Iva Lloyd,1, Kieran Cooley,2, Shawn O’Reilly,4 and Paul Richard Saunders4
ABSTRACT
Objective: This cross-sectional analysis describes the entry to practice and continuing registration of cohorts from the two accredited naturopathic medical educational programs in Canada.
Methods: Cohorts from the Canadian College of Naturopathic Medicine (CCNM)-Toronto and CCNM-Boucher were included and analyzed based on jurisdiction of registration, time between graduation and registration, current registration status, and the percentage achieving advanced training and certification.
Results: A total of 565 graduates from CCNM-Toronto and 296 graduates from CCNM-Boucher were analyzed. 53.3% (n=459) were registered with the naturopathic regulator in Ontario, 34.0% (n=293) with the naturopathic regulator in British Columbia, 9.1% (n=78) with other regulators or professional associations in Canada and 3.6% (n=31) internationally. 47.3% (n=360) acquired registration within 5 to 7 months of graduation and 23.1% (n=176) within 8 to 11 months. The registration status of 74.8% (n=644) was listed as active. Of the naturopathic doctors (NDs) working in jurisdictions where these certifications are optional, 69.0% (n=392) had their prescribing certification and 49.8% (n=302) had their Intravenous and Injection Therapies (IVIT) certification.
Conclusion: This cross-sectional analysis indicated that 2 to 3 years following graduation, the NDs sampled have a similar or higher retention rate as other healthcare professionals. The majority of graduates are registered to practice in the same province as the naturopathic program they attended. A higher percentage of NDs practicing in British Columbia than in Ontario have additional training and certification in prescribing and intravenous therapies, which may be a reflection of the broader scope of practice in that province.
Key Words Naturopathy, naturopathic education, naturopathic medicine, naturopathic workforce, accredited naturopathic educational programs
Naturopathic medicine has been practiced in Canada since the end of the 19th century and is currently practiced in every province and territory other than Nunavut.1 The first province to regulate the naturopathic workforce was British Columbia in 1923, followed by Ontario in 1925, Manitoba (1946), Alberta (1948), Saskatchewan (1954), Nova Scotia with title protection (2008), and Northwest Territories (2022).2 The therapies and practices commonly practiced by the naturopathic workforce globally include clinical nutrition, applied nutrition, herbal medicine, homeopathy, lifestyle counseling, and hydrotherapy.2 Naturopathic training in Canada includes naturopathic manipulation and acupuncture.3 In addition, naturopathic doctors (NDs) in Canada are eligible to take advanced training in areas such as intravenous therapy and injection therapies (IVIT) (mesotherapy, prolotherapy, etc.) and have prescribing authority based on the regulations in their jurisdiction.4,5 Prior to registration with a naturopathic regulator in Canada, a candidate must graduate from an accredited naturopathic medical education program, pass standard entry-to-practice examinations, and acquire malpractice insurance.4,5
The Canadian College of Naturopathic Medicine (CCNM), which first opened as the Ontario College of Naturopathic Medicine (OCNM) in 1978, was the first dedicated naturopathic medical educational program in Canada.1 Throughout the late 1990s, CCNM tripled its enrollment, and today, CCNM offers the largest accredited naturopathic medical educational program in North America.1 In 2001, a second naturopathic medical educational program, the Boucher Institute of Naturopathic Medicine (BINM), opened in British Columbia.1 CCNM and BINM amalgamated in 2021 and are now referred to as CCNM-Toronto and CCNM-Boucher.3 The vision of CCNM is to make naturopathic medicine an integral part of health care through pre-eminent education, research, and clinical services and for CCNM to be a leading voice in naturopathic medicine.3
Medical school accreditation in North America began with the Flexner Reports for the United States and Canada in 1910.1 Accreditation, defined as “the formal process of evaluation of an educational program, institution, or system against defined standards by an external body for purposes of quality assurance and enhancement,”6 is ongoing for conventional medical programs, naturopathic medical programs, chiropractic, nursing, and other medical education programs. Accreditation seeks to implement, strengthen, and support quality medical education.6,7 Accreditation of the 4-year naturopathic medical educational programs in North America began in 1978 through the Council on Naturopathic Medical Education (CNME).8 CCNM-Toronto acquired CNME accreditation in 2000 and BINM was accredited in 2008.1
Between 2005 and 2020, CCNM and BINM reported a total of 2,198 graduates.9 During that same time frame, the Canadian Association of Naturopathic Doctors (CAND) recorded growth of the naturopathic workforce in Canada, which increased by 1,700 members (from 1,300 to over 3,000)10. In a 2018 CAND survey of its members, 91% of respondents indicated that they had graduated from Canadian naturopathic educational programs.11 Hence, overall, between 2005 and 2020 the cumulative retention rate of NDs in Canada between 2005 and 2020 appeared to be over 80%.
