Ontario Association of
Naturopathic Doctors
Phase 1: Research & Discovery
Presented October 31, 2013
Version 10, Revised November 25th, 2013
1
Overview
•
•
•
•
Introduction
Patient Profile
Awareness Interest
Consideration & Selection
– ND
– MD
– other CAM providers
• Keeping Patients
• Losing Patients
• Practice Building
2
Introduction
• This research is part of a multi-phase campaign development
process
• Several different methodologies were used to uncover insights
– This allows for the opportunity to evaluate issues through multiple
lenses
• The findings from each methodology have been integrated to create
a single presentation
• This research will be used to develop a strategic recommendation
for OAND campaign development
3
TDC Branding Process Overview
• Research and Discovery (this document)
• Strategic Platform (next step)
• 360 Vision Development
– Creative idea
– Key messaging
• Consumer Testing
• Execution of campaign
• Soft launch
4
Research Objectives
• The objectives of the research are to identify:
– Current attitudes and usage of NDs in Ontario
Typical patient profile
Reasons for using service
Strategies for building patient compliance/loyalty
– Barriers (real and imagined) to growing NDs usage in Ontario
– Patient segments/demographics that are potentially underserved by
NDs
5
Research Methods
• Secondary Research
– Published articles
Numerous articles reviewed from Canada, USA and Australia.
Articles are referenced on each slide and included in a bibliography in the appendix.
– Online listening
Review of social media comments made by ND patients in Ontario on their experiences
with naturopathic medicine.
• In-depth Interviews (NDs, Public)
– OAND members
24 phone interviews with OAND members representing a range of years of experience and
regions of practice. Discussion guide included in the appendix.
– Online Survey (NDs)
OAND members invited to participate in an online survey similar to interview. Interview
questions included in the appendix. (N=43)
– Ontario Public
Recruited from the TDC AHAA™ (Active, Healthy, Affluent, Aware) online panel. 24 phone
interviews with ND users and nonusers representing a range of ages. Discussion guide
included in the appendix.
6
Overview
• Patient Profile
• Awareness Interest
• Consideration/Selection
– ND
– MD
– other CAM providers
• Keeping Patients
• Losing Patients
• Practice Building
7
Higher Education
• Users of CAM have higher levels of education (supported by both
US and Canadian published data)4-8
• Those with a higher level of education may be more likely to:
– Be exposed to nontraditional/CAM practices
– Educate themselves about their illnesses and the treatment options
available
– Question the authority of conventional practitioners
4. Nguyen, L. et al. (2010). Use of complementary and alternative medicine and self-rated health status: results from a national
Survey. J Gen Intern Med. 26(4): 399–404
5. Innovative Research Group. (2011). Attitudes toward naturopathic medicine
6. Millar, W. (1997) Use of alternative health care practioners by Canadians. Canadian Journal of Public Health. 88(3): 154-158
7. Blais, R et al. (1997) How different are users and nonusers of alternative medicine? Canadian Journal of Public Health. 88(3): 159162
8. Wolsko, P. et al. Insurance coverage, medical conditions, and visits to alternative medicine providers. Arch Intern Med. 162(3):
281-287.
8
More Engaged in Their Health
• US data suggests CAM users are4:
–
–
–
–
62% more likely to report their health as ‘Better’ than in the prior year
9% more likely to rate their health as ‘Excellent’
More likely to visit a healthcare provider in the last 12 months
More likely to say they are healthier versus previous year
4. Nguyen, L. et al. (2010). Use of complementary and alternative medicine and self-rated health status:
results from a national Survey. J Gen Intern Med. 26(4): 399–404
9
Not Necessarily Healthier
• US data suggests CAM users are more likely to4:
– Be a drinker of alcohol
25% more likely to self-identify as a heavy drinker
–
–
–
–
Be a smoker or ex-smoker
Have visited an emergency room in the last 12 months
Have ‘spent the day in bed’ in the last 12 months
Higher level of anxiety (self-reported)
4. Nguyen, L. et al. (2010). Use of complementary and alternative medicine and self-rated health status:
results from a national Survey. J Gen Intern Med. 26(4): 399–404
10
Not Necessarily Using Less Traditional
Healthcare Resources
• Minority of Ontarians with an ND feel naturopathy has (significantly
or noticeably) reduced:5
–
–
–
–
Use of Rx (28%)
Visits to family doctor or GP (25%)
Emergency room visits (19%)
Visits to specialists (18%)
5. Innovative Research Group. (2011). Attitudes toward naturopathic medicine
11
Predominantly Female
• US data and Ontario research suggest men are less likely to go to
seek medical care, especially for preventive services11
Leading theory: cultural myths that men are the stronger sex and do
not need to be concerned about their health keep men from seeking
medical care
“Before the age of 16, the utilization of health care is equal by gender. After age 16, there
is a dramatic reduction in health-services utilization by males. Why is there no gender
discrepancy before age 18? Mom. Mom takes both boys and girls equally to the
doctor. After age 18, boys disappear. The same phenomenon even holds truth for
oral care. I don’t think men have healthier teeth than women. It’s something about
gender.” Ridwan Shabsigh, President International Society of Men’s Health
11. Astin, J. (1998). Why patients use alternative medicine. JAMA. 279(19): 1548-1553
12
Why So Few Men?
