Integrative, Collaborative, Naturopathic Primary Care

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According to the World Health Organization (WHO)1, the fundamental concept of primary health care is that everyone has the right to good health. They define primary care as a whole-of-society approach to bring services for health and wellbeing closer to communities, with three components1:

  1. Integrated health services to meet people’s health needs throughout their lives
  2. Addressing the broader determinants of health through multisectoral policy and action
  3. Empowering individuals, families, and communities to take charge of their health

Did you know that many naturopathic doctors (NDs) work as primary care physicians (PCPs)? In fact, naturopathic doctors play a crucial role as primary care providers in supporting whole-person health and working in an integrative and collaborative fashion with other healthcare professionals.  Further, they can actively reduce the current shortage of primary care providers across the U.S. 

To learn more about the different settings, we sat down with three naturopathic doctors who are members of the specialty naturopathic association, the Naturopathic Academy of Primary Care Physicians (NAPCP): Dr. Hannah Gordon, ND, FNP, RN is the Assistant Medical Director at International Community Health Services where she sees patients as a naturopathic doctor. She is also co-chair of the INM Primary Care Task Force and the President of NAPCP.  Dr. Ian McLogan, ND, is NAPCP’s  Vice President and practices at Natural Medicine of Seattle.  Dr. Logan Rost, ND, MPH, sees patients at Family Health Centers and is an NAPCP Board Member as well as the first resident physician of the INM Primary Care Task Force.

What is a Naturopathic Primary Care Physician?

Gordon wants to see naturopathic doctors better included in the category of Primary Care providers alongside all other healthcare professionals. She notes that the curriculum of naturopathic medical education perfectly positions naturopathic doctors as PCPs. And Gordon should know. In addition to being a naturopathic doctor, she is a Registered Nurse and Nurse Practitioner. She has found that, when compared to the medical education of some other healthcare professionals, naturopathic education focuses on health promotion in addition to disease management. 

“For naturopathic medicine, our curriculum focuses on health promotion. We have an extensive curriculum focusing on diet, nutrient therapy, counseling, and disease prevention,” Gordon explains.  “We take pharmaceutical classes, herbal classes, and we look at how the body works. We look at the cellular level, at whole-person health.” She is quick to note that all healthcare providers have a role to play in primary healthcare. To better explain the strength of incorporating naturopathic medicine into the primary care setting, Gordon observes, “Most medical curriculum excels at disease management but is often lacking in the health promotion portion of the education. While health prevention is very much included in the curriculum, it’s important to note the difference between prevention and promotion. Our healthcare system needs more health promotion educated providers.” 

According to the 2022 NAPCP Primary Care Position Paper 2, ND PCPs seek to:

  • Promote individual and community wellness
  • Provide patient-centered education and advocacy
  • Prevent illness via proper utilization of screening evaluations and immunization practices
  • Diagnose and treat disease
  • Consult, co-manage, and  refer appropriately for care that is necessary to maximize patient outcomes

How Naturopathic Doctors Use Integrative, Collaborative Medicine in Different Settings

Like other healthcare professionals, naturopathic doctors work in various primary care settings, including private clinics, as part of larger systems such as Federally Qualified Health Centers (FQHCs), Community Health Centers (CHCs), and hospitals. While private clinics may see patients with more health insurance coverage or a higher income, CHCs, and FQHCs may focus on underserved populations and qualify for Medicare/Medicaid coverage. What do all these healthcare settings have in common? They all provide essential opportunities for integrative and collaborative care. 

Federally Qualified Health Centers and Community Health Centers

Gordon works at the FQHC International Community Health Services in two different capacities. She is the Assistant Medical Director for one clinic in the system and sees patients as a PCP. She finds that differing state laws governing naturopathic medicine can present challenges. “In some states, the prescriptive license, rights, and insurance coverage are minimal. Medicare is a huge hang-up.” Gordon explains. “In Washington, for instance, Medicaid includes NDs, but this is not for every state.” Two other limitations in Washington state include restrictions on certain scheduled drugs (like opioid medications). Additionally, on the federal level, Medicare does not include naturopathic doctors; however, there is some coverage under Medicare Advantage B.”

Now, Gordon is seeing more naturopathic doctors being hired by CHCs and FQHCs in Washington and Oregon. While she is doing her part to explain that the health promotion skills offered by naturopathic doctors can effectively round out in-house primary care services these clinics already provide, she is also hearing about another benefit: “ND PCPs can also be integrative medicine providers,” notes Gordon, referring to their ability to use naturopathic medicine safely alongside conventional medicine. “CHCs and FQHCs need primary care providers and, with the unique combination that naturopathic doctors can provide, we can adapt to the needs of the clinic or organization.” Community Health Needs Assessments, which are required by CHCs and FQHCs, tell the system what the community needs. In Washington and Oregon, we’re hearing the need for integrative, naturopathic, herbal, and Indigenous medicine. Each organization has to decide what their patients need.”