The status of graduates from naturopathic medical educational programs in Canada has not previously been explored. This cross-sectional analysis describes entry-to-practice and continuing registration status of naturopathic graduates by analyzing cohorts from the 2 CNME-accredited naturopathic medical educational programs offered by CCNM and BINM with respect to registration status, jurisdiction of practice after registration, months to registration, and advanced certification status for IVIT and/or prescribing authority.
A cross-sectional analysis of available administrative data from Canadian naturopathic medical educational programs and regulatory authorities.
The aim of the study was to describe entry-to-practice and continuing registration status of ND graduates, from the 2 CNME accredited naturopathic medical educational programs offered in Canada. The study analyzes the length of time between graduation and registration, the jurisdiction of registration, current registration status and the percentage of graduates that undertook additional training in order to receive pharmaceutical and/or IVIT certification.
Since the inception of CCNM-Toronto in 1978, there have been over 3,600 graduates.1,9 For the purpose of this study 6 graduating cohorts (1997, 2002, 2007, 2012, 2017, 2020) from CCNM-Toronto were selected. Due to the large number of graduates, the selection of the CCNM-Toronto cohorts was based on 5-year intervals limited to the last 25 years of graduates. The cohort selection was made a priori, purposely by the primary author and approved through discussion and consensus of all authors to minimize cohort effects that could not be overcome with study design or statistical analyses such as small sample sizes or confounding variables.12 As such, we avoided graduating years with significant confounding external factors that might have affected the results, including: periods of substantive changes in enrollment (1999), or disruption to the educational institutions (e.g., the move of the CCNM educational institution to its current location in August of 1999 and the accreditation of the CCNM naturopathic medical educational program in 2000 by CNME).1 None of these potential confounding factors were experienced by the CCNM-Boucher cohorts. The last cohort was chosen as 2020 versus 2022 to ensure sufficient time after graduation to allow for accrual of registration and registration status outcomes, hence minimizing the influence of time-based opportunity on our findings. Based on the significant difference in class size between CCNM-Toronto and CCNM-Boucher, and the desire of the authors to have a sizable, comparable number of graduates from each educational institution, all CCNM-Boucher cohorts were included (from 2004 until 2020). The cohorts from CCNM-Boucher were grouped to allow for comparison with the cohorts from CCNM-Toronto. A listing of graduates prior to 2008 was contained in the book The History of Naturopathic Medicine, a Canadian perspective.1 The listing of graduates from 2009 to 2020 was verified by CCNM-Toronto and CCNM-Boucher personnel.9
The study analyzed available data listed on Canadian regulators’ websites. A minimum sample size of 300 is recommended for descriptive survey research.13 In analyzing the cohorts selected, the inclusion rate was calculated based on the number of individuals for whom practice status could be identified and included for those who were listed with a recognized naturopathic regulator or a national or provincial/territorial association in Canada (see Table 1) or where it was indicated that the ND was in active healthcare practice according to a website analysis as outlined below.
