Conventional medical and osteopathic students have readily available, sufficient information available to make an informed decision about entering medical school. Prospective naturopathic students have more information available than they did over a decade ago, but it is still lacking.”
Update 8/18/2023: While overall this article is a good guide to the realities of naturopathic medicine and financial outcomes, there have been some changes since this article was originally published on 2/5/2020. Boucher Institute of Naturopathic Medicine merged with the Canadian College of Naturopathic Medicine in November 2020. Southwest College of Naturopathic Medicine is now Sonoran University of Health Sciences. The federal government has been reporting data on naturopathic doctor graduates. I will be working on a new article over the next few weeks. I am repairing broken links below where possible.
Update 09/15/2023: Repaired broken links. Note that Bastyr and NUNM have announced a merger.
There are numerous factors to consider if you are thinking of becoming a naturopathic doctor. What are students taught? Where can NDs practice, and what can they do? What can grads actually do with an ND degree? What is the work actually like?
Before I talk about those factors, though, I want to look at some other mundane but important factors that prospective students should consider. Regardless of where you stand on naturopathic medicine itself, this is information you will want to know before deciding to go to naturopathic medical school. What information do you need to make a decision about signing up for the program?Where do you find that information? How does the information compare to that available for MDs (medical doctors) and DOs (osteopathic doctors)?
In addition to finding out information about the career itself, you would want to know:
- What are the odds that I will complete the program? And how long will it take?
- How much money will I need to complete the naturopathic medical program?
- What is the pass rate for licensing exams for students from that naturopathic school?
- How many naturopathic students from that school, or in the profession as a whole, match to a naturopathic residency?
- What do statistics show about career and employment outcomes for naturopathic medical school graduates?
- Will my earnings as a naturopathic doctor, or using my ND degree, allow me to pay the student loan debt and sustain myself? While no one goes into medicine solely for income (or shouldn’t), the reality is that healthcare providers need to eat and pay their bills, like anyone else.
Some information is harder to find, is not updated annually, and varies from school to school. Very little data is available for the profession as a whole. Below are sources for this information – where it exists – and a summary of the overall info. I also compare it to what is available for conventional medical and osteopathic students.
This is a longer piece, so use the headings to jump to sections of interest.
Table of Contents
- Costs
- Retention rates and graduation rates
- Licensing exam pass rates
- What does the data say about outcomes for graduates?
- How does this compare to information available about conventional medical and osteopathic medical schools?
- What do the data show?
- Graduate outcomes
- Wrap up for prospective students
- Suggestions for the schools and national organizations
- MD and DO sources
Costs
All schools will list the tuition and average costs per year. Costs vary, but Bastyr, NUNM and SCNM have the highest tuition ($36K-$37K). Textbooks and other equipment can run $6000+. (Yes, you purchase your own stethoscope, ophthalmoscope/otoscope, and sphygmomanometer. Spelling quiz at 11:00.) This does not include the cost of living, which for Bastyr is estimated at ~$26,000 per year. Bastyr-California’s disclosures state that the average amount borrowed for the naturopathic degree at Bastyr-California was over $260,000.
Retention rates and graduation rates
Bastyr University (BU) has a Fast Facts page, with overall information about the school and links to each of the programs. At the bottom of the page are links to sections for retention rate, graduation rates, and outcomes for graduates. These are broken down by degree program and locations (Kenmore, WA and San Diego, CA). Additionally, California required disclosure sheets are available from either the links in the page footer, or by clicking on the Doctor of Naturopathic Medicine link. These show graduation rates and time to complete for the Bastyr California campus. Bastyr appears to have the most information available on retention and time to graduate. The California disclosure shows average student loan debt load for the California campus.
Added 8/18/2023: Link to PDF screenshot of retention rate screen against it being removed. Graduation rates are no longer available for the Kenmore Campus. California graduation rates are available.
Southwestern College of Naturopathic Medicine (SCNM) has a Facts and Figures page. Retention rates and graduation rates are listed in the subsections.
National University of Naturopathic Medicine (NUNM) lists attrition rates on page 20 of a 2018 report. These are for the university as a whole. It also has a Consumer Information page. The retention rate link is to an external page that does not provide either retention or graduation rates. Graduation statistics show degrees awarded by year, but do not show how many of each entering cohort completed a degree and in what time.
