other providers and particularly providers who may have a different philosophical approach and maybe different tools in their toolbox. I'd love to see coming at it from something like maybe what do you do when a patient asks you about a botanical medicine. For instance, they come asking you, "Should I use this? Should I not use this?” What do you do in those instances? Because I think there's a really important educational piece there, where understanding maybe not just yes or no, but how do you find the tools to be able to answer that question? Whether that's another practitioner, whether that's databases...where do you look for that sort of information?  

I think that's a really helpful skill for any practitioner to have is, you know, under what circumstances do I make referrals? And what's going to happen when that referral happens? Because I think that's often a big unknown. A lot of times with medical doctors or osteopathic doctors, they may say, “Well, I'm going to refer you to this naturopath or this chiropractor.” But it's kind of like a black box of what happens once they get there. I think it's helpful, actually, for that practitioner to know that we do have certain standards that we follow. We have kind of a common approach amongst most practitioners in those fields, and we're still going to try to communicate as effectively as possible with them to make sure that their patient stays safe and that they're really getting the care that they need. I think the less siloed we can all be, then, of course, the better for a patient. 

Michael: Yeah, right...more of a team framework for everything both within practices and between them, right? I'm afraid to say we're almost out of time, but we always like to give our guests a chance to leave our audience with some advice. You’re around students all the time, so this will be an easy one for you. What is your go-to advice for students and young professionals? 

Dr. Conner: For students, there's a couple things that I usually recommend. One is learn how to be a lifelong learner. I really think that's actually the major task of your medical training. It’s not just all the content that you put into your head, but knowing how to apply it, knowing how to look for answers, and knowing how to adapt, because, especially as we've seen in the past couple of years, every healthcare practitioner has to know how to adapt and sometimes adapt very quickly to changing circumstances. So, I think that's a really important skill. It's probably the most important skill to get out of your training. 

I think it's very important for young practitioners, especially, to be openminded skeptics. To be critical thinkers, but also be open to different possibilities. I think that will help them as they go forward in their career and it will also give them a lot more joy from their jobs, seeing it as a challenge and as an adventure. 

The last thing I always emphasize -- I'll talk about this with our students during orientation -- is to make sure that they stay connected to their purpose, the real reason why they're there. When you have those really tough days when you're in school and when you're practicing, coming back to the reason why you're there is always going to be important and valuable. 

Michael: And you find that to be the case, I'm sure, in your own career. So, how have you managed to do that...to stay connected?

Dr. Conner: Yeah, for me, I really do regular check-ins where I just shut everything down and reconnect to my overall goals. I think your personal and professional goals may intersect, and I think a lot of continual reevaluation of that is important to make sure that you're staying on track. So, for me, I do regular kind of mini retreats and I do try to take time during my day, no matter what, to take some time to reflect upon those things, to thank people who've helped me that day and to just make sure that you don't lose the person piece in your career and in your professional life.

Michael: Well, that's great advice and a very sort of practical way for people to think about it, too, I think, by breaking it down every day. 

Well, listen, I'm afraid we're going to have to leave it there, but I want to thank you very much, Dr. Conner, for being with us today. It's been really interesting and we wish you all the best there at Bastyr University. 

Dr. Conner: Yeah, thank you. Thank you for your wonderful questions. I really enjoyed the discussion. 

Michael: I’m Michael Carrese. Thanks for checking out today's show and remember to do your part to raise the line and strengthen the healthcare system. We're all in this together. Thank you.