• According to OAND members:
– Women tend to be more patient
– Men appear to be:
Less in tune with their bodies
Seeking a magic pill
“I find in general men have a
less preventative mindset.”
ND, 4 years in practice*
“Men are very problemsolution focused. They’d rather
see a specialist in their
problem than a generalist.”
ND, 8 years in practice*
“Men come in with specific
issues, they want quicker
resolutions.”
ND, 11 years in practice*
* TDC phone interviews with OAND members. September 2013.
13
Patient Profile4,5:
CAM user vs. non-CAM user*
Skews (more likely in ND user)
Ontario
Research
US/ Australian
Data
Female
✔
✔
White/Caucasian
✔
✔
Income
✔
No Skews (equally likely in ND user)
Ontario
Research
US/ Australian
Data
Health insurance coverage
n/a
✔
Hypertension/high blood pressure
n/a
✔
BMI/obesity
n/a
✔
*The CAM group consists of respondents who used any type of CAM in the past 12 months.
4. Nguyen, L. et al. (2010). Use of complementary and alternative medicine and self-rated health status:
results from a national Survey. J Gen Intern Med. 26(4): 399–404
5. Innovative Research Group. (2011). Attitudes toward naturopathic medicine
14
Psychographic Insights**
• Naturopathic medicine users are:
– More likely to prioritize mental well-being
– More likely to take part in adventure sports/tourism (e.g.: mountain
climbing, backpacking)
– Less likely to sacrifice features in order to save money when it comes to
buying products/services
– More likely to eat healthy, use alternative medicine, choose natural
products (foods, household cleaners, etc.)
– More likely to prefer socially responsible companies/be willing to pay
more for products from socially responsible companies
– More likely to volunteer for a non-profit organization
**From AHAA™ user group database, Ontario residents.
15
Patient Profile Summary
• Ontario patient, based on review of all research sources:
–
–
–
–
Female skew
Higher education
Higher income
More engaged in health, but not necessarily healthier
Willing to spend money on ‘the healthier option’
– Higher levels of anxiety
Spends more time thinking/worrying about health
– Mindset: ranges from passionate supporters of natural health to those
who seek naturopathic medicine as a last resort
16
Overview
• Patient Profile
• Awareness Interest
• Consideration/Selection
– ND
– MD
– other CAM providers
• Keeping Patients
• Losing Patients
• Practice Building
17
CAM User Segmentation
• Primary Positioning: Complementary to Traditional Medicine
– Those who use alternative care in conjunction with conventional
medicine tend to:
Have a holistic philosophy of health
Not have negative attitudes or experiences with conventional care
• Secondary Positioning: Alternative to Traditional Medicine
– Individuals who rely primarily on alternative therapies to treat health
problems tend to have a:
Distrust of and dissatisfaction with conventional physicians
Desire for control over health
18
CAM User Segmentation
• Primary reason for visiting: Chronic Health Issue(s)
– Individuals may seek out alternatives to treat their problems as they
have:
Less success in treating their health problems
Symptoms unaccounted for by pathological findings
• Secondary reason for visiting: Prevention
– Those who see an ND or use CAM for health maintenance tend to have:
Higher levels of anxiety
19
Public Perception of Naturopathy
Largely Accurate
•
•
•
•
Holistic approach
Natural alternative
Healing people in a natural way
Naturally adding what your body is lacking
“It’s not just writing a
prescription.”**
F18-24
“They help identify problems, not
necessarily solve problems.”**
F18-24
“They are good for ongoing
problems.”**
F45-64
**From AHAA™ user group database interviews, Ontario residents.
20
NDs Are Part of a Very Personal
Health Journey
• Reasons for going to an ND/considering an ND are highly varied
“If my doctor told me to take a bunch of
drugs, that’s when I might look at exploring
options with an ND.” M35-44**
“I just like to try the natural
route if I can.” F35-44**
“It’s for not too severe stuff – muscle
pains – definitely not cancer.”
F25-34**
“If I was diagnosed with cancer I’d
definitely see an ND first, before chemo
or whatever.” F18-24**
**From AHAA™ user group database interviews, Ontario residents.
21
Patients Are Looking for Integrated Care
• Ontario research suggests:
– Majority of patients actually prefer their primary care physician to
routinely ask about their personal CAM use1
– The relationship that’s hard to replace is the traditional doctor1
“We’re taking care of them, but they don’t want to sort of ruin that relationship with their
family doctor, right? Because it's so hard to get one.” 1
1. Hollenberg, D., Lytle, M. Walji, R. Cooley, K. (2013). Addressing provider shortage in underserviced
areas: The role of traditional, complementary and alternative medicine (TCAM) providers in Canadian
rural healthcare. European Journal of Integrative Medicine. 5(1): 15-26.