University of Bridgeport Naturopathic Medicine program is no longer accepting new students and shows no information.
Neither Canadian College of Naturopathic Medicine (CCNM) or Boucher Institute of Naturopathic Medicine (BINM) appear to have retention or graduation rates on their sites.
National University of Health Sciences (NUHS) has a consumer information page. They list a graduation rate for the school as a whole. Unlike the other schools, NUHS is located in an unlicensed state and it is primarily a chiropractic institute. They state: “National is working on gathering information from graduates of the ND, MSAc and MSOM programs as the first graduates of those programs began practicing in 2009 and 2010.”
Licensing exam pass rates
Bastyr, NUNM, Boucher, and SCNM list pass rates for the NPLEX 1 and 2, which are the licensing exams required to practice in licensed states. CCNM and NUHS do not appear to list NPLEX pass rates. (Starting 2020 CCNM graduates who wish to practice in Ontario will need to take Ontario-specific licensing exams).
The NUNM, Bastyr and Boucher data show national pass rates; Boucher has the most up to date data. First-time failure rates can be as high as 30% for the NPLEX 1 and as high as 20% for the NPLEX II, but it varies from year to year. It’s unclear how many graduates do not pass licensing exams after retakes.
What does the data say about outcomes for graduates?
Ideally, outcomes should include residency match rates, employment, income, and whether or not the graduate stays in the field. At this time, the main pieces of evidence for the latter are the steady 20% survey return rates and numerous observations by individual NDs about the number of those who seem to quietly fade out from the field. While a 20% survey return rate is not bad, I find it concerning that the executive director of one of the larger state associations (WANP) stated back in 2007 that he suspected that the 80% of non-responding grads were no longer in the field.
In other professions, national organizations track how many practitioners are actively licensed. At this time, none of the national naturopathic organizations do so. Yes, we have no clear figures on how many NDs are actively in practice across the US and Canada.
None of the schools appear to list residency match rates. Some of the surveys do list the percentage of respondents who are not working in their fields.
Bastyr links to an alumni outcome survey from the Fast Facts page. This appears to be for all alumni from all degree programs, including undergraduate degrees and dietitian programs. A publicly available report lists data from the 2016 and 2017 surveys, starting on page 95 (106 on the PDF). Page 96 (107) contains the data from the 2019 survey in table format with some information on the changes in questions.
SCNM lists 6-month post-graduation employment rates on its Facts and Figures page. This also appears to be for the school as a whole.
NUNM has carried out some of the better surveys of alumni outcomes. The 2014 survey is the most recent available. There are also surveys for 2010 (containing information from 2009 as well), and 2004. (Note that these were carried out when NUNM was known as National College of Natural Medicine, or NCNM.)
Note: The 2004 NUNM survey was found on a publicly available server. The 2010 survey was retrieved from a naturopathic doctor’s website. There is a possibility that neither is the original survey. However, a 2009 AMA scope of practice report on naturopathy refers to the 2004 survey [1] and cites numbers that match those found on the report listed here. The 2010 survey likewise appears to be the original. I include the data below for completeness. Update 9/15/2023: Both surveys have now been traced to the archived URLs.
[1] The AMA survey cites some outdated and incorrect data; for instance claiming that The Textbook of Natural Medicine (TONM) is the main/sole textbook for naturopathic students to learn diagnosis and treatment. To my knowledge, this is not correct and other textbooks, including conventional medical ones, are used to teach diagnosis and treatment.
BINM has a 2015 survey on alumni outcomes.
The Association of Accredited Naturopathic Medical Colleges (AANMC) has a page on income expectations which links to a 2015 graduate survey. A 2004 AANMC survey is no longer available, but results were discussed in a 2007 article.
How does this compare to information available about conventional medical and osteopathic medical schools?
Conventional and osteopathic medical schools do not list information about incomes or career outcomes on their sites (those are listed by national organizations).
California medical schools list retention and graduation rates, and residency placement rates. Some of the less-well known medical schools will list pass rates for the USMLE Step 1 and 2 medical licensing exams, or post residency placement rates.
Osteopathic schools are more apt to list outcomes such as graduation rates, scores on the COMLEX (the osteopathic medical licensing exam), and residency placement rates.