TABLE 1 Naturopathic regulator or naturopathic professional association used to verify practice status and the estimate of number of NDs by province9
Data from each cohort were listed on an Excel spreadsheet with columns to capture registration jurisdiction months to registration, current registration status, prescribing status, IVIT status and a notes field. The registration jurisdiction column included 4 possible entries: the College of Naturopaths of Ontario (CONO), the College of Naturopathic Physicians of British Columbia (CNPBC), Canada (which included all other Canadian regulators and naturopathic professional associations (see Table 1), and International (for graduates who were determined to be practicing outside of Canada). To determine last known status, the websites for each of the above were searched during November 2022 by one member of the study team, and a random selection including roughly 10% of the data was verified by a second author. Jurisdiction of registration was determined by searching the published list of registrants of the regulator in the province of the graduating cohort (e.g., CCNM-Toronto graduates were first searched under CONO), then other naturopathic regulators in Canada, then provincial associations and then a Google search, when needed. The study only recorded one jurisdiction for each active graduate and did not account for graduates who may have been registered in more than one jurisdiction.
Based on the month and year of graduation (e.g., May according to the CCNM-Toronto calendar), the timespan (in months) from graduation to registration was calculated.3 Hence, due to entrance-to-practice exams being offered in August or September with results one month or so later, 5 months was generally the minimum timeframe between graduation and possible registration.4,23 For those NDs associated with a naturopathic professional association, as opposed to a regulatory authority, or those working internationally, the number of months to registration was recorded as not applicable (N/A). The current registration status was based on the data found on the regulators’ websites and included active, revoked, resigned, inactive, and/or cancelled. Due to the variability in the terms used by the different naturopathic regulators, the terms revoked, resigned, and cancelled were categorized as “cancelled” for the purposes of this analysis.
For those NDs practicing in a non-regulated jurisdiction in Canada or practicing internationally, the status entry was recorded as active if they were listed as a current member of a professional naturopathic association or if their professional website, LinkedIn or Facebook profile indicated that they were currently practicing as a naturopathic doctor and that they had graduated from CCNM. Given the nature of private practices of most naturopathic doctors, these public-facing sources for practice status were deemed to be reasonable information sources. Internet queries used the Google search engine and employed an iterative search strategy beginning with name and using the terms “naturopath*” and the name or initials of the graduating institution.
If an active ND was working in a regulated jurisdiction where prescribing and/or intravenous therapy was part of the scope of practice, their prescribing and/or IVIT certification status was recorded. If prescribing and/or IVIT was not permitted or the ND was working in a non-regulated jurisdiction, the status was recorded as not applicable as their status could not be verified. The registration status “unregistered” was used to indicate a graduate who was working in the healthcare industry as a non-naturopathic practitioner, such as a health coach or personal trainer, but was not registered with a healthcare regulator. The notes field was used to record the location of NDs practicing outside of Ontario or British Columbia or to record other comments such as the type of practice that unregistered graduates were engaged in.
Each ND in the cohorts selected was analyzed using the search function of the naturopathic regulators in Canada (starting with the regulator in the same province as their naturopathic educational program) and the listing of naturopathic doctors on the naturopathic national or provincial/territorial association websites. If required, a search for the graduate on public websites using their name was conducted, as outlined above, in an attempt to capture last-known status.
Using standard Excel counting formulas, the number of occurrences for each defined word was counted and summary data tables were compiled. Missing data for each variable and non-applicable data were excluded from the analysis for that category. Not all regulators and none of the provincial associations, for example, included the date of first registration. Descriptive statistics were prepared for each variable (i.e., place of registration or practice, months to registration, prescribing and IV status, registration status) using the Excel function. The graduates from CCNM-Boucher were grouped for ease of comparison with the years sampled from CCNM-Toronto. That is, the groupings were 2004–2007, 2008–2012, 2013–2017 and 2018–2020.
This cross-sectional analysis reviewed 592 graduates from CCNM-Toronto and 304 graduates from CCNM-Boucher. As outlined in Table 2, practice status data on 95.4% of CCNM-Toronto graduates and 97.4% of CCNM-Boucher graduates was acquired. Of CCNM-Toronto graduates included in the final analysis, 79.8% were listed on CONO’s public register, 7.1% with CNPBC, 9% with other naturopathic regulators or professional associations in Canada and 4.1% internationally. Of CCNM-Boucher graduates, 85.5% were listed on CNPBC public register, 2.7% with CONO, 9.1% with other regulators or professional associations in Canada and 2.7% internationally.
