What does accessibility in healthcare mean to you? My journey to providing accessible healthcare began shortly after attending the Canadian College of Naturopathic Medicine (CCNM). During my first year I learned about the affordable healthcare model that has been successfully practiced at The Herbal Clinic and Dispensary.
This resonated with me strongly based on my family’s history and background (you can read more about my family’s story here. I couldn’t stop thinking about this business model and was excited to implement it in my own practice. In fact, it felt wrong and inauthentic not to practice this way.
Throughout the program I thought a lot about providing affordable Naturopathic Medicine. It wasn’t until after graduation that I took the necessary steps to truly learn how to implement this model. I sent dozens of emails connecting with like-minded practitioners and set up meetings to discuss their practice, what worked for them, what didn’t work for them, and got their suggestions on how to make accessible healthcare possible.
I focused heavily on making Naturopathic Medicine financially accessible. However, through several meaningful conversations, I learned that there are so many other ways we can make high quality healthcare accessible (read about what this means to me by clicking here).
The purpose of this post is to share what I have learned through multiple conversations about the considerations of starting a naturopathic practice, and how we (as a profession) can help remove barriers to wellness. Let’s take a look at 5 changes you can make in your practice to reduce barriers to naturopathic care.
1. Know Your Product
With any business, it is important to know your product. You should know who you are, what you are doing, what you are trying to achieve, and who it is for. You should always ask yourself if you are here to solve a problem. In this case, the problem is the high number of people who are unable to access high quality healthcare). Understand what you are offering and how you are solving said problem.
Whatever your branding is, consider providing barrier free ways for people to sample your product. For example, offering complimentary 15-minute consults allow people to test “your product/service” for free with no commitment. Because let’s be honest, naturopathic fees are not pocket change for many. It's also a great opportunity for them to get a sense of your energy and how you can help them solve their problem.
In addition, it is important to consider all other potential barriers for everything you do. These could range from the set up of your website, to your booking system, to choosing your clinic space. Anything that can be viewed as an “obstacle” should be addressed (see #5 below for more information).
Tip: Ask yourself what reasons exist for someone NOT to see you based on your current set-up?
2. Market by Word of Mouth
All of the Naturopathic Doctors I spoke with said their main marketing avenue is word of mouth and referrals. This is true for any and all businesses. If you have customers or patients who really like you, they will rave about you.
I had the opportunity to chat with a motivational speaker, and he brought up the concept of having “1,000 true fans”. The goal is not to obtain a million fans, but to obtain 1,000 true fans. True fans are the ones that will buy all your albums, attend every concert, and buy all your merchandise. These fans will naturally do the marketing for you. I thought this was an interesting concept and it made a lot of sense.
With Naturopathic Medicine, we are able to spend a significant amount of time with our patients to build that relationship. If they do well and see results, they will become your biggest fans. When you encourage referrals, they will be happy to do so. Of course, as Naturopathic Doctors we probably don’t need 1,000 fans. But having a secure client base (whatever your number is) is a good start.
Market Through Conversations
If you’re a chatty individual this one is for you! Tell whoever you interact with about what you do (in a natural way). Whether you are at a café, chatting with a local business owner around the corner, or having a random conversation with someone you just met, you can always sprinkle in what you do in an organic way. Pique their interest, tell them why you love doing what you do, and offer some business cards.
Tip: Get to know your community. Go around and introduce yourself. Carry around extra business cards with you. You never know when a good networking opportunity will come up!
Market Through Social Media and Ads
Many NDs found that social media yielded very few patients, if any at all. The bombardment of ads on social media may actually deter individuals as it can become annoying (but they still work). Regardless of the relationship you choose to have with social media, it can still be beneficial to build an online presence so the public knows that you exist in the first place.
Even if the conversion rate is low, there is great potential for indirect conversion. Those who saw your ad may not come to see you, but they may tell someone else about you. And that person just may book an appointment. Either way, you are still taking up space online.
Of course, this has changed since the pandemic. As we try to navigate transitioning to/incorporating online services, we rely much more heavily on our online presence.
Market Through Postering
It's likely that you patients either live in your clinic’s neighbourhood, or pass through regularly. To increase your exposure, postering around the area can help (although it is not the most sustainable way to do so). Offer flyers to local businesses or hang some on telephone poles and bus stops. Having your name and face around will help build your presence in the community.
Market Through Volunteering
This strategy aligns well with providing accessible healthcare. So many volunteer opportunities exist in so many different areas! Not only are you able to provide free naturopathic care, you are also building your branding.
Of course, there is a fine line between volunteering to build your brand (which is more performative) vs. volunteering because you are passionate about accessible healthcare (and then having the side benefit of building your brand).
If you are genuine in what you do, patients will sense this and will likely stick with you for the long-term. Depending on where you are volunteering, it allows you to promote yourself as well. Everybody wins!
Tip: You may have a sense of social obligation and want to give back as much as you can. But make sure what you do is sustainable for YOU. You don’t have to volunteer weekly and burn out to provide accessible care. Do what works for you.
