Even as integrative medicine gains ground in the American mainstream,1 naturopathic doctors (NDs) struggle to earn the same career development opportunities as their counterparts in conventional medicine. One exception stands out: the ITI-AANP Residency Training Scholarship, known as STAIR. A joint effort of Integrative Therapeutics, Inc. (ITI), and the American Association of Naturopathic Physicians (AANP), the STAIR Program affords new NDs a salaried, one-year postgraduate residency in the field of integrative medicine.
The STAIR Program is fully accredited through the Council on Naturopathic Medical Education (CNME) and overseen by Bastyr University. The program presents a twofold competition to match resident doctors with training sites. Candidates vie for appointment to established naturopathic practices throughout the country. Simultaneously, clinics compete to mentor—and learn from—the newest class of naturopathic practitioners.
The dually competitive selection process raises the stakes for residents and clinics alike. STAIR recipients receive $30,000 in compensation through ITI for their yearlong residency, which allows them to focus wholly on their training. Meanwhile, STAIR sites benefit from a fresh staff member, at no cost, for a year. The match is a win-win situation that promotes prestige and awareness in the naturopathic community and beyond.
Tara Brown, professional education and community relations manager at ITI, says the STAIR Program addresses issues of practice and practicality in the field of naturopathic medicine. The scholarship is designed to address a direct need: real-world opportunities are lacking for many new NDs. “ITI created the program when we learned that only 20% of naturopathic doctors actually went on to successful practices after graduation. While ND graduates receive excellent medical educations, they lack for the practical application opportunities and business development skills they need to make it on their own.”
Before launching the STAIR Program, ITI had sponsored a larger number of smaller awards. While morally encouraging, smaller scholarships failed to afford naturopathic physicians the chance to engage in significant training after medical school. Community partners channeled this feedback to ITI, and ITI replaced the smaller scholarships with two large ones. Instead of funding $500 here and $2,500 there, ITI brought all the money back home and recalibrated to reach big. With AANP as a partner, the first $30,000 scholarships were awarded in 2007.
National numbers support Brown’s assertion that opportunities are sparse for NDs. CNME accredits only 43 first-year residency positions in the U.S.2 and another 3 second-year posts.3,4 Unfortunately, advanced training programs such as residencies are often considered luxuries in naturopathic circles. On the other hand, 25,500 residencies in conventional medicine were awarded in the United States through a single residency-matching program in 2010.5 AANP Executive Director Karen Howard explains: “Since naturopathic medicine is not recognized by Medicare, and Medicare is the primary funder of medical residencies, the [naturopathic] profession is required to create its own opportunities.” Indeed, in 2008 alone Medicare spent nearly $9 billion on graduate medical education in the form of payments to resident doctors and their host sites.6 The disparity is discouraging, but the naturopathic community is essentially optimistic. “Since we can’t rely on federal funding at this point, STAIR represents our commitment to ensuring access to this advanced training,” Howard explains.
In the last four years, the STAIR Program has provided clinical practice and critical exposure to eight resident NDs from across the country.
In the last four years, the STAIR Program has provided clinical practice and critical exposure to eight resident NDs from across the country. From consulting patients and engaging communities to tracking records and balancing financials, STAIR Residents become well versed in the daily operations of a naturopathic practice. 2010 STAIR recipient Kelly Simms, ND, points to such practical experience as essential. “The residency will be an opportunity to learn from an experienced naturopathic physician in a small, private clinic setting that focuses on family practice. … The small-clinic setting will allow me to experience the business aspect of practice as well.”
As STAIR Residents become familiar with the nuts and bolts of running a naturopathic clinic, their involvement also closes the divide between naturopathic and conventional medicine. Brown points out that the STAIR Program “builds a bridge between naturopathic and conventional medicine that creates opportunities for enhancing patient-centered healthcare. For prospective residency sites to qualify, they must have a successful integrative medical practice with an ND and MD on staff.” Alternatively, qualifying sites may pair NDs and MDs who practice within a 30-mile radius. This integration of practices is not accidental; it is designed to forge new relationships among practitioners in naturopathic and conventional medicine. The result is greater dialogue, understanding, and collaboration among naturopaths and conventional physicians. Such networks are invaluable in medical circles and in communities at large.
2010 STAIR recipient Corinne Sell, ND, points to the larger context in which the residency impacts practitioners, patients, and the naturopathic profession. “[With] healthcare reform and a national focus on health promotion, prevention, and chronic disease management, the STAIR residency provides a working clinical model that demonstrates a collaborative approach to patient-centered healthcare and integrative medicine.” Sell believes the fact that the residency connects naturopaths with conventional health professionals is an important advancement that “will strengthen licensure efforts, reimbursement opportunities, and overall development of the naturopathic profession.” Indeed, issues such as licensure, reimbursement, and development are critical to the sustainability of naturopathic medical practices.
Today, the STAIR Residency Program boasts a 100% ongoing practice rate. All STAIR Residents since 2007 are still in business in their chosen specialties. In a field that has traditionally struggled to retain talent, STAIR’s success is compelling. The STAIR Program answers a clear and distinct need in naturopathic medicine. As Brown observes, the best and brightest too often emerge from medical school into a professional vacuum without the infrastructure to practice or the mentorship to learn and succeed. ITI and AANP have set out to change the path of professional development for naturopathic doctors for the better. Together with Bastyr University, the organizations have reason to be proud of STAIR’s accomplishments. Moreover, though, advocates of naturopathic medicine can look to the STAIR Residency Program as a powerful model in securing the role of integrative medicine in today’s healthcare landscape.