Table 2 Comparison of jurisdiction of registration, registration status and additional certifications of graduates from the two CCNM campuses
In addition, Table 2 outlines the registration status of NDs and indicates that 74.8% of all NDs included in the final analysis were active in practice, and 6.0% were listed as inactive at the time of the analysis.
Table 3 further outlines that 97.6% of NDs who graduated from CCNM-Toronto in 2020 and 94.1% of those from CCNM-Boucher who graduated from 2018–2020 were in active practice as an ND as of November 2022. For all cohorts analyzed from CCNM-Toronto, 71.2% were in active practice, 6.9% were listed as inactive, and 19.3% have had their registration cancelled either due to its being revoked or the ND resigning (Table 2). The analysis of graduates from CCNM-Boucher spans graduating years since its inception in 2004 until 2020 and indicated that 81.8% were active in practice, 4.4% were inactive, and 10.8% have had their registration cancelled (Table 2). 2.5% of graduates from the CCNM-Toronto and 1.4% of graduates from CCNM-Boucher were listed as unregistered, that is, practicing as a healthcare provider, but not as an ND (Table 2). As expected, the percentage of active graduates was highest for the most recent graduates, with 97.6% of CCNM-Toronto graduates from 2020 listed as active, while 54.1% of those from 2002 (20 years ago) were active (Table 3). Likewise, the percentage of active graduates from the 2018–2020 CCNM-Boucher was 94.1%, while 76.7% of the 2004–2007 cohort were still active (Table 3).
Table 3 Comparison of CCNM-Toronto and CCNM-Boucher with respect to registration status
The percentages of inactive graduates were fairly consistent across the 2002, 2007, and 2012 cohorts from CCNM-Toronto and were recorded as 9.2%, 11.2%, and 8.7%, respectively. The percentage of unregistered graduates was highest in the CCNM-Toronto 2017 cohort at 5.8% (Table 3). The percentage of inactive graduates from CCNM-Boucher ranged from 3.3% to 10%. None of the graduates in the 2018–2021 cohort were listed as inactive (Table 3).
As outlined in Table 2, 47.1% (n=233) of graduates from CCNM-Toronto acquired registration within 7 months of graduation, 23.2% took between 8 and 11 months and 25.5% took 12 to 23 months, with 4.2% taking more than 2 years following graduation to acquire registration. Of the CCNM-Boucher graduates, 47.7% acquired registration within 7 months of graduation, 22.9% within 8 to 11 months, 22.9% within 12 to 23 months, and 6.4% took 24 months or longer. As outlined in Table 4, in 2012, 61.4% of CCNM-Toronto graduates acquired registration within 7 months compared with only 31.9% in 2020. The percentage of CCNM-Boucher graduates acquiring registration within 7 months has remained fairly consistent over the cohorts ranging from 40.0% to 54.0%.
Table 4 Comparison of CCNM-Toronto and CCNM-Boucher campuses with respect to months to registration
Table 2 lists the percentage of regulated, eligible, active NDs that have undertaken the additional requirements for prescribing and/or IVIT certification. Of the 360 eligible NDs who graduated from CCNM-Toronto, 54.7% have their prescribing certification and 30% have their IVIT certification, compared with CCNM-Boucher graduates, 93.8% of whom have their prescribing certification and 83.4% their IVIT certification.
This study presents an overview of the registration status of NDs graduating from the two accredited naturopathic medical educational programs offered in Canada and provides insight into their retention and additional certifications. This study provides naturopathic graduates, potential naturopathic students, and other healthcare professionals a glimpse into the retention and registration status of NDs in Canada.
