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

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.”

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.

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

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Deb Hubers

Debra Hubers is a serial entrepreneur and has started seven businesses; ranging from an advanced genomics to an employer health care purchasing cooperative. Deb has over 35 years of experience in healthcare finance, education, technology, and pharmacogenomics.

Ms. Hubers has dedicated her career to measuring and improving healthcare outcomes. Her expertise is leveraging technology to deliver personalized, preventative medicine. Ms. Hubers co-founded La Vita Compounding Pharmacy in 2007. Collaborating with her business partner, physicians and strategic partners, Deb has grown La Vita to be one of the most respected and sought-after personalized medicine providers on the west coast. She is also Co-Founder of EpigeneticsRx, a leading provider of precise, personalized, prevention which positively impacts genetic expression.

Alex Keller, ND

Dr. Alex Keller, ND, AFMCP is a graduate of the University of Ottawa with an Honours Bachelor in Health Sciences and Psychology. Although originally intending to attend conventional medical school, following a three-month volunteer internship at a rural Kenyan hospital where he observed how doctors used local food to treat patients, he shifted his career goals and pursued a degree in naturopathic medicine at the Canadian College of Naturopathic Medicine in Toronto.

After one year of practicing with the esteemed Dr. Chris Pickrell, ND, RH in a community acupuncture setting, in 2015 he and his wife Dr. Jenn Keller, ND moved to rural Ottawa, Canada where they started an organic farm and retreat center. In the same year, Alex and his athletic therapist sister Jess Keller combined their practices to form Keller Active Health, an integrative physical therapy clinic.

Ever curious and passionate about the education of evidence-based natural medicine, in 2017, Dr. Keller joined a fledgling Ottawa-based health tech startup named Fullscript. He serves as its Medical Director and oversees the development of medical education content for practitioners across North America.

Prior to medicine, Alex worked in the renewable energy sector, where he developed a deep passion for sustainable agriculture and environmental stewardship. This connection between medicine and agriculture now drives Alex to focus much of his energy on bringing awareness to the quality and sourcing standards in the supplement and organic agriculture supply chains.

Today, he splits his professional time practicing as a clinician, working for Fullscript, and expanding the farming operation while chasing his kids with Jenn and occasionally running ultra-marathon trail races. He is also currently completing an Executive MBA through the Quantic School of Business & Technology with a focus on supply chain innovation.

Pamela Snider, ND

Pamela Snider, ND, is Executive and Senior Editor for the Foundations of Naturopathic Medicine Project, producing a first of its kind international textbook of Naturopathic medicine through a series of international retreats and symposia. A nationally recognized integrative health and policy leader, she is active in both national and regional integrative health initiatives. Dr. Snider serves on the Board of Directors, was founding Executive Director and co-founder of the Academic Consortium for Integrative Health (ACIH/ACCAHCa consortium of the councils of schools, accrediting agencies and certifying bodies of the licensed, traditional and emerging integrative health professions, and is currently Vice Chair and co-founder of the Integrative Health Policy Consortium (IHPC).  Dr. Snider served as a founding Board Member of the Academy of Integrative Health & Medicine from 2014-2016. Her public policy work includes completing a two year appointment to the DHHS Center For Medicaid and Medicare Services (CMS) Medicare Coverage Advisory Committee (MCAC); serving as a Steering Committee Member for  the HRSA funded American College of Preventive Medicine NCCIM Integrative Medicine in Preventive Medicine Residency program, co-directing in USPHS Region X the Building Bridges Between Provider Communities Group, an exploration of interdisciplinary collaboration and common ground between public health and CAM; serving for 22 years on Washington State’s Health Professional Loan Repayment and Scholarship Program Advisory Committee (HPLRSP); providing technical assistance to and developing key language for the enabling legislation for NIH Center for Complementary and Alternative Medicine (NCCIH/NCCAM); and staffing Joseph Pizzorno ND during his appointment as Commissioner on the White House Commission on CAM Policy.

From 1994-2003, Dr. Snider served as Associate Dean for Public and Professional Affairs and Naturopathic Medicine at Bastyr University, dividing her work between academic and public affairs activities, including chairing the Naturopathic Medicine Program Curriculum Review Committee.  Dr. Snider has been teaching, publishing and lecturing widely on Naturopathic philosophy, theory integrative health, public policy, and other topics for over 30 years. Currently, an Associate Professor at National University of Natural Medicine (NUNM) in Portland, OR, Dr. Snider also continues at Bastyr University in her 22nd year as a faculty member teaching naturopathic medicine history, clinical theory, and global context. Among her Naturopathic medicine professional roles she serves on the Institute for Natural Medicine’s Leadership Council.  In 1989, she co-led the naturopathic profession with Dr. Jared Zeff, in developing a unifying definition of naturopathic medicine and its principles of practice adopted unanimously by the American Association of Naturopathic Physicians (AANP) House of Delegates. She was a co-investigator in the 2004 NIH NCCAM research study, the North American Naturopathic Medical Research Agenda and CAM Advisor in NIHCCAM’s Financing Integrative Health Care (University of Washington).  Her areas of experience include healthcare education; naturopathic and interdisciplinary clinical theory, curriculum development; clinical practice; government and legislative affairs, public policy, interdisciplinary collaboration, and community organizing.  Dr. Snider has received the Ontario Naturopathic Physician of the Year Award, the Physician of the Year Award from the AANP, the President’s Outstanding Vision Award and Distinguished Alumnus Award at Bastyr University, AANP’s President’s Award, an honorary Doctorate of Naturopathic Philosophy from the Canadian College of Naturopathic Medicine (CCNM), the William A Mitchell Vis Award from the AANP and The Gathering – NMSA’s Beacon Award. She received her ND degree in 1982 from Bastyr University of Natural Health Sciences and is a licensed naturopathic physician in the State of Washington. She lives with her husband and children at their homestead in North Bend Washington, in the beautiful mountain to sea landscape and home of The Revival – Restore the Vis, an annual student-led community gathering.