Market Through Presentations
One of the most commonly discussed ways of marketing in the naturopathic profession is providing talks and/or workshops. This makes sense because we are providing free information on a selected topic, and we are able to give the public a sense of who we are and how we can help them.
However, there is a strategy behind it. One-off talks or general talks about ‘what Naturopathic Medicine really is’ don’t convert. If you do decide to lead these events, it is better to do focused topics and consider doing a series of them. This provides valuable take-away information, and allows more opportunities for people to attend if they are unable to attend the whole series.
This ties in nicely with volunteering. Many community centres look for healthcare professionals to do educational workshops or talks. They want to provide valuable information to the public that otherwise would not be given. Again, this aligns well with the accessible healthcare model.
Of course, with the pandemic, more people are offering talks, masterclasses, and webinars online instead – but the concept is similar.
3. Choose the Right Wording
As subtle as this is, your choice of wording is crucial. This applies to your website and all your marketing strategies. For example, distinguishing between affordable and accessible for clarity, and alternatives to using “pay-what-you-can” to avoid stigma around “discounted” services (which can be misinterpreted to mean lower quality service)
This is also important in the LGBTQ2S+ community. If you are providing accessible healthcare to this community, make sure your forms and the questions phrased in visits are appropriate. Dr. Cyndi Gilbert, ND offers great resources on how to ensure your practice is LGBTQ2S+ friendly. It’s the little details that make a big difference!
4. Pricing Different Healthcare Delivery Models
Depending on how you define accessible healthcare in your practice, the set-ups may be different. Here are a few options with pros and cons for each.
Pricing Visits With Set Times
With this, you offer certain time slots for affordable care. This often happens during down time, and allows you to fill up those slots. You can set up a wait list if you get booked up, and boundaries should be established. Although this provides the opportunity for someone to see you at an affordable rate, it is not as accessible since there is a huge time/date restraint. This may not be possible for those who need to work as they live paycheque-to-paycheque.
Pricing Home Visits
This is great for patients who cannot leave the house or have extreme mobility issues. The advantage is that you get to keep 100% of what you make. However, travel time and ability to transport equipment can become huge obstacles. Unless you have a car, it is not very doable. Even with a car, it can be time consuming and may not be worthwhile if you are seeing enough patients at your clinic. You can also charge extra for travel but this reduces the affordability.
Pricing Telemedicine Visits
This is a great way to hold a patient visit in the comfort of their own home. Similar to home visits, it is suitable for those who cannot leave the house, have extreme mobility issues, live far away, or just have a busy schedule. It is convenient for the patient which means that they are more likely to attend the appointment. Of course, this is only for consults or counselling that do not require any physical treatments (i.e., acupuncture) or testing. Regardless of the type of practice you have, this is a great asset. The importance of telemedicine has risen since the pandemic. If you haven’t yet incorporated telemedicine into your practice, make sure you do so!
Pricing Sliding Scale Visits
You can come up with a cost range for patients to choose from. Often, the lower end of the scale is determined by your overhead. It is the value that is enough to sustain your practice (or pay for your overhead) if every patient paid this amount.
Tiered Pricing System
You can have your regular full rate, 75% of your rate, or half your rate - however you choose to design the model. This makes things a bit easier on the billing side, and is easier for the patient to choose from. Again, providing accessible healthcare means so much more than just financial accessibility. It's OK to charge regular rates!
Pay it Forward Pricing System
Here you are charging your regular rates, but give the option for your existing patients to contribute additional money towards a bursary fund. Once the fund reaches a balance that is equivalent to a session, you can offer an appointment for free to the next person on the bursary wait list. With this set-up, free sessions are more unpredictable which can impact the accessibility you offer to your community.
Other Pricing Considerations
Often clinics do not require proof of income as this can become awkward for the patient. Asking for proof can be seen as a potential barrier to receiving your service.
Think about how you want to communicate your billing. Some practitioners would mention it at every single visit, others will assume a regular rate unless the patient states otherwise. Do you want full transparency on your website or do you want patients to ask you directly? Do you want to communicate and determine the amount at the beginning of the visit or at the end?
There is no hard and fast rule on how to do accessible healthcare properly. Do what works for you and your patients. Just to reiterate, it is important that you are sustaining yourself and your practice when you are providing affordable healthcare!
5. Choosing a Clinic
This has been one of the most difficult aspects of practice for me. The process of finding the right space has been a long one. I’ve been very patient with the process, and tried not to settle for a space just for the sake of starting practice sooner. Here are some steps and considerations to help you find the right clinic space.
Explore Clinic Websites
Google existing clinics in different neighbourhoods. Go through their website to get a sense of their vibe, understand their values, and who is practicing there.
Drop into Clinics
See how busy they are. Do they naturally get foot traffic from nearby stores, gyms, integrative clinics, yoga studios etc.? What energy do they give off? Does it resonate with you? Don’t write off clinics that do not practice accessible healthcare. If they are supportive of the model, it is possible to provide such a model out of this space.