Patients, too, are interested in integrative medicine.  And this trend is reaching conventional doctors, too. “More healthcare providers are educating themselves or getting additional certificates in integrative medicine, herbal medicine, and physical medicine,” Gordon observes. “And that’s because patients want it.”

Dr. Logan Rost, ND, MPH, works at the FQHC Family Health Centers, out of their Tonasket, Bridgeport, and Brewster Medical Clinics, located in rural parts of Washington State. There, she finds many opportunities for both integrative and collaborative patient care. Other healthcare providers refer patients to her for naturopathic questions. In contrast, she refers patients to other healthcare providers with experience in a specific area or access to specific settings (such as internal medicine doctors with hospital access). “We refer patients back and forth, do consults, and care for patients together. We co-manage care. It’s been wonderful to work in an integrative, truly collaborative setting,” Rost notes.

Rost enjoys working at an FQHC; patients come to her in many different ways and with varying approaches to health. “Some patients have no idea that I’m a naturopathic physician. They come to me because I have an opening in my schedule, and they just need to see a medical provider. They don’t necessarily care what degree that provider has,” Rost explains. “But some patients have zero interest in conventional medicine and want to establish care with me as a specialty naturopathic doctor.” 

Like Gordon, Rost can function as a PCP or specialty naturopathic doctor. And there is another advantage. “Because I work in a rural area, I find there is a desire for naturopathic medicine and providers who can straddle the divide between “natural” medicine and conventional medicine and speak with patients about how they want to address their health.” Often, patients are excited to learn that it’s even possible to see naturopathic doctors at FQHCs. “Especially in rural areas, it’s hard to find naturopathic doctors working in clinics that accept insurance specifically for low-income or underinsured patients.”

When it comes to collaborating with other healthcare providers, Rost finds it well worth the effort. “The point is to give our patients the best care possible to meet their needs. It’s about making them feel heard, recognized, and supported around how they want to achieve health and well-being. The goal is always just good patient care.”

Private Clinics

McLogan works at the all-ND primary care clinic, Natural Medicine of Seattle. There, he finds great opportunities to integrate naturopathic medicine with conventional medicine. “The metaphor that I like to use for integrative medicine is, it’s really hard to play jazz if you don’t know the scales,” explains McLogan. He uses established frameworks for preventative medicine, including following yearly guidelines for screening exams, lab workups, and treatments for different conditions. But then, he builds upon this framework using individualized medicine to meet patients where they are. “Oftentimes, medications are covered by insurance, and supplements are not. Supplements are often quite expensive,” McLogan explains. “I present a number of different options, including the standard of care for patients. I integrate all parts of care and take the best from everything using the framework that exists.”

He finds patients are grateful for his explanations of the treatment options for different conditions and for empowering them to decide how they want to combine these options. And while he acknowledges that his patient base may have a certain level of privilege and education that better allows them to do their medical research (and understand it), only some people want to figure it out on their own.

“I see a number of allied health professionals as patients, including nurses, firefighters, and EMTs,” says McLogan. “Certain subpopulations really appreciate knowing what the options are and having it fully explained to them.”

When collaborating with different healthcare professionals, he focuses on building relationships with specialists he trusts who have a good track record. This collaboration also provides the opportunity to educate other healthcare practitioners about naturopathic medicine. 

And how does this collaborative approach benefit patients? When NDs have medical information from their other healthcare providers, that allows NDs to recommend treatments that will work alongside any current conventional therapies. But sometimes, it’s the conventional doctor’s approach that needs explaining. “Their specialist visits may be very brief and intense. I can be a resource to debrief and review these findings. Patients are really responsive when I’m as engaged in their care as possible,” McLogan notes. For him, keeping the lines of communication with other doctors open means many faxed progress reports and updates to specialists. In other words, his role as a naturopathic doctor often means both managing and interpreting patient care with their specialists.

How Naturopathic Doctors Can Help Reduce Primary Care Physician Shortages

It’s no secret there is a severe shortage of primary care physicians across the U.S. And, as the Association of American Medical Colleges (AAMC) notes, it won’t get better any time soon. The aging population will need more medical care, but many doctors will soon retire. The  AAMC estimates that the U.S. could see a shortage of up to 48,000 primary care physicians by 2034.3

Although some barriers remain, ND PCPs have great potential to reduce this vital shortage4. “There’s a primary care shortage. We have NDs that can work in primary care. The two biggest hang-ups are the scheduled drugs and Medicare. If those two things weren’t an issue, we could get hired a lot easier,” notes Gordon. She finds herself frustrated with healthcare provider egos (in both conventional and naturopathic medicine) that result in competition, putting one type of medicine above another. Ultimately, this approach is not forward-thinking or helpful when solving this shortage crisis. All PCPs must play their part—and that includes naturopathic doctors. 