The American Association of Medical Colleges lists attrition rates and time to graduation rates for the overall US medical school population. It appears that for both MDs and DOs, attrition is a little over 3% over the 4+ years of the program. (Increasingly, medical school students take longer than 4 years to finish school).
Pass rates for the UMSLE Step 1 & Step 2 for the medical schools as a group are found at the AAMC. Typically grads from US and Canadian medical schools have a 95% to 96% pass rate.
Overall residency match rates are listed at the National Residency Matching Program.
The AAMC also has reports on the overall physician workforce.
The American Osteopathic Association (AOA) also lists student attrition rates and has annual reports on the number of DOs practicing.
Income data is generally found through professional organizations such as the AAFP. It is often specific to a particular medical specialty. The AOA puts out annual reports on DO incomes. Medscape has annual reports on physician incomes.
What do the data show?
Retention rate
Bastyr appears to have a yearly attrition rate of 3% to 8% for the naturopathic medical program, with an average of 5.5% per year. Between 11% and 17% of students have not completed the program within 7 years.
SCNM’s site states that 88% of students are retained after the first year and 78% of students are retained in a 5-year cohort. This would appear to be an overall 22% attrition rate.
The other schools do not show data for the naturopathic program separately, or for the school at all.
Graduation rates
Bastyr’s data shows that:
- Of those ND students who entered in 2013, 78% completed the program in 5 years or less.
- For the 2010 to 2013 Kenmore cohorts, 6-year completion rates vary between 66% to 89% (within 6 to 7 years).
- Bastyr’s California fact sheet shows that of 49 students who entered the naturopathic program in 2012, 61% graduated in 4 years and 81% graduated within 6 years.
- The numbers for BU California (San Diego) on the link from the Bastyr Fast Facts page may be more recent. For the 2012 to 2014 cohorts, from 69% to 86% graduated within 6 years.
SCNM states that for the naturopathic program, an average 74% of students graduate in five years or less. For cohorts entering between spring 2008 and winter 2013, they show 6-year graduation rates varying between 69% and 91%.
Graduation rates for the other schools are not available separately for the naturopathic program, or in some cases for the school as a whole.
Summary: From 15% to 20% overall of naturopathic students fail to finish within 6 years. This is 5 to 6 times the roughly 3% attrition rate of medical or osteopathic students.
Graduate outcomes
For naturopathic students, the outcomes include employment (grads are usually self-employed) and earnings. The information available here is…. sparse. The AANMC has apparently performed two surveys over the years, one of which is no longer readily available. The schools have performed more surveys, with NUNM doing the best job at asking real questions (“What was your gross revenue last year from clinical practice?”) as opposed to feel-good questions about “satisfaction with degree”.
A note about money
The NDs that I know well did not get into the profession for monetary reasons. Like their MD and DO counterparts, the naturopathic grads and students that I know went in with genuine belief in what they were doing. Many naturopathic students enter the profession with high hopes of working with underserved populations, improving the healthcare system, etc. But those student loans do not pay themselves. Rents have to be paid, as do EHR bills, phone services, etc. It’s crucial that potential students know what is – or isn’t – known about incomes and employment outcomes for naturopathic doctors. Many NDs that I know personally love the work; many also struggle financially.
Bastyr’s and SCNM’s graduate outcome surveys do not provide outcomes for naturopathic doctors separately from those of the school as a whole. Bastyr also graduates quite a number of nutrition majors and acupuncture/Traditional Chinese Medicine majors. So it’s impossible to use these survey results to determine what the outcome is for naturopathic medical graduates.
It’s difficult to compare the data from the AANMC, BINM and NUNM surveys because:
- The different surveys use differing measures of income as well as differing criteria for part-time and full-time work.
- Many NDs are self-employed and will report both gross revenue from a practice as well as net income (after practice expenses, but before taxes and personal deductions). NUNM’s and BINM’s surveys clarify what constitutes gross and net income. BINM reports only gross revenue. Bastyr’s most recent survey does not ask about income that I am aware. The AANMC survey is less clear as to what they mean by “personal, gross, pre-tax”.
- Additionally, many NDs have dual degrees in both naturopathic medicine and Oriental (East Asian) medicine such as acupuncture. They may practice under their acupuncture degree instead, or see patients for different services.