22
High Satisfaction with MD Makes Patients
Less Likely to Try ND
• MDs with highly satisfied patients seem to be actively engaged in
pursuing natural options and alternatives to drugs
• Patients who are satisfied with MDs tend to be less likely to consider
an ND
• Dissatisfaction with MD does not necessarily lead to ND trial
“My doctor [MD] is amazing. I think
naturopathy is good, I just don’t
see the need for me to go.”
F45-64**
“My doctor [MD] understands and
appreciates that I’d rather go the
natural route if I can.” F35-44**
“My doctor is just like take this
antibiotic and call me in two weeks if
you’re not better.” F18-24**
**From AHAA™ user group database interviews, Ontario residents.
23
Why Patients Visit
• Specific health concern that traditional medicine can’t help
– Often coming in as a last resort for concern not resolved by traditional
Med/Rx
– Different from 2011 phone survey which identifies “seeking a more
natural approach to health/wellness” as primary reason to visit ND
• Patients who consider NDs as cheaper, less invasive, first option
• Patients looking for a more natural, gentle modality
• Prevention
“If the patient identifies stress,
“…referral from friend, other
practitioner or media….start with
issue management and work
towards preventative care.” ND=
mental/emotional factors as a
contributor to their disease state, they
will seek naturopathic care.” ND=
“Chronic conditions usually no
doctor can fix.” ND=
= Responses from OAND online survey. October 2013.
24
Prevention is an Underdeveloped Mindset
• Few patients’ initial visits are prevention focused
• Prevention is an effective way to convert them into loyal patients
• An adjunctive perspective
“Some are coming for prevention, like
their mom got breast cancer and they
want to take steps to reduce their risk.”
ND, 1 year in practice.*
“When I see people for the first time in my
clinic, they never feel they are in good
health. They’re never here to preserve
their good health”
ND, 11 years in practice.*
“Nobody comes in with ‘prevention’
written on their intake form. Once I
deal with what’s bothering them, I
can usually start a conversation about
family history and prevention. ”
ND, 11 years in practice.*
“Once they’re coming in regularly,
and seen some results, I can get
them to start thinking about
prevention. ”
ND, 10 years in practice.*
* TDC phone interviews with OAND members. September 2013.
25
People Need a Reason to Go
• Few go for prevention
• The very healthy don’t have a reason to visit
“It’s expensive to go, so I need a
reason.” F18-24**
“I have no reason to go. I’m
happy with what my doctor
and dermatologist have done
for me.” F35-44**
“I’ve never considered it. I was brought
up to see a MD and I think I’ll just
continue to see doctors of that
profession.” F35-44**
**From AHAA™ user group database interviews, Ontario residents.
26
Overview
• Patient Profile
• Awareness Interest
• Consideration/Selection
– ND
– MD
– other CAM providers
• Keeping Patients
• Losing Patients
• Practice Building
27
Marketing/Outreach
• Few NDs do formal marketing/promotion
– NDs with 10+ years experience do almost none
• Tactics that lead to a personal connection are most effective
– Tradeshows/fairs
– Free consultations
– Radio shows/talks, local media exposure
• Google ad words common tactic with younger NDs
28
Finding a Naturopathic Doctor
• Word of mouth (WOM) is the strongest practice builder
–
–
–
–
Girlfriend to girlfriend
Co-worker to co-worker
Female to male
Like begets like (i.e. fertility patients bring in more fertility patients)
• Referrals from adjacent practices (i.e. chiropractor, acupuncture, etc.)
• Men seem more likely to find ND through web search
“I have a successful blog that attracts new
patients…most of my patient base has
come from me giving talks.” ND=
“I get a few referrals from MDs, not
many, but I like to get them—they are
usually good patients.”
ND, 15 years in practice.*
“I ask all of my patients how they found
me and there are only 2 answers: online
or word of mouth.” ND=
“Midwives love us, we get a lot
of referrals through that
channel.”
ND, 15 years in practice.*
= Responses from OAND online survey. October 2013. * TDC phone interviews with OAND members.
September 2013.
29
Choosing/Finding
• Methods most often mentioned when finding/choosing an ND
– WOM
Friends
Family
MD
– Online reviews/comments
– Geography very subjective
Some people are willing to travel long distances, others are not
30
Online Listening
Dec
Dec
Dec
Charts show that ‘naturopath’ search
is essentially flat worldwide, but is
slowly trending up in Canada.
Dec
Dec
Dec
Dec
Dec
Dec
Worldwide
Canada
Source: Google analytics. Accessed October, 2013.
31
Online Listening
Search: Naturopath
Regionally, ‘naturopath’ searches are
clustered in Australia and Canada. Within
Canada, searches are most intense in BC,
followed by Ontario and Alberta.
Worldwide
Canada
Source: Google analytics. Accessed October, 2013.
32
Online Listening
Naturopath
Naturopathic
doctor
In Canada, ‘naturopath’ is searched for
more often than ‘Naturopathic doctor’, or
‘Naturopathic medicine’, and is growing as
a search term.