A survey by Statistics Canada in 2000 showed a high retention rate in conventional health occupations among health graduates, with about 93% still employed in a health occupation after 3 years.24 The lowest retention rate (88.2%–90%) was reported in nurses.24,25 The naturopathic graduates sampled have a similar or higher retention rate 2 to 3 years into practice, with 97.6% of the 2020 CCNM-Toronto graduates and 94.1% of the 2018–2021 CCNM-Boucher graduates listed as active. There is a lack of current research identifying the long-term retention of healthcare workers, especially those in the fields of traditional, complementary and integrative healthcare (TCIH), yet a 2010 study of chiropractors in California found that the 10-year attrition rate was between 20% and 25% for chiropractors registered between 1992 and 1998.26 The results of our analysis indicate a similar trend, with 79% of CCNM-Toronto and 84.4% of CCNM-Boucher still active 5 years after graduation and 67.4% of CCNM-Toronto and 76.7% of CCNM-Boucher graduates still active as NDs 15 years after graduation. Although comparative statistical analysis was not performed, this data suggests that the active rate between the two CCNM campuses is fairly consistent over the last 10 years.
Inactive status is recorded by regulators when registered NDs request time away from practice for a range of reasons including child rearing, sick leave, caring for a sick or elderly relative, or a work sabbatical. The lowest rate of inactive status was seen in the most recent graduates (1.2% in the 2020 CCNM-Toronto cohort and 0% in the 2018–2020 CCNM-Boucher cohort). The highest percentage of inactive was in the 2007 CCNM-Toronto cohort (11.2%) and in the 2018–2012 CCNM-Boucher cohort (10.0%). Although the overall percentage of inactive was only 6.0%, further analysis into the reasons for inactive status and support mechanisms for NDs requiring inactive status should be explored. The scope of the study did not identify or address whether or not inactive status impacted long-term retention in naturopathic practice.
Healthcare educational programs are an integral part of a profession’s advancement and stature.27 They are tasked with ensuring that health professionals who can safely and effectively provide healthcare services within their designated profession are trained, that there is ongoing research to support the advancement of the profession, and that their educational programs stay current. They are a valuable part of civil society and addressing healthcare challenges.27 To ensure the advancement of the naturopathic profession, it is also necessary that a percentage of graduates use their knowledge and training to support the profession in fields such as education, research, government work, support of the natural health products industry, and other fields. The percentage of graduates listed as cancelled includes those who have chosen to utilize their knowledge and training in other areas. As our analysis was based primarily on the publicly available data reported by regulators in Canada, we are not able to report on the current status of those listed as cancelled, but as of 2022, there are 6 naturopathic graduates working in various directorates and departments of the Canadian federal government, primarily within the Ministry of Health in the Natural and Non-Pharmaceutical Health Products Directorate (NNHPD),10 and over thirty NDs working in research.9 CCNM indicates that there are 165 individuals who have graduated from an ND program who are working as supervisors, teaching assistants, and/or staff at CCNM alone.9 There are also NDs working in non-regulated healthcare educational roles or supporting the natural health product industry in Canada. Many NDs maintain active practices, either full- or part-time. Further analysis of this data would be valuable and would help clarify the distinction between registration being cancelled due to disciplinary actions taken by a naturopathic regulator and a naturopathic doctor cancelling their registration to work in another field. Unregistered practitioners were defined as naturopathic graduates who were deemed to be working as non-naturopathic healthcare practitioners in unregistered fields, such as health coaches and personal trainers. Although the percentage of unregistered graduates from CCNM-Toronto and CCNM-Boucher was low, this is a marker worth tracking.
The majority of graduates acquire registration in the jurisdiction of their educational program. This likely explains why Ontario (NDs=1,740)4 and British Columbia (NDs=740)5 account for over 80% of the total naturopathic workforce in Canada (NDs=3,000) (Table 1) despite there being statutory regulation in 7 jurisdictions. It is important to note that, in order to indicate support for government regulation and/or for insurance purposes, graduates working in unregulated provinces often seek registration with a regulator in a province that regulates their naturopathic workforce. The percentage of graduates listed as registered outside of Ontario and British Columbia is similar between the 2 campuses, yet CCNM-Toronto saw a significant shift in 2017, with 15.9% of all graduates registered in other provinces. Growing the naturopathic profession across Canada is essential, and looking at ways to increase this trend and understand what may be driving it would be beneficial. Over the last decade, CCNM enrollment indicates that roughly 15% of its student population is international,9 yet the data indicate that the percentage of graduates that acquire registration internationally is significantly lower, at 3.6%. Further exploration of this discrepancy would be beneficial.
