Few students choose naturopathic medicine with the idea of getting rich. In fairness, the majority of people in other healthcare professions don’t choose their professions for the money, either. Whatever the degree, healthcare involves dealing with fraught situations and (sometimes) fraught-er people, not to mention insurance phone trees and preauthorization procedures.
However, prospective and current students reasonably want to know if they are going to be 1) able to pay their student loan 2) pay their bills and 3) stay fed, clothed and sheltered. Determining what, exactly, the typical naturopathic doctor makes has been…. hard. Various surveys have been conducted over the years, all by the schools or naturopathic organizations. The majority of these surveys are vague about crucial details such as “Is this gross revenue from the clinic practice or net income after expenses but before taxes?”
As it turns out, the federal government collects data on such items as financial outcomes for students in graduate programs. Lots of data. And recently the HEA group published their analysis of federal data on earnings and student loan debt for graduate programs. HEA Group thoughtfully makes the data available for download from their article, “Some Graduate Schools Never Pay Off“. So I downloaded the data and off I went, using Tableau Public to visualize the data.
I was curious what the HEA Group dataset showed about degrees from naturopathic medical schools. How well can naturopathic doctors pay back their student loans and sustain themselves? How does this compare to other healthcare providers such as medical and osteopathic doctors, dentists and pharmacists and optometrists? I also compared naturopathic doctor earnings to chiropractors.
Degrees, fields of study and schools
All of the above professions require a doctoral-level or first-professional degree that takes four or more years to complete. I did not include acupuncturists because most acupuncture degrees are masters degree level. And the dataset does not let me readily break out nurse practitioners or physician assistants, so I couldn’t compare naturopathic doctors with grads in those fields.
I filtered the HEA Group dataset to show just institutions that offer doctoral or first professional degrees in alternative and complementary medicine, as well as medical and osteopathic degrees, optometry, pharmacy, dentistry and chiropractic. (Chiropractic is a separate field of study from alternative medicine in the federal data.)
Interestingly, in this this dataset the only alternative and complementary medicine programs that also offered a doctoral or first professional degree were the five accredited schools of naturopathic medicine. At the time, these schools were:
- Bastyr University
- National University of Natural Medicine (NUNM)
- The school formerly known as Southwest College of Naturopathic Medicine (SCNM), now Sonoran University of Health Sciences. SCNM was incorrectly classified as being in the “medicine” field of study. For the visualization I corrected it to “alternative and complementary medicine”.
- And the now-closed University of Bridgeport ND program.
To my knowledge, none of these naturopathic medical schools were offering doctoral degrees in anything other than naturopathic medicine in the years covered by this data (2013-2015). So while the charts show “alternative and complimentary medicine”, in effect the only schools included are naturopathic medical schools, and the degrees mentioned are most likely doctor of naturopathic medicine degrees.
(For the curious: the HEA group understandably did not include institutions that did not show data for earnings, debt, etc. This evidently removed other, non-naturopathic alternative and complementary institutions that do offer doctoral degrees as well.)
Which earns more: an ND or a PhD in music?
I go into the data in more details below, but here is the short-and-sweet summary.
Even four years after graduation, naturopathic doctors (ND) earned less than other healthcare professionals – and than PhDs in music. Yet the median debt load for naturopathic doctors is higher than similar healthcare professionals. Only dentists borrow more.
- With a debt-to-earnings ratio (D/E) of 585%, naturopathic doctor degree holders are less able to pay their student loans than chiropractors (D/E 379%), dentists (D/E 205%), MDs/DOs (D/E 204%) optometrists (D/E 175%), and pharmacists (D/E 116%).
- In fact, naturopathic doctorate grads are less able to pay their student loans than doctoral/first professional grads in any field of study, including religious studies (D/E 298%) and music doctoral degree grads (D/E 116%).
- The one exception was the now-closed University of Bridgeport program, which had a D/E of 306% for its 2013-2015 grads.
- When looking at the median income of the naturopathic medical schools (shown as “alternative and complementary medicine” on the graphs), the doctoral/first professional degree holders had the lowest average median income* ($41,749) of any of the doctoral/first professional degree grads in any of the fields of study listed. That includes music ($48, 612).
- Yet for naturopathic programs as a whole, the average of the median graduate student debt ($233,414) was higher than the other healthcare professions listed here, except for dentists ($274,490)
In short, if you are unsure about whether you would really rather wrangle the gastrointestinal tract instead of a guitar, it might be best to reconsider your career choices.