Naturopathic
medicine
Naturopathy
Source: Google analytics. Accessed October, 2013.
33
Online Listening
‘Naturopath’ is most widely used in B.C.
‘Naturopathic doctor’ is most widely used
in Ontario.
Naturopath
Naturopathic Doctor
Source: Google analytics. Accessed October, 2013.
34
Online Listening
“He is knowledgeable, patient, and has always been
there for me. He has corrected problems that have been
longstanding for years. ”
Positive comments (technical)
“My naturopath is incredibly helpful, finding
solutions to problems that doctors ignored…”
- Knowledgeable/intelligent
- Effective
- Fair prices
“He makes a difference when other doctors give up. Thanks
for not turning your head the other way.”
“Seemed very knowledgeable and
listened to my concerns. Did not feel
rushed during my appointment –
very rare nowadays!”
“Along with being very
knowledgeable in his field, he is
kind and extremely easy to talk
to.”
“This man is incredibly smart and intuitive. He is generous
and giving and humble.”
“I feel very comfortable with [Dr], in part because of her
extensive research background with leading institutions like
Sick Kids Hospital.”
Source: Ratemds.com, Yelp.ca comments on Toronto naturopaths. Accessed September 2013.
35
“He is the first doctor to really listen to my
bizarre symptoms and believe in me…we are
figuring this out together. Extremely
professional, knowledgeable and kind.”
Online Listening
Positive comments (emotional)
- Great relationships
- Trusting
“I find her to go above and beyond
in terms of time and effort and am
most impressed with her vast
amount of health knowledge.”
“A great physician who actually
really cares about his patients
ad provides them with
treatment that actually works!”
“She is just a superb human being…She just genuinely
cares about her patients…incredibly compassionate
and extremely professional.”
“…excellent naturopathic doctor who has helped me
tremendously. Going to this clinic makes you feel like
family rather than a patient.”
“I call him whenever I need something, and I trust him
with my life. He has helped me with so many health issues
that no doctor could assist me with.”
“As a long time skeptic, [Dr] has done so much good for me. He
is a personable guy and actively listens to your concerns.”
Source: Ratemds.com, Yelp.ca comments on Toronto naturopaths. Accessed September 2013.
36
Online Listening
Minimal negative comments
• Expensive/driven by money
• Not effective/knowledgeable
“This doctor is only concerned with making
money. His treatments are band-aid solutions
and he always recommends expensive
remedies that never work for me.”
“Attempted to treat me with iron
supplements on a whim. If I hadn’t stopped
taking them, I would have gotten iron
poisoning. Don’t waste your time or money. ”
“3 visits of about 45-60min per visit at $80 for every 15
min. no relief! But assured I would be cured after 10-12
visits. I feel really ripped off!”
“I made a huge mistake when I bought
service package ($1450) that included
expensive tests that he doesn’t know how to
read. You are better off with Dr. Google.”
“Seems more interested in selling her snake
oil treatments that a quacky machine tells
her to make. GIANT money making scam”
“…a great sales woman. She does NOT
tolerate you seeing related practitioners…SHE
ONLY CARES ABOUT THE MONEY; not you”
Source: Ratemds.com, Yelp.ca comments on Toronto naturopaths. Accessed September 2013.
37
Overview
• Patient Profile
• Awareness Interest
• Consideration/Selection
– ND
– MD
– other CAM providers
• Keeping Patients
• Losing Patients
• Practice Building
38
Position in the Spectrum of Care
• Most see NDs as complementary/adjunctive to traditional medicine
• People appreciate the contradictions/conflicts between MDs and
NDs
– Feel that both disciplines have skills and limitations
“I would like to see the ND and the
MD together so that they balance
each other out.” F35-44**
“I use my MD to get referrals so that
they are covered .” F25-34**
“I think they’re [NDs] good at
things that aren’t true medical
problems.” F45-64**
**From AHAA™ user group database interviews, Ontario residents.
39
Differences from Traditional Medicine
•
•
•
•
•
Spend more time with each patient
Focus on holistic health
More gentle modalities
Extra caution around meds
House calls
“People no longer see their
doctor as a god, they are more
realistic about their
limitations.”
ND, 4 years in practice*
“A lot of patients are frustrated
by the lack of caring from their
MDs.”
ND, 8 years in practice*
* TDC phone interviews with OAND members. September 2013.
40
Competitive Advantages
• A patient-centered approach
“You know, [some patients have] never really had any great explanations” 1
“I spend time with my patients. I think that's maybe something that some of the other
healthcare groups don’t do.” 1
• Time spent with the patient also facilitated the other roles of
education and focusing on prevention1
1. Hollenberg, D., Lytle, M. Walji, R. Cooley, K. (2013). Addressing provider shortage in underserviced
areas: The role of traditional, complementary and alternative medicine (TCAM) providers in Canadian
rural healthcare. European Journal of Integrative Medicine. 5(1): 15-26.