“Regardless of our naturopathic degree, we can help fill gaps in patient care,” Rost adds. “We are a valuable part of the health force in providing primary care to patients.”

How Naturopathic Doctors Can Help Address Health Inequities

An essential part of reducing health inequities is addressing the social determinants of health (SDH), a concept acknowledging the influence that non-medical factors can have on health. 

The WHO 5 notes that SDH can have a greater influence on health than health care or lifestyle choices: research suggests SDH accounts for between 30-55% of health outcomes. 5 They also note that SDH influences health inequities, pointing to a universal truth: across the world and at all income levels, the lower the socioeconomic position, the worse the health.5 The WHO provides several examples of SDH, including 5

  • Income and social protection
  • Education
  • Unemployment and job insecurity
  • Working life conditions
  • Food insecurity
  • Housing, basic amenities, and the environment
  • Early childhood development
  • Social inclusion and Non-discrimination
  • Structural conflict
  • Access to affordable health services of decent quality.

Regarding how naturopathic doctors working in primary care can help reduce health inequities, Gordon points to the importance of asking the right questions: “Learning more about your patients, their demographics and their determinants of health, is all part of being a primary care provider. Asking questions like, ‘Are you safe at home? Are there guns in the house?’ are key.”

This allows naturopathic doctors to recommend treatments that are possible for the patient to achieve. As Gordon notes, “A great treatment plan isn’t beneficial if the person can’t do it. Let’s say I teach you how to eat kale. But what if you don’t have kale access? Or you’re working 12-hour shifts and have three kids to feed?” asks Gordon. “That’s a stress level you can’t fix with high blood pressure meds or herbal medicine. We must include people’s daily lives in a way that also includes their health.”

Rost adds further examples of treatment recommendations from all kinds of healthcare providers that include assumptions about patients. An exercise recommendation won’t work without a safe place to move your body. Recommending more social and spiritual connections won’t work without enough time to engage in these activities. 

Gordon also advocates for naturopathic doctors to get involved in the communities they serve. By volunteering in the community, naturopathic doctors learn first-hand about the barriers their patients may face. Such community involvement can also present opportunities for naturopathic doctors to collaborate with those outside the healthcare system. “We need to work with community centers, social workers, nurses, and network with care managers,” says Gordon. “We work with shelters, but we need to work with other people too.”

Regarding the potential for community advocacy, Rost notes, “When we see patterns of lack of access in communities, naturopathic doctors can become advocates. How do we change our communities’ access so people can get those determinants? These are often things that are affected by social and financial inequity and cause health disparities and inequities.”

INM Primary Care Taskforce 

Since 2018, the Institute for Natural Medicine’s Primary Care Task Force6 has been leading the charge to improve health outcomes for underserved populations and expand the primary care workforce in Oregon and Washington State by adding naturopathic physicians. The task force promotes naturopathic physicians as one possible solution to the primary care physician shortage in the Pacific Northwest region. So far, the task force has formed partnerships with several stakeholders, including the Washington Association of Naturopathic Physicians (WANP), the Naturopathic Academy of Primary Care Physicians (NAPCP), the Northwest Regional Primary Care Association (NWRPCA), the Oregon Association of Naturopathic Physicians (OANP), Bastyr University, and the National University of Natural Medicine. 

In addition to ND workforce development, the task force is also exploring creating more naturopathic primary care residency opportunities in rural areas and piloting a nutrition education program to track health outcomes for diabetes and high blood pressure.


1. Primary health care. World Health Organization. Accessed January 6, 2023.

2. Position Papers. Naturopathic Academy of Primary Care Physicians. Accessed January 6, 2023.

3. Aging patients and doctors drive nation’s physician shortage. AAMC. Accessed January 6, 2023.

4. Inclusion of Naturopaths in Northern Ontario Primary Care: A Proposed Solution for The Health Human Resources Shortage. CANDJ. Accessed January 6, 2023.

5. Social determinants of health. World Health Organization. Accessed January 6, 2023.

6. INM Primary Care Task Force. Institute for Natural Medicine. Published May 20, 2022. Accessed January 6, 2023.

This article is provided by the Institute for Natural Medicine, a non-profit 501(c)(3) organization. INM’s mission is to transform healthcare in America by increasing both public awareness of naturopathic medicine and access to naturopathic doctors for patients. INM believes that naturopathic medicine, with its unique principles and practices, has the potential to reverse the tide of chronic illness that overwhelms existing healthcare systems and to empower people to achieve and maintain their optimal lifelong health. INM strives to achieve this mission through the following initiatives:

  • Education – Reveal the unique benefits and outcomes of naturopathic medicine
  • Access – Connect patients to licensed naturopathic doctors
  • Research – Expand quality research of this complex and comprehensive system of medicine

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.