*The data shows earnings as median earnings, broken out by the institution and the field of study. To compare earnings across fields of study, I took the average for all the median values in each field of study. It is difficult to take the median of a median and get an accurate number.
Real data, real results
Where did the HEA Group get the data from? Found at College Scorecard, this earnings data is reported by institutions of higher education to the federal government, starting one year after a cohort of students complete a degree program and continuing for some years. (Other data is reported during enrollement as well.) Debt figures are for student loans disbursed through the institution. Earnings data is from aggregated, de-identified tax returns for students who are working and are not enrolled in school. It shows W-2 wages and “positive self-employment earnings from Schedule SE”. [1]
Crucially, this data shows income – not gross revenues from a practice, not losses. Nor does it include financial data from grad students who were not working. This means that this is the data from the “success stories” – naturopathic grads who have a clinic that is at least breaking even. Income can be from any source, not just working in the field that the student trained in.
The schools report the median earnings, which is the point at which half of the reported earnings are above and half are below. This gives a better picture than the average or mean, which can be distorted by a few unusually high or low outliers, such as the student cohort’s version of multi-billionaire social media founders.
The schools also report the median graduate student loan (Stafford and Grad Plus) issued by the schools for graduate students in that field of study. Finally, the HEA Group’s dataset shows the ratio of the median student loan debt to the median earnings for a graduate in that field of study – the debt to earning ratio. A good ratio is 100% or below – that is, the graduate’s annual income after graduation is at least as much as the debt that they graduated with.
The earnings and debt reported are for students who graduated in 2013-2014 and 2014-2015. So the data was collected in 2018-2019 and 2019-2020. The government notes that some earnings may have been affected by the pandemic measures in 2020.
The data in more detail
Below I show some of the data as well as images of graphs from the visualization I created in Tableau Public. You can download the dataset I used from there.
Individual naturopathic medical schools – earnings and debts
First, sorting the data by the debt-to-earnings ratio shows that National University of Natural Medicine (NUNM) and Bastyr have the highest and second-highest debt-to-earnings ratio out of all 6,371 institution and degree program listings. The school formerly known as Southwest College of Naturopathic Medicine & Health Sciences (SCNM – now Sonoran University of Health Sciences) is in fifth place. National University of Health Sciences is in seventh place.
| Institution | Field of Study | Type of Degree | Median earnings of graduates working and not enrolled 4 year after completing | Median Stafford and Grad PLUS loan debt disbursed at this institution | Debt-to-Earnings Ratio |
|---|---|---|---|---|---|
| NATIONAL UNIVERSITY OF NATURAL MEDICINE | Alternative and Complementary Medicine and Medical Systems. | First Professional Degree | $34,431 | $263,594 | 765.6% |
| BASTYR UNIVERSITY | Alternative and Complementary Medicine and Medical Systems. | Doctoral Degree | $43,703 | $300,530 | 687.7% |
| OREGON COLLEGE OF ORIENTAL MEDICINE | Alternative and Complementary Medicine and Medical Systems. | Master’s Degree | $27,012 | $175,882 | 651.1% |
| SOUTHWEST COLLEGE OF NATUROPATHIC MEDICINE & HEALTH SCIENCES | Alternative and Complementary Medicine and Medical Systems. | First Professional Degree | $38,297 | $224,000 | 584.9% |
| COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | Film/Video and Photographic Arts. | Master’s Degree | $28,141 | $163,605 | 581.4% |
| NATIONAL UNIVERSITY OF HEALTH SCIENCES (THE) | Alternative and Complementary Medicine and Medical Systems. | Doctoral Degree | $35,127 | $203,837 | 580.3% |
The now-closed University of Bridgeport program is in 63rd place. It has somewhat higher earnings, but also significantly lower debt
| Institution | Field of Study | Type of Degree | Median earnings of graduates working and not enrolled 4 year after completing | Median Stafford and Grad PLUS loan debt disbursed at this institution | Debt-to-Earnings Ratio |
|---|---|---|---|---|---|
| UNIVERSITY OF BRIDGEPORT | Alternative and Complementary Medicine and Medical Systems. | Doctoral Degree | $57,185 | $175,111 | 306.2% |
Here is the data in more visual form, from the Tableau visualization.