41
Negatives about NDs
• Lack of coverage – especially for diagnostics
• Overuse of supplements
“It’s $500 for a consultation, way too
much.” F18-24**
“It drives me crazy that they
instantly go to supplementation
versus trying changes to diet and
exercise.” F25-34**
“People say they are good listeners,
but I say they are worse because
they need a lot more time to get to
the point.” M18-24**
“They gave the same stuff
[supplements] to me and my kid,
even though we came for different
reasons. It didn’t make sense and
didn’t seem like it was needed.”
M18-24**
**From AHAA™ user group database interviews, Ontario residents.
42
Accurate Idea of ND Approach
• Very positive overall perception to naturopathy
– Nearly 100% with AHAATM group, 57% from 2011 phone survey
– Public can accurately describe what a naturopathic doctor is and how they
treat/heal
– Naturopathic doctors described as:
Using natural sources – not prescribing Rx
Using a natural approach that includes looking at diet and exercise
Having holistic mindset
Looking at the body’s deficiencies
43
Lack of Awareness Regarding ND Training
• Very little awareness of the amount of education NDs possess
• Naturopathic medicine seen as a hobby
– Very different from traditional medical practice
“My mom is studying it.”
F35-44**
“Oh, my aunt’s a naturopath, she’s
read all the books.”
F35-44**
“I take my dog to a naturopath at
the Vet.”
F35-44**
**From AHAA™ user group database interviews, Ontario residents.
44
Relationship with MDs
• MDs not a strong barrier to use
– Cultural shift to recognizing MDs as no longer having all the answers
– Offer little/no guidance on NDs
• Negative MDs can slow down (but not prevent) process (i.e. refuse
to share medical records) but few actively prevent patients from
going
– Most common objection: it’s a waste of time and money
“MDs are usually passive resisters, but it’s
not a relationship you want to upset for
the patient.”
ND, 11 years in practice.*
* TDC phone interviews with OAND members. September 2013.
45
Relationship with Other CAM Professionals
•
•
•
•
Lots of office sharing (one stop shop concept)
Many referrals within CAM
Keeping people within CAM is a strategy to develop patient loyalty
Differentiator from traditional medical practice
46
Rural Ontario CAM Usage
• A lot of rural usage driven by medical doctor shortage, financial
resources, transportation and distance to traditional healthcare
services1
• Physician shortages are exacerbated by geography1
– 14% of Ontario family physicians and 2.5% of Ontario specialists are
caring for Ontario's rural patient population, which represents
approximately 20% of the province
1. Hollenberg, D., Lytle, M. Walji, R. Cooley, K. (2013). Addressing provider shortage in underserviced
areas: The role of traditional, complementary and alternative medicine (TCAM) providers in Canadian
rural healthcare. European Journal of Integrative Medicine. 5(1): 15-26.
47
Complementary Care From NDs
Not On Equal Footing with MDs
• CAM providers may become important as “other” types of healthcare
providers who may assist with Canadian rural models of care1
• There is little physician-initiated communication regarding patients’
use of CAM1
“… I certainly am many people's [patients’] only doctor because they [patients] don’t have
a medical doctor, so they do all their Paps with me and all their blood tests, regular checkups and everything else.” 1
“There are some patients of mine that have a hard time getting in to see their doctor, their
medical doctor. There are patients that don’t have MDs, so there are times where I may be
the only health provider that's doing a physical exam or running blood work.” 1
1. Hollenberg, D., Lytle, M. Walji, R. Cooley, K. (2013). Addressing provider shortage in underserviced
areas: The role of traditional, complementary and alternative medicine (TCAM) providers in Canadian
rural healthcare. European Journal of Integrative Medicine. 5(1): 15-26.
48
Government Regulatory Changes Have
Impact on Attitude for Some
• Little change to the positives/users
• Positive effect on the neutrals/nonusers
“Regulations aren’t as important as
hearing from people .”
M45-54**
“I’d be scared giving them too much
power without regulation.”
F18-24**
**From AHAA™ user group database interviews, Ontario residents.
49
Overview
• Patient Profile
• Awareness Interest
• Consideration/Selection
– ND
– MD
– other CAM providers
• Keeping Patients
• Losing Patients
• Practice Building
50
Barriers
•
•
•
•
Knowledge
Mindset
Cost of tests/diagnostics
Cost/coverage a limiting factor
“Canadians are reluctant to spend any
money on their health so I try to
advertise the value of my services.”
ND=
“Many patients won’t come back
that year once their coverage runs
out. But once the new coverage
cycle begins they usually come
back.” ND=
“Cost and fear of repercussion from
their family doctor.” ND=
“There are still a lot of misconceptions
too…I have people telling me that they
want to continue to see their MDs as if
they fear I would advise them not to!”
ND=
“No insurance coverage so we might
only have 1-2 visits.” ND=
= Responses from OAND online survey. October 2013. * TDC phone interviews with OAND members.
September 2013.
51
Keeping Patients
• Clinical AND emotional connection needed in first visit
– Make some kind of difference on the very first visit
• Develop a real connection
– Outreach should always be conversation starters
– ‘A quick win’, an emotional connection or a health insight is key
“About 90% of people I see for a
free 15 minute consultation will
book a full appointment.”