Naturopathic care in Canada is diverse and includes clinical nutrition, applied nutrition, botanical medicine, lifestyle counselling, homeopathic medicine, hydrotherapy, and naturopathic manipulation and acupuncture.2 In some jurisdictions in Canada, the scope of practice for the naturopathic workforce also includes intravenous therapy, injection therapies (meso- or prolo-therapy), and prescribing authority based on an exclusionary list or a defined schedule of substances.4,5 Additional certifications—such as acupuncture, minor surgery, meso- or prolo- therapy—may be part of the scope of practice dependent on an ND’s jurisdiction, but only IVIT and prescribing were analyzed as these were recorded on the regulator’s sites and were consistent in the jurisdictions where the two CCNM campuses reside and were analyzed. NDs in British Columbia with prescribing authority have an exclusionary list of drugs for prescription, while in Ontario, NDs are restricted to a narrow schedule of substances that they are permitted to prescribe. The broad scope of practice in British Columbia28 is likely a strong contributing factor to the high rate of graduates who take the additional training to acquire certification in IVIT and prescribing. 93.8% of CCNM-Boucher graduates, compared with 54.7% of CCNM-Toronto graduates, are listed as having prescribing certification, and 83.4% of CCNM-Boucher graduates, compared with 30% of CCNM-Toronto graduates, have their IVIT certification.
Medical licensing examinations are considered an essential part of the process in certifying that a doctor is ready to practice.29 Recent studies of licensing examinations and candidate performance found a positive correlation between national license examination performance and patient outcomes and a negative correlation with rates of complaints.29 A separate study found a correlation with honours grades and examination outcomes even after correction for gender, institution, and test-taking ability, and a positive correlation with clinical performance.30 The Naturopathic Physicians Licensing Examinations (NPLEX) established by the North American Board of Naturopathic Examiners (NABNE) have been available to Canadian CNME-accredited naturopathic graduates since the early 1990s.1,23 In 2019, the Council of Naturopaths of Ontario (CONO), the regulator of the naturopathic workforce in Ontario, created its own entrance-to-practice examination for those naturopathic doctors seeking registration in Ontario.31 The CONO entrance-to-practice exam has been accepted by naturopathic regulators in Alberta, Saskatchewan and the Northwest Territories, but not in British Columbia or Manitoba.5 With the exception of Ontario, the NPLEX exam continues to be accepted in all regulated Canadian jurisdictions.
The NPLEX exams are offered twice a year, in August and February.23 The CONO entrance-to-practice exams are offered in February and August or September for the clinical science exam and March and September for the biomedical exam.31 The timing of exams after graduation results in graduates not being eligible for registration for at least 5 months—time to write the exam and for the regulatory authority to mark and to advise the graduates of their results; NPLEX results are released in September and March, respectively. After writing NPLEX, the percentage of graduates from CCNM-Toronto who received registration within 7 months was between 39.1% in 1997 and 61.4% in 2012. After the entrance-to-practice examination was changed to the CONO exam, the rate that received registration within 7 months dropped to 31.9% in 2020. The CCNM-Boucher graduates, who primarily wrote NPLEX, did not see the same drop in registration within the first 7 months of graduation. CONO indicated that the pass rate for the 2020–2021 entrance-to-practice exam was 55% for the biomedical and 74% for the clinical sciences exam.31 The pass rate for those taking the NPLEX entrance-to-practice exam as graduates from CCNM-Toronto and CCNM-Boucher over the last 5 years has ranged from 76% to 88%.32 Research into the impact of delayed registration should be explored as it relates to registration status and/or competency and retention of naturopathic graduates. Further research should be conducted to fully understand the entrance-to-practice examination factors and the sociodemographic factors that impact delayed registration.
This is the first study addressing retention rates and registration status of naturopathic doctors from accredited naturopathic educational programs in Canada, and further research is required to understand the factors impacting registration status, such as workload, income, practice location, and/or sociodemographic factors (e.g., gender, race, age, family status, etc.).