Naturopathic doctor grads have low income and high debt
There’s a reason that the debt-to-earnings ratios are so high. That’s because overall, the (presumably) naturopathic doctor (ND) graduates of these schools have the lowest earnings compared to doctoral/first-professional degree grads in other healthcare fields of study. Yet NDs have the second highest student loan debt after dentists – who earn far more.
Graduates of chiropractic programs were second lowest in earnings of all the groups, and second highest in the overall debt to earnings ratio.
(In this table, the only schools in the “Alternative and complementary medicine and medical systems” grouping were the naturopathic schools listed above.)
| Field of Study | Average Debt-to-Earnings Ratio | Average of the Median earnings of graduates working and not enrolled 4 year after completing | Average of the Median Stafford and Grad PLUS loan debt disbursed at this institution |
|---|---|---|---|
| Alternative and Complementary Medicine and Medical Systems. | 585% | $41,749 | $233,414 |
| Chiropractic. | 379% | $52,355 | $195,118 |
| Dentistry. | 205% | $137,520 | $274,490 |
| Medicine. | 204% | $102,155 | $203,562 |
| Optometry. | 175% | $110,671 | $192,488 |
| Pharmacy, Pharmaceutical Sciences, and Administration. | 116% | $131,930 | $154,372 |
Again, an image from the Tableau visualization:
MDs and DOs vary, but do much better
The full list of conventional medical schools (regular and osteopathic) is too long to list here, but here are the first seven medical schools, ranked from the highest debt-to-earnings ratio on down. You can see see that the medical and osteopathic schools with the highest earnings to debt ratios are still far lower than four out of the five naturopathic medical schools. You can dig further in in the visualization here.
| Institution | Field of Study | Type of Degree | Median earnings of graduates working and not enrolled 4 year after completing | Median Stafford and Grad PLUS loan debt disbursed at this institution | Debt-to-Earnings Ratio |
|---|---|---|---|---|---|
| WEST VIRGINIA SCHOOL OF OSTEOPATHIC MEDICINE | Medicine. | First Professional Degree | $63,408 | $269,399 | 424.9% |
| TULANE UNIVERSITY | Medicine. | First Professional Degree | $89,940 | $322,603 | 358.7% |
| VIRGINIA POLYTECHNIC INSTITUTE & STATE UNIVERSITY | Medicine. | First Professional Degree | $72,205 | $251,904 | 348.9% |
| NORTHEAST OHIO MEDICAL UNIVERSITY | Medicine. | First Professional Degree | $59,635 | $194,149 | 325.6% |
| UNIVERSIDAD CENTRAL DEL CARIBE | Medicine. | First Professional Degree | $60,092 | $191,451 | 318.6% |
| MEHARRY MEDICAL COLLEGE | Medicine. | Doctoral Degree | $99,159 | $314,277 | 316.9% |
| GEISINGER COMMONWEALTH SCHOOL OF MEDICINE | Medicine. | Doctoral Degree | $88,002 | $273,352 | 310.6% |
The same chart in an image from the visualization:
Follow up: what next?
I plan to write a follow-up article on what the reasons for the differences in income may be.
If you are a prospective or current naturopathic student, use this data to inform your choices. What is the best investment of your money and your time? Consider that programs with a high debt-to-earnings ratio mean that you will spend more years with a large amount of debt hanging over your head. That debt can prevent you from buying a home, getting the loan to start your practice, and many other things.
Be aware that you will need significant financial resources not only to get through school but also to set up a practice and then sustain yourself – and the practice – throughout the years that it is losing money. If you do not have these resources, you may find yourself unable to practice more than in a very part time fashion and working at another job altogether to make ends meet.
It is true that the value of an education is in more than the income you make. But as the HEA Group noted in their article, an education should not leave you worse off than before you got into it.
Thanks to the naturopathic friend who alerted me to the HEA Group’s excellent article and analysis; they do not wish to be cited here.
Many thanks to the HEA Group and Mike Itzkowitz, who graciously confirmed some details.
[1 ] https://collegescorecard.ed.gov/assets/InstitutionDataDocumentation.pdf page 29 retrieved 8-8-2023.
Robert Kelchen also performed another analysis earlier this year: https://robertkelchen.com/2023/01/19/sharing-a-dataset-of-program-level-debt-and-earnings-outcomes/