ND, 11 years in practice.*
“If you can shed some light on the
issue they are having, just one or two
sentences, they are sold.”
ND, 15 years in practice.*
“Obviously if you make people feel better,
they will come back. I also feel that
personality goes a long way.” ND=
“Trust and the establishment of a relationship
with my patients.” ND=
“If I can get a patient in the door, I have a
very good chance of keeping them.” ND=
* TDC phone interviews with OAND members. September 2013. = Responses from OAND online survey.
October 2013.
52
Keeping Patients
• Setting expectations
• Follow-up
• Don’t overprescribe/oversell
natural health products (NHPs)
“Great results, excellent customer
service….” ND=
“If you send them out the door with
$400 worth of supplements, you’ll never
see them again.”
ND, 11 years in practice.*
“Making sure to book them in for their next
visit when they get to reception is really
important.” ND=
“Follow up is key, as is getting results.” ND=
“Cost would be the number one
challenge…ensuring new patients
know not every visit will be as long
and expensive as the first 2 is
important. I also try not to
recommend any supplements until
the 3rd visit in so their bill isn’t too
high right from the start.” ND=
“When finances are tight, I use
primarily body-work and
diet/lifestyle to eliminate/reduce
cost of supplements.” ND=
* TDC phone interviews with OAND members. September 2013. = Responses from OAND online survey.
October 2013.
53
Losing Patients
• They feel better
– Not converted to a prevention mindset
• Life overwhelms them
– Particularly true of new mothers
• They’re deeply entrenched in the traditional medical world (i.e. the
very sick)
“Patients disappear because
they feel better. They don’t
often call back to say hey I feel
great now.”
ND, 11 years in practice.*
“Their busy schedule. Lack of
commitment to the process.” ND=
“…it’s convincing regular patients to
move into health maintenance once
they’re out of physical discomfort that
I struggle with.” ND=
“The treatment plan is hard, the therapies
are hard, changing lifestyle.” ND=
* TDC phone interviews with OAND members. September 2013. = Responses from OAND online survey.
October 2013.
54
Losing Patients
• They were skeptical in the first place
– Do-it-yourselfers, self-prescribers, dabblers/specialist day-trippers
– Self-described experts
• Personality clash
– ND/patient relationship relies heavily on fit, like a friendship
• Extremely ill – fear of the unknown
“Some people are put off by the
tough questions we ask.”
ND, 6 years in practice*
“If I lose a patient it’s usually a
screening and intake problem.”
ND, 8 years in practice*
“If a patient hasn’t completed everything in
their plan they cancel or push back their next
visit…self sabotage?” ND=
“When [older patients] health really starts
to fail they tend to go with the familiar
which is most likely orthodox medicine.”
ND, 10 years in practice*
* TDC phone interviews with OAND members. September 2013. = Responses from OAND online survey.
October 2013.
55
NHP Detractors
• Focus on exclusive alternative use
• “Killed Steve Jobs”
“It is one thing to note the obvious, the added benefits of healthy choices for a body; it is
quite another to assert that they can replace scientifically-proven medical treatments to
treat diseases already present.” 2
2. Flanagan, T. (2013). The scientific method and why it matters. C2C Journal. 7(1)
56
Overview
• Patient Profile
• Awareness Interest
• Consideration/Selection
– ND
– MD
– other CAM
• Keeping patients
• Losing patients
• Practice Building
57
Knowledge Gaps
• Level of education
– Trained to treat the same conditions as MDs
– Primary care physicians
“Many need to know we are
educated and have the
education to treat & diagnose
just as MDs.” ND=
“We have a minimum of 8 years of
education comparable to MDs.” ND=
“We can help with PRIMARY CARE and
do the job of a GP for those who may not
have one… ” ND=
= Responses from OAND online survey. October 2013.
58
Knowledge Gaps
• Substitute for MDs vs. offers something unique from MDs
• Most people have coverage for NDs
“We are not an alternative or
equivalent to medical doctors. What
we offer is unique…” ND=
“It is a superior substitute for the
lackluster care given by most
family doctors.” ND=
“Evidence based, effective.”
ND=
“…we are covered by many
private insurance plans.” ND=
“We need to be much more confident in our
medicine and our value. Too many NDs only
seem to want to do “evidence based
medicine”…the current MD model of
evidence based medicine is failing too many
people.” ND=
= Responses from OAND online survey. October 2013.
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Patient Types Where Naturopathy Makes a
Real Difference
• Complex cases, e.g. “Nobody knows what’s wrong with me.”
– Not helped with traditional medicine
• Ideological opposition to Rx/traditional medicine a minority segment
– Most patients also have a primary care MD
• Prevention
– Higher level of anxiety in this patient class
– Typically a female between 30-50
• General/primary care
– Especially in rural communities where access to MDs may be limited
“I see a lot of GI concerns,
mental-emotional distress.” ND=
“Most common are digestive
issues…mental health
(anxiety/depression).” ND=
= Responses from OAND online survey. October 2013.