A limitation of this study is that the data from any of our information sources (regulators, internet searches) do not capture the reasons why NDs chose other professions/careers, are inactive, resigned, or who have had their registration cancelled or revoked, nor their activities. The information and the categorizing of information provided by the various naturopathic regulators is not consistent and limited our ability to make direct comparisons. For example, CONO’s categorization includes active, revoked, resigned, and inactive, whereas CNPBC’s categorization includes active, inactive, and cancelled. This study did not capture information regarding practitioners who may have been registered in more than one jurisdiction and did not verify the status of those practitioners listed as inactive or cancelled. This study also did not verify that practitioners listed as registered in a jurisdiction were actually practicing in that jurisdiction. The selection of CCNM-Toronto cohorts may not be reflective of all CCNM-Toronto cohorts. The impact of grouping CCNM-Boucher cohorts was not determined. Determining the exact number of months between graduation and registration was challenging as some students attended their convocation in May or June, but did not actually fully complete the requirements for graduation and did not receive their diploma or certificate of graduation until a few months later. Another limitation was that the date of entrance exams varied slightly between the cohort years and between NPLEX and CONO’s entrance exams. For the purpose of the study, all graduates were deemed to have graduated in May. The precision and accuracy of the information sources utilized to capture status is unknown. However, our study used all reasonable approaches to capture the last known status of graduates through publicly accessible means.
The annual class size at CCNM-Boucher is generally around 35 students, compared with CCNM-Toronto at around 110 students.9 The impact of class size on registration status has not been explored. The majority of the graduates where no data were available were part of the graduating classes from 2017 and 2020 for CCNM-Toronto. Based on the relatively low pass rate of the 2021–22 CONO exam, there is a concern that some of the graduates from 2020 where information was missing were impacted by this exam outcome.
Some information, such as total number of graduates from CCNM, the number of faculty or staff holding an ND designation, the total number of NDs in Canada, the number of NDs working at Health Canada, and NPLEX average pass rates were received based on communication with senior leadership personnel. Every effort was made to verify the data.
The naturopathic graduates sampled have a retention rate similar to or higher than that of other healthcare professionals surveyed by Statistics Canada 2 to 3 years into their practice. Based on these findings, it may be argued that a high percentage of NDs remain in practice for a significant number of years. It takes over 50% of the graduates more than 7 months between graduation and the start of practice, the length of time appearing to be correlated with the timing of the entrance-to-practice examinations. Addressing the length of time between graduation and registration and its impact on ongoing registration status requires further evaluation. The majority of graduates appear to practice in the same province as the naturopathic program they attended. Additionally, there appears to be a higher percentage of NDs practicing in British Columbia who have certification in prescribing and intravenous therapies, which may be a reflection of the broader scope of practice in that province.
1World Naturopathic Federation, Toronto, ON, Canada;
1,2,4Canadian College of Naturopathic Medicine, Toronto, ON, Canada;
3Canadian Association of Naturopathic Doctors;
4Naturopathic Physicians Licensing Examinations.
The authors are grateful to Jacqueline Cooper and Leticia Spinelli who assisted with this project.
KC and PRS are employees of CCNM. IL teaches part-time at CCNM. PRS is unpaid President of NPLEX.
This research did not receive any funding.
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Correspondence to: Dr. Iva Lloyd, ND, 53 Snapdragon Drive, Toronto, ON M2J 4X5, Canada. E-mail: i.lloyd@naturopathicfoundations.ca
To cite: Lloyd I, Cooley K, O’Reilly S, Saunders PR. Retention and registration status of naturopathic doctors from accredited naturopathic educational programs in Canada - across-sectional analysis. CAND Journal. 2023;30(1):16-23. https:/doi.org/10.54434/candj.135
Received: 18 January 2023; Accepted: 27 February 2023; Published: 30 March 2023
© 2023 Canadian Association of Naturopathic Doctors. For permissions, please contact candj@cand.ca.
CAND Journal | Volume 30, No. 1, March 2023