A Naturopathic Safety Net, Primary Care for Portland’s Underserved

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Carrie Baldwin-Sayre, ND, first worked with homeless youth through a local organization, Outside In, during an internship while in school. Fast forward to today. Her passion for helping the underserved continues unabated through Dr. Baldwin-Sayre’s work as associate dean of clinical education for National University of Natural Medicine (NUNM) and its safety-net community clinics. She believes that naturopathic primary care and complementary care help support our vulnerable populations, including those on Medicaid, uninsured, underinsured, undocumented, and who have low or no income. Here’s Dr. Baldwin-Sayre’s story about how naturopathic medicine has a positive impact on the Portland community. 

A Typical Day at the Clinic

Carrie Baldwin-Sayre, ND

Dr. Baldwin-Sayre describes a typical day. “I work at our main on-campus clinic, the NUNM Health Center – Lair Hill. It is one of 10 health centers and community clinic sites where NUNM students provide health care to the community. To understand our patient population, it helps to know how services are paid for. About one-third of our patients use Medicaid (state insurance for low-income Oregonians), one-third have private, commercial insurance, and the last one-third are self-pay.”

The clinic patients have a wide array of concerns and medical conditions, and many come for preventive services like annual visits and screenings. Some haven’t seen a doctor in many years and have overlying complex medical needs that cannot be addressed by natural methods alone. 

“I supervise six to eight 3rd and 4th-year medical students and one resident during a five-hour, weekly shift,” Carrie explains. “We provide healthcare services for patients with acute and chronic conditions ranging from colds and flu to diabetes, heart disease, and mental illness. Alongside our students, I help educate our patients about nutrition and lifestyle from the standpoint of the individual and offer relevant recommendations based on what the patient is able to do and what they can afford. I prescribe herbs, nutritional supplements, and pharmaceuticals, depending on what the patient needs and desires.” 

Carrie adds, “NUNM clinic staff always work with a patient-centered approach and never assume that what works well for one person will be good for another. Naturopathic principles are always at the heart of our work and the concept of ‘first do no harm’ extends not only to potential harms from side effects of treatment but the financial harm of high-cost treatment, as well.”

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The State of Health in Portland

To provide context to this story, here is a description of some of the factors impacting health care in Portland, Oregon. Portland has experienced tremendous growth in recent years, especially in the tech world, with some calling it the “Silicon Forest.” This growth has strengthened Portland’s economy but has also increased income disparity driving up housing prices and cost of living. Unable to afford this higher cost of living, Portland’s homeless problem has rapidly increased in the last five years, with a city government racing to find ways to address the problem. Recent estimates in Multnomah County alone identified 4,177 people without homes on any given night, up 10% from 2015. 

And with homelessness comes health problems. Experts describe the physical and psychological aspects of homelessness as a public health concern (Schnazer, Dominguez, Shrout, & Caton, 2007). The American Psychological Association (APA) paper on homelessness and health further details:

  • Correlations of poor physical health with those in poverty and who are without homes
  • Rates of mental illness twice the rate found in general populations
  • Higher rates of depressive disorder, tuberculosis, hypertension, asthma, diabetes, and HIV/AIDS than the general population

In addition to homelessness, Portland, like any city, also has a large percentage of people struggling to make ends meet. They may have a home, but they’re constrained by low income. They may lack health insurance or receive Medicare.

What makes Portland unique, however, is its effort to create healthcare solutions for those who need it.

Increased Access to Primary Care Solves Problems

Oregon hasn’t been willing to simply chase problems, understanding that improving health care would require a multifaceted approach. In 2009, the Oregon legislature established the Patient-Centered Primary Care Home (PCPCH) program. The goal was to increase access while lowering costs to primary care across the state, including the growing Portland area. This meant providing preventive care and lifestyle modification, in addition to acute care and diagnostics approaches. As part of this push for primary care access, currently, 10 clinics are associated with NUNM. 

Care programs must promote six Core Attributes: Accessible, Accountable, Comprehensive, Continuous, Coordinated, and Patient and Family-centered.

While some may have felt this program was a gamble, a multi-year study by Portland State University shows that this approach works. Results include:

  • $240 million in healthcare savings in just the first three years
  • $41 savings per patient, per quarter
  • $13 in savings for every additional $1 invested

And when it comes to primary care, naturopathic doctors are uniquely positioned to provide an exemplary whole-patient approach.

How Naturopathic Care Treats the Whole Patient

Key tenets of naturopathic care for underserved individuals are listening and empathy. When a patient has a complex set of medical concerns, there isn’t necessarily a quick fix for that, naturopathic or otherwise. Naturopathic doctors take the time to listen to patients over multiple visits if necessary, trying to understand the person as a whole. 

  • What are all the contributing factors to what is going on for them?
  •  Is it a lack of housing? A lack of access to healthy food or a lack of specific knowledge about the benefits of a healthy diet? 
  • Are there financial or other stressors? 

Dr. Baldwin-Sayre describes a typical day. “I work at our main on-campus clinic, the NUNM Health Center – Lair Hill.

NUNM’s clinic physicians and residents are known for taking the necessary time and effort to help patients not only with their health concerns but with getting access to resources and social services to help address underlying causes that create and maintain the illness. These physicians also help patients understand the factors that contribute to chronic illness, versus simply putting a “bandaid” on the symptoms. 

For example, Carrie notes, “If we have a patient with long-standing, untreated hypertension, it is crucial for that patient have their blood pressure lowered as soon as possible. It is also important that we help them protect their heart, arteries, and kidneys from damage. If the stressors and dietary choices that led to the high blood pressure in the first place are not remedied, the likelihood of that individual simply needing higher and higher doses of blood pressure medication over time is very high. A comprehensive, incremental plan, is then provided that focuses on stress management techniques, nutrition, and exercise, while also using the most cost-effective treatments available for lowering blood pressure.“

Naturopathic doctors like those at NUNM provide the comprehensive and accessible care needed in the Portland community–making a difference in the lives of the patients they assist.

Naturopathic professionals: 2019 marks 100 Years of Licensure in the United States. Celebrate the past, present & future of naturopathic medicine at AANP 2019, the Annual Convention on August 15-17 at the Oregon Convention Center and explore more of the fabulous naturopathic community in Portland.

Carrie Baldwin-Sayre, ND

Dr. Carrie Baldwin-Sayre is the associate dean of clinical education for the College of Naturopathic Medicine at the National University of Natural Medicine (NUNM) and president of the Oregon Association of Naturopathic Physicians (OANP). Dr. Baldwin-Sayre works with patients, students and residents as an attending physician in the NUNM Health Centers, as well as a clinical assistant professor at Oregon Health & Sciences University. As associate dean, she seeks to create and maintain high standards of excellence within the clinical curriculum. Her mission is to respond to the changing demands of the transforming healthcare landscape by helping NUNM produce the highest quality naturopathic physicians in the country.

About The Author(s)

INM's team is made up of naturopathic doctors and health journalists.

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