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Underserved Categories
“The elderly in Ontario are over
medicated. We can help a lot of
them cut down on their meds.”
ND, 15 years in practice.*
• Varies widely, common themes:
– Men
Back/MSK, GI
– Children
Allergies, Diet, ADD
– Teens
Allergies, Derm (acne), Weight, Stress/Anxiety
– Elderly
“There’s amazing things we can do
for male diseases like cardiovascular
disease, hypertension, back...”
ND, 12 years in practice.*
Reduced dependence in Rx, Vitality
Consensus that this group is treated poorly by MDs: they just medicate and send them home
– Diabetes
“I’ve got elderly with 12 different medications and you
can tell their MD doesn’t really care about their case.”
ND, 1 year in practice.*
* TDC phone interviews with OAND members. September 2013.
61
Insights
• Very positive associations with naturopathy
– Near 100% among subjects (AHAATM group)
– 72% of Ontarians have a positive impression of naturopathic medicine5
• Coexistence within greater spectrum of care desired
– Problematic second best position for NDs
• From a patient perspective, good MDs are ‘very similar’ to NDs in
their approach to care and present a strong barrier to ND use
• Problematic relationship/classification with some other CAM
practitioners
• Strong sense of public service among NDs
– Saving healthcare system money
– Taking on the cases that traditional medicine has abandoned
• ND professionalism is not well understood
5. Innovative Research Group. (2011). Attitudes toward naturopathic medicine
62
Next Steps
• R&D:
– OAND Internal Review (Oct 21-24)
– OAND to TDC Approval to Proceed (Oct 25)
• Strategic Platform:
–
–
–
–
TDC Working Period (Oct 28-Nov 8)
TDC Presentation (w/o Nov 18)
OAND Internal Review (Nov 25-28)
OAND to TDC Approval to Proceed (Nov 29)
63
APPENDIX
64
References/Bibliography
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Hollenberg, D., Lytle, M. Walji, R. Cooley, K. (2013). Addressing provider shortage in underserviced areas: The
role of traditional, complementary and alternative medicine (TCAM) providers in Canadian rural healthcare.
European Journal of Integrative Medicine. 5(1): 15-26.
Flanagan, T. (2013). The scientific method and why it matters. C2C Journal. 7(1)
Wardle, J. et al. (2013). Current challenges and future directions for naturopathic medicine in Australia: a
qualitative examination of perceptions and experiences from grassroots practice. BMC Complementary and
Alternative Medicine. 13(15)
Nguyen, L. et al. (2010). Use of complementary and alternative medicine and self-rated health status: results
from a national Survey. J Gen Intern Med. 26(4): 399–404
Innovative Research Group. (2011). Attitudes toward naturopathic medicine
Millar, W. (1997) Use of alternative health care practioners by Canadians. Canadian Journal of Public Health.
88(3): 154-158
Blais, R et al. (1997) How different are users and nonusers of alternative medicine? Canadian Journal of Public
Health. 88(3): 159-162
Wolsko, P. et al. Insurance coverage, medical conditions, and visits to alternative medicine providers. Arch Intern
Med. 162(3): 281-287
Richardson, J. (2004). What patients expect from complementary therapy: a qualitative study. American Journal
of Public Health. 94(6): 1049-1053
Harmon, S., Ward, C. (2007) Complementary and alternative medicine: awareness and attitudes. Academy of
Health Care Management.
Astin, J. (1998). Why patients use alternative medicine. JAMA. 279(19): 1548-1553
Canada. Statistics Canada. Access to a regular medical doctor, 2010
Briggs, B. (2012, November 14). Too tough to get sick: why men won‘t go to the doctor. MSNBC News.
Retrieved from: http://www.nbcnews.com/
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OAND Member Interviews Discussion Guide
Discussion Guide
August 26th, 2013
Draft V01
Objectives
Identify common business challenges Naturopathic Doctors (NDs) face in running a
successful practice
Identify ways in with the OAND can help/guide their members
Questions
How likely is a new patient to return for a second visit? Probe:
In-office experience
Solution(s) offered
Compliance issues
Cost/convenience
Returning/regular patients:
What percentage of your patient consults are with returning/regular visits?
What is the gender split (in %)? Probe:
If not 50/50 why?
Do your patients also have a traditional doctor?
Who we are, disclosures, etc.
Purpose – how information will be used
Confidentiality
20 minutes in length
Briefly describe your practice
Potential patients:
Generalist vs. specialist
What patient types are you not seeing that ND could be helping?
Solo/group practice
Why do you think they are not coming in?
Years in operation
Cost – insurance coverage, income ranges
Typical patient experience in your practice (# of visits, time in office, treatment
programs, results)
Effort – finding, visiting, program compliance
New patients:
Trust – proof, detractors, alternatives
How do new patients learn about naturopathic medicine?
OAND Support:
How do new patients select a ND (i.e. you) to visit?
Should OAND be promoting naturopathic medicine awareness?
What issues/ailments typically bring in the most new patients?