Susan Haeger

Susan Haeger is Founder/Principal of Transformative Health Solutions Inc. She has applied her twenty plus years in executive leadership to help shape and drive adoption of progressive health policy for whole person healthcare. She was a section contributor to the 2021 INM/AANP published professional white paper, Naturopathic Physicians as Whole Health Specialists: The Future is Whole Person Health Care that provides supporting evidence for the profession’s significant and unique contributions to preventive, whole person care and models of integrative clinical practice.

Bruce Barlean

Bruce Barlean is an owner and founder of Barlean’s, a global dietary supplement manufacturer located in the Pacific Northwest in Ferndale, WA. Bruce has been actively involved in the Natural Products industry since 1989 and is passionate about making a difference in the world and positively impacting the lives of others.

Bruce believes that people can make a difference in the world through ordinary purchases. He is committed to improving the quality of life for every person on the planet by making the best products and by using the profits to support outreach programs. Bruce summarizes it simply, “We make good stuff to do good stuff”.

In the late 1980’s Bruce became passionate about how health could be dramatically improved with Flax Oil Supplementation. Bruce along with his entrepreneurial parents saw the potential to improve the lives of many people and in 1989 they began selling Flax Oil under the Barlean’s name. From 1989 – 2000 the business grew an average of 40% year over year. While most companies saw a decline in business in the 2001 recession, Barlean’s continued to grow and soon became America’s #1 selling flaxseed oil and continues to be to the present. The brand has since expanded to include additional oils, green food concentrates and other premium supplements. Bruce continues to drive innovation and over the years his products and company have won countless awards including: Eight consecutive Vity Awards for #1 EFA, Six consecutive Vity Awards for #1 Greens Food Supplement, Natural Choice Award for Best Specialty Supplement, Best Product of the Year, Best New Product, Gold Medal Taster’s Choice Award, Gold Medal American Masters of Taste Award, #1 Health Food Store Brand for Consumer Satisfaction by Consumer Lab, and Manufacturer of the Year.

In 2013 as the company was on the eve of celebrating the 25th year in business Bruce and his parents decided to take their desire to help people to a new level that they call Pathway to a Better Life – which is now seen in the Barlean’s logo. Bruce and his parents had always been generous in their giving and support of charities, but as part of the Pathway to a Better Life they decided to increased partnership with charitable organizations such as: Vitamin Angels, Compassion International, KidsTown International, Autism Hope Alliance, Engedi Refuge, Project 92, and others. And because so many people are unable to meet basic nutritional needs, Bruce created a comprehensive Omega-3 and multivitamin formula that he distributes free-of-charge to local food banks. In addition, Bruce decided the company would supply food banks with organic coconut oil to provide people with a health alternative to standard cooking oils.

Always generous with his time Bruce has served as a youth leader for his local church for several years and continues to mentor youth. He has been on several not for profit boards including; Whatcom County Pregnancy Center (2003-2006), Natural Products Association (dates?), and the Institute for Natural Medicine Leadership Council (presently).

The Barlean family have been avid supporters of Bastyr University since the 1990’s and in 2013 were given Bastyr’s most prestigious honor, the Mission Award, which recognizes their leadership over time in improving the health and well-being of the human community.

Bruce currently resides in Ferndale, WA with his wife Lisa and their two dogs: Heinz & Shadow. When he’s not helping others he can be found fishing (catch & release).

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Michelle Simon

Michelle Simon, PHD, ND

President & CEO

As president and CEO of INM, Dr. Simon brings her passion for working with organizations dedicated to improving the quality and delivery of healthcare. This desire stems from her years of practice as a licensed naturopathic physician. In addition to holding a Naturopathic Doctorate from Bastyr University she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill.

She has served on boards for the American Association of Naturopathic Physicians (AANP), the Naturopathic Physicians Research Institute (NPRI), and several advisory boards. Dr. Simon served nine years on the Washington State Health Technology Clinical Committee, as Ambassador to the Academy of Integrative Health and Medicine (AIHM) and was recognized as 2018 AANP Physician of the Year. Dr. Simon shares with her husband a passion for adventure travel, preferably by boat or motorcycle. She also enjoys teaching a women’s off-road motorcycling class.