This is from a post on the ND Chat, which is a Google Group. If you are an ND student from an accredited school, you can join the group but you will not be able to post until you are an ND. Still valuable, however. This post was in response to another NDs concern about high attrition rates in the ND profession.

Thank you for your incisive and thoughtful analysis. If I am understanding you correctly, your main concern is the high attrition rates within the profession and how a better articulated theoretical model that intelligently differentiates naturopathic philosophy, clinical theory, clinical practice, and business application could potentially decreasing those rates. Fortunately, such models do exist.

For brevity, let’s choose one of these models and apply it to the naturopathic profession. In terms of its business pedigree, the model I have chosen is used in several Fortune 500 companies. The model itself is one of the dominant productivity methodologies in the world today, with applications ranging from personal life management to institutional and corporate consulting. I am, of course, speaking of the Getting Things Done (GTD) methodology developed by David Allen.

Since information on GTD is ubiquitous on the Internet, I will not go into detail here. Rather, let’s apply GTD to the problem, as you define it, of the unclear, fuzzy, pseudo-religious thinking that may be degrading clarity in areas critical to the success of naturopathic physicians.

To borrow a parable from Gurdjieff, imagine a fine carriage that has fallen into disrepair, whose driver is drunk, and whose horse is sick and weak. Since the driver is drunk, anyone can get into the carriage and order the driver to take them wherever they want. I believe this is a fair depiction of a profession whose recidivism rate of graduates is 75% at 5 years. Now imagine the driver begins to wake up. He or she stops drinking, fixes up the carriage, and attends to the needs of the horse. Being sober, he or she can now ascend to the box and firmly control the reins. Upon doing so, it is discovered that the carriage is actually motorized. After a bit of trial and error, the necessary skills are mastered. At this point, the true owner of the carriage returns and reveals that the carriage is not a carriage at all, but rather a jet. Driver and owner launch happily into a new world of possibilities.

This analogy allows us to map GTD principles onto the structuring of naturopathic medicine. The day-to-day tasks of running a business, seeing patients, managing staff, etc. all occur on what Allen calls the “runway” level. For this level he developed his famous “workflow process” that involved 5 distinct phases: collect, process, organize, review, and do. As you astutely noted, the runway is not the place to be discussing philosophy – this is the arena of pragmatic action.

Taking the airplane up higher, Allen defines the 10,000 foot level, the area of project management. Also not an arena of philosophy. But it is the 30,000 (goals and objectives), 40,000 (vision) and 50,00 (purpose and principles) levels that provide the type of differentiation I believe you are asking for.

For example, naturopathic philosophy would reside at the 50,000 foot level and be dealt with appropriately there. Clinical theory might reside at the 30,000 foot level, where it would be informed by the higher levels and would inform the lower levels.

Against this backdrop, let me address something you wrote that I did not agree with and found unnecessarily harsh: “the cult-like pseudo religious nature of the ideologies and exaltation of 'philosophies' that tend to permeate the training of this portion of the naturopathic field encourage this sort of self sabotage and immolation.”

Having worked extensively in health care field, both in the military and in conventional hospitals for 15 years, I can assure you that this exaltation of philosophies is not confined to the naturopathic profession. However, while their own type of rabid dogma has not damaged the ability of allopathic physicians to generate income, it has damaged them personally. In the book, The Complicated Medical Patient, it is noted that: “When the rates for substance abuse and suicide are considered together, it is estimated that the biomedical profession loses the equivalent of seven medical school graduating classes each year.” So there are pluses and minuses to each philosophy, but there is no way to have a profession without some sort philosophical “glue” holding it together. As with love, no one emerges unscathed.

More than philosophy, I believe the inability of the profession to generate more successful physicians is due largely to deficits in logistical and pragmatic priorities. For example, my wife is an exceptional clinician and a gifted business person. Because of her skill, dedication, and leadership we went from working out of our house to owning our own clinic building in under ten years. Our clinic is an official preceptor site with Bastyr University and we were part of the mentorship program there for new graduates until it ended. Yet despite all of this, she receives little to no support or acknowledgement from our profession – support that would allow her to mentor more emerging ND graduates. Without that support, there is a limit to how much financial and logistical stress our practice can tolerate in the name of education.

Speaking of which… Having guest lectured in naturopathic philosophy courses as well as Dr. Yarnell’s excellent business course at Bastyr, I am well aware of the substandard foundation that we offer our graduates. This has little to do with “ pseudo-religious ideologies” or “self sabotage and immolation” and everything to do with entrench bureaucracies, an abiding scarcity mentality, tribal politics, and poor reimbursement for naturopathic faculty.

However, your point about differentiating intellectual entities is well taken and I believe the GTD model has more than sufficient discriminatory power to assist with that while incorporating methodologies that will improve not only clinical practices but business practices as well.

For example, we need a methodology that makes us competitive on the runway. This is exactly why McDonnell Douglas, Motorola, etc. use this methodology. As I remember, the official reason the mentorship program at Bastyr was shuttered was lack of interest, but I believe the underlying reason was that it was not well promoted and that the students were overwhelmed. The workflow model in GTD offers sophisticated time management and life organizational skills that could help with that. If students were less overwhelmed they could not only avail themselves of more business-focused resources but could also better integrate successful business thinking into their practices.

In addition, however, we need to establish healthy boundaries between our vision of naturopathic medicine, the philosophy of naturopathic medicine, and the clinical theories we use in the practice of naturopathy. GTD offers a framework to do that as well through its attention to control (runway level) and perspective (levels of focus from 10,000 to 50,000 ft).

In closing, if I can be allowed a bit of company promotion, in order to be clear about what our philosophy is and is not, it would be helpful to review its history. I believe you would find that many of your concerns were shared by Benedict Lust, one of the architects of our profession. His autobiography is available on our website: (http://www.healingmountainpublishing.com/)

I should add that I have no financial interest in GTD, nor am I associated with David Allen’s company. For an alternative perspective, Steven Covey’s methodology could potentially work as well as GTD.