Promote industry
What else drives new patients? Probe:
Partnerships/lobbying
Dissatisfaction with traditional medicine
Should OAND be helping clinics find patients?
Control over your healthcare/health choices
Key word searches
Relationship with healthcare provider
Find a ND capabilities
Cost
Should OAND be helping members build a successful practice?
Convenience
Help members effectively manage clinic
Lunch n learn
Workshops, etc.
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OAND Member Online Survey 1 of 2
•
•
•
Thank you for taking the time to answer a few questions about your patient population and for providing your perspective on the
drivers and barriers to seeking naturopathic care. Your responses will be invaluable in developing OAND's marketing strategy with
the general public in Ontario. Please press the Start Survey button below to begin.
*1. Are you currently practicing as a Naturopathic Doctor?(*Required)
Select one.
–
–
•
*2. How long have you been/ were you practicing as a Naturopathic Doctor?(*Required) Select one.
–
–
–
–
•
•
Less than 5 years
5 to 10 years
11 to 20 years
More than 20 years
*3. Is/ was your practice located in a small town/rural, suburban or urban area?(*Required) Select all that apply.
–
–
–
•
•
Yes
No
Small town/ Rural
Suburban
Urban
*4. Please enter the first 3 digits of the postal code for your practice in the box below.(*Required)
5. How would you describe your patient population? Are all your patients very similar, do they fall into distinct subgroups, or are
they all very different? Please describe any defining characteristics of your patient population (i.e.: age, gender, education,
attitude, life experiences, health status)
6. What situations typically drive new patients to seek naturopathic care with you? Please describe any health issues, health
goals, experiences, etc. that commonly bring new patients to your practice.
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OAND Member Online Survey 2 of 2
•
•
•
•
•
•
•
7. In your experience, how do your new patients first learn about naturopathic medicine?
8. How do new patients go about selecting you as their naturopathic doctor? e.g.: ND referrals, yellow pages, walk-ins, friend
referrals
9. What are some of the barriers to seeking naturopathic care for some of your potential patients? Please describe any successful
strategies that you have implemented to overcome these barriers.
10. What are some of the drivers of return/ regular visits?
11. What are some of the challenges in getting new patients to return or to become regular patients? Please describe any
successful strategies that you have implemented to overcome these barriers.
12. In your opinion, what does the general public need to know about naturopathic medicine that they do not currently know in
order to be motivated to take action and seek an ND?
13. Do you have any other comments/information to share?
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AHAATM (Ontario Public) Discussion Guide
1of 2
Draft for OAND/AHAATM Discussion Guide
Sept 12, 2013
INTRO
How and why data being used
20 min length
Recorded
Confidentiality
$25 honorarium
HEALTH STATUS
Describe your current health
Anything you would describe as a chronic pain/discomfort/illness?
In a typical 12 months how many trips do you make to a healthcare provider?
What are general the reasons for each?
Include NDs, ERs
***based on AHAATM profile, verify on phone which section from the below three to use
with subject***
CARE PROVIDERS (MD ONLY)
What reasons prompt you to visit your MD?
Who do you actually see in the office?
Are they helpful?
Do they listen to you?
Do you feel they devote enough time to you?
How do you feel after a typical visit?
Probe for feelings of satisfaction, anxiety, etc.
If you had an extremely unsatisfactory experience with you MD, what would you do?
CARE PROVIDERS (ND ONLY)
What reasons prompt you to visit your ND?
Who do you actually see in the office?
Are they helpful?
Do they listen to you?
Do you feel they devote enough time to you?
How do you feel after a typical visit?
Probe for feelings of satisfaction, anxiety, etc.
If you had an extremely unsatisfactory experience with you ND, what would you do?
CARE PROVIDERS (MD & ND)
Who do you consider your primary care provider?
How do you decide when to go to each one?
Do they interact well i.e. share information?
Do they both listen well?
Do they both spend enough time with you each visit?
How do you feel after a typical visit with each?
Probe for feelings of satisfaction, anxiety, etc.
If you had an extremely unsatisfactory experience with your ND or MD, what would you do?
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AHAATM (Ontario Public) Discussion Guide
2 of 2
ND KNOWLEDGE (FOR EVERYONE)
How would you describe the practice of naturopathy?
How do you think they are different from a MD?
What types if illnesses/issues do you think they are most effective in resolving?
What types if illnesses/issues do you think they are least effective in resolving?
Are they covered by your health insurance?
Are they expensive?
Is it hard to find a good one?
ND ATTITUDE (FOR ND NONUSERS)
Have you ever considered visiting a ND?
Why/why not?
What would it take to get you to visit one?
Probe:
Personal recommendation
Recommendation from MD
Specific issues
Cost/coverage change
Government regulations
Scientific proof
ND ATTITUDE (FOR ND USERS)
Do you see yourself visiting your ND more or less in the future?
Why/why not?
Does government regulation/endorsement of NDs change your perception of them,
how?
Do you ever recommend your NDs to friends/family?
Under what circumstances?
What do you say?
What do they say?
What’s the best thing about NDs?
What’s the worst thing about NDs?
70