Chat with Clinic Receptionists and Owners
Get a sense of the receptionist’s attitude and how they work. They are the frontline workers of the clinic. No matter how good you are, a bad receptionist affects the entire experience.
What are the clinic owner’s values? Do they align with yours?
Get to know the practitioners there (if there are any). What is their dynamic like? What are their experiences?
One Clinic or Many?
How many locations do you want to work out of? Most clinics offer part time rentals. Depending on how many days you want to work, you may be at 2-3 different clinics - unless you want to run your own clinic of course! Some prefer being at one clinic, others enjoy working out of multiple locations.
This depends on how you work and the type of person you are. If you don’t want to spread your energy across different areas, want to avoid lugging around equipment or materials, and want more of a consistent routine/schedule - one clinic may be for you.
If you want to work in different environments with different people, avoid office politics, and provide your services to varying patient populations, multiple locations may be better for you. You can also inquire about their demographics if you have a specific niche. There is no right or wrong way, it just depends on what works for you.
Pay Rent or Do a Split?
For rent, consider the average rates in the neighbourhood.
For a split, most agree that a 65/35 split should be the absolute minimum. Ask the renter what it does and doesn’t include. Here’s a list to get you started. Does the rent include:
Use of the front desk/reception staff
EMR, booking and POS system
Services like laundry, cleaning and garbage removal
Supplies like cotton, swabs, paper towels, alcohol, hand sanitizer, garbage cans, linens, needles, biohazard disposal etc.
Wi-fi
Building access
Website profile and online marketing
Commission if there is a dispensary on site
Assess Patient Barriers
Does the space pose any barriers to patients? For instance, individuals seeking affordable care may feel uncomfortable walking into an upscale clinic or neighbourhood even if you provide affordable rates. If your space has several flights of stairs, elders, those with chronic pain, and individuals who need support with exercise may dread going to their appointments as the act of physically going into the clinic is an obstacle itself.
Think Five to Ten Years Ahead
Would you want to practice there 5-10 years down the road? Relocating is stressful and you will likely lose a lot of your patients. Try to stay in a particular area. But also know that it is OK to move if the space just isn’t working out for you. If you find that you are not growing or progressing after a full year (despite all your efforts), it may be time to relocate (assuming you want more growth).
5. Face Challenges By Embracing an Abundance Mentality
There are obvious challenges with starting your own business. However, there are specific challenges that come with accessible healthcare, especially in regards to affordability.
As passionate practitioners, it is easy to work out of “social obligation” or “labour of love”. We want to give back to the community, and we want to help everyone.
However, this leads to burn out and is just not sustainable. It is important to ensure our model is sustainable for us. If it's not, we won’t be able to practice in the way that we truly desire. Be aware and recognize when these feelings come up. Ask yourself how you can make ‘x’ more sustainable for you.
Another huge challenge revolves around the scarcity mindset. This is the belief that there is not enough to go around. We may get criticisms on our practice model. Others may believe that you are “taking from them”, or devaluing our services.
However, this is not accurate - we are not doing this to compete. The patients we attract are unlikely to be the same ones they attract. We are not devaluing our services because our intent is accessibility, and not because we don’t believe in our services. Of course, these criticisms are out of our control. We can only control how much we let this affect us.
Lastly, with an affordable healthcare model, it is easy to tie our self worth to the amount our patients pay us. There may be a patient who comes in wearing a $700 jacket, but pays you the minimum for your service.
Naturally, this can be bothersome. However, in order to not let this affect the way we practice and the quality we provide, it is important to learn how to decouple the association.
Most of the time, it has nothing to do with you or your worth, but more about what works for the other person. Yes, there is a risk that patients may “take advantage” of the system. But there is no way for us to know their story or situation and why they made particular decisions.
By having an abundance mentality (the belief that there is more of everything), we can shift our thinking and give ourselves the space to practice in the way that is truest to us.
My journey towards accessible healthcare has been an exciting and challenging one. I am grateful that I was able to join the clinic that started it all (The Herbal Clinic & Dispensary), along with another amazing clinic closer to home (Urban Wellness).
Wherever you are on your journey, I believe that when the time and space is right, it will happen. Be patient, do your due diligence, and the right things will come along.
I hope this article has been helpful for new practitioners, and for those wanting to offer accessible healthcare – we need more of it!
Special thanks to the wonderful people who took the time to chat with me:
Dr. Chris Pickrell, ND; Dr. Cyndi Gilbert, ND; Dr. Caroline Meyer, ND; Dr. Crystal Chanderbhan, ND; Richard Kwan, Laura Burns, Dr. Yan Yen Loo, ND; Dr. Suzanne Ho-Miecznikowski, ND; Dr. Stephanie Cordes, ND; Dr. Brianna Dowdall, ND; Dr. Leslie Solomonian, ND; Kevin Rempel, and Dr. Emily Bennett, ND!
Are you a Naturopathic Doctor interested in issues of social and environmental justice? Follow Naturopathic Doctors for Social and Environmental Trust (NEST) on Instagram and Facebook @nestnds or check out our website to learn more!