However, here is what I can find by looking at the data.
Practicing: full-time, part-time, or not at all
The below shows how many of those practicing were defined as full time, for each survey. The NUNM 2014 survey does not include data for those not in practice. Totals for the other surveys may add up to less than 100%. AANMC and NUNM do not clarify what count as “working hours”; BINM specifies patient contact hours. Comparing the AANMC and NUNM surveys across 10 years, when full time is defined as 32 hours or more, only half of NDs appear to be working full time.
Percent of respondents working FT or PT
| Hours worked* | NUNM 2004 | NUNM 2009 | AANMC 2015 |
|---|---|---|---|
| FT 33 or more | 49% | ||
| FT 32 or more | 53% | 53% | |
| PT 32 or less | 22% | ||
| PT 31 or less | 45% | 45% | |
| Practice + non-clinical work – hours not defined. | 14% | ||
| Not practicing | 2% | 2% | 15% |
FT = Full time as defined by that survey. PT = Part time as defined by that survey. Hours worked for those ND respondents employed in healthcare only.
BINM: This survey is not in the table, as it did not use the same measures. BINM’s survey asked about patient contact hours rather than hours worked and defined a full patient load as 26 patient contact hours a week. 22% had a “full patient load”. “Half… indicated insufficient patient numbers” and the survey states that 59% of those had 11-20 contact hours a week, for a total of 30% seeing patients from 11-20 hours a week. Another 27% limited patient contact hours by choice and eight percent were not working at all due to caring for children.
Respondents to BINM’s survey graduated between 2004 and 2013. The other surveys include NDs who graduated starting in the early 1980s. The results for BINM are more typical for NDs in the early years of practice.
| Hours worked* | NUNM 2010 (all respondents) | NUNM 2014 (respondents in healthcare only) | NUNM 2014 (all respondents – see notes below) |
|---|---|---|---|
| 26 or more | |||
| 25 or more | 66% | 79% | 66% |
| 25 or less | |||
| 24 or less | 26% | 21% | 17% |
| Not employed in healthcare | 8% | Not included in calculations | 17% |
Survey questions and categorizations changed over time for NUNM.**
**Notice the apparent jump in percent employed 25 or more hours between 2010 and 2014. In reality, how the percentages were calculated changed, and it appears that more respondents were not working in healthcare than in 2010.
The NUNM 2010 survey calculated “percentage working 25 or more hours” out of all respondents, not just those employed in healthcare. Eight percent of respondents were not employed in healthcare.
It’s unclear why this is. It may be that more respondents who were no longer in the field responded in 2014 than in 2010. Or it may be that fewer ND grads from NUNM were working in healthcare.
NUNM 2014 survey calculated “percentage working 25 or more hours” out of only those working in healthcare. When looking at the raw numbers, out of 599 total NDs responding, only 499, or 83%, worked in healthcare. That means that 17% did not work in healthcare – over twice the 2010 percentage. Of those 499 NDs in healthcare, 395 or 66% of all respondents worked 25 or more hours a week, in line with the 2010 figures.
Income
Every survey has different classifications for both FT/PT income and what constitutes income. The NUNM/NCNM surveys break it down by year. For this article, I have summarized the data as best as I could in the tables below. The full reports are available at the links in the text above.
Numbers reported are for those in healthcare only. Values are USD unless otherwise noted.
Gross is gross revenue before clinic expenses and taxes. It’s unclear how NUNM/NCNM classified gross pay from employment.
An AANMC 2004 survey , reported in a blog, stated that the net income for those “just starting out” was $25,000 a year. For those in “large, busy practices” the net income was listed as $85,000. Income is defined as “personal, gross, pre-tax”. They noted a minority of high-income producers had $200,000+ and that supplement sales played a part in this.
Regarding supplement sales: the NUNM 2010 and 2014 surveys reported on the amount of income derived from supplement sales (medicinary, dispensary, etc.) In 2010 a median of 15% of income was from supplement sales and in 2014 it was 20%. Anecdotally, I’ve heard higher figures (in the 40% to 50% range) from those with thriving practices.
Income for NDs from 2004 to 2015
| Annual measure | NUNM 2004 (see note) | BINM 2015 (see note) |
|---|---|---|
| Median gross 32+h/wk | $82,000 | |
| Median gross all h/wk | $67,000 | |
| Mean gross for all hours worked * | $145,900 CAD(from ND services or employment) | |
| Median net (after tax) 32+h/wk | $45,000 | |
| Median net (after tax) all h/wk | $34,000 |
The NUNM 2004 survey defined “net income” as “after expenses and after taxes”. Later surveys defined “net income” as “after expenses and before taxes”.
The BINM 2015 survey reported gross income only.
I have used median rather than the mean because the median usually represents what is more “typical” for respondents. The median is the value where half of all respondents fall below and half fall above. The mean value can be skewed higher or lower than the median if there are one or two unusually high values.
Below I list some of the the NUNM 2010, NUNM 2014, and AANMC 2015 survey results.
| Annual Measure | NUNM 2010 | NUNM 2014 | AANMC 2015 |
|---|---|---|---|
| Median net for 25+ h/wk & <15 y in practice | $50,000 | ||
| Median net for 25+h/wk “using degree” | $50,000 | ||
| Median pre-tax income*, 33+ h/wk, US | $75,000 USD | ||
| Median pre-tax income, 33+ h/wk, CA | $55,000 CAD or USD? | ||
| Median pre-tax income, <33 h/wk, US | $35,000 USD | ||
| Median pre-tax income, <33 h/wk, CA | $30,000 CAD or USA? |
The AANMC defined incomes as “personal, gross, pre-tax”. This sounds as if it would be either gross pay for an employee or what NUNM would call “net income” – after expenses and before taxes. AANMC’s report did not specify if Canadian numbers were in US dollars or Canadian dollars.
I will look at these surveys more in depth in a future article.
Wrap up for prospective students
If you’re considering a career in naturopathic medicine, strongly look at the following:
- The overall data for naturopathic education shows that naturopathic students have a significantly higher chance of not completing the program – roughly 5 to 6 times higher.
- There is further attrition due to failure to pass NPLEX examinations.
- A good four out of five ND grads will not be able to land a naturopathic residency.
- Median reported income, whether gross or net, tends to be well below what is required to pay off student loan debt that often approaches a quarter of a million.
- It is unclear at this time how many NDs are actively practicing. About 15% of respondents in two recent surveys appear to not be practicing at this time.
- The national organizations do not appear to be collecting much data about the profession.
Suggestions for the schools and national organizations
The AANMC should provide information comparable to its medical and osteopathic counterparts, such as:
- Attrition rates for the schools overall. This would take the pressure off individual schools, which may be reluctant to report attrition rates.
- National pass rates for the NPLEX I and II.
- Residency placement rates for the schools overall.
- Graduate outcomes, with surveys that drill down into whether or not that “degree-related employment” is opening a practice, writing articles for a supplement company, or working in a health food store as a floor assistant.
- Income surveys for the profession as a whole.
- A full count of currently practicing naturopathic doctors.
- Find additional methods of locating and reaching out to alumni: mail, email, phone calls, Facebook and Twitter announcements.
Schools should continue (or begin) to collect information about attrition rates, graduation rates, and residency placement rates. Reports should clearly describe data in a way that is meaningful for prospective and current students, and explain terms used (E.g. what does it mean to say that a student is “N/A” or “available for graduation”?) Break out outcome surveys by degrees. Consider evaluating patients per month rather than hours worked or patient contact hours.
MD and DO sources
For MD degrees, I looked at the site for the University of Washington School of Medicine in Seattle, WA, Baylor College of Medicine in Houston, Tx, Washington University – St. Louis, University of California San Francisco, and John Hopkins University School of Medicine. For the osteopathic degree, I looked at the site for the Pacific Northwest University of Health Sciences.
UW School of Medicine: They list acceptance statistics (4.1% of applicants), but not retention rates or residency match statistics and placements. Tuition and budget are found under financial aid.
John Hopkins: The disclosures page doesn’t list retention rates or student outcomes.
Baylor College: Gives USMLE pass rates and more information than the others.
Washington University School of Medicine in St. Louis lists match rates and information about the number of students in each year.
University of California San Francisco School of Medicine lists quite a number of statistics about student outcomes.
Pacific Northwest University of the Health Sciences has what I consider an outstanding facts page.