Getting aligned…why I decided to offer a sliding scale
I feel like this post has, in one way or another, been rumbling around somewhere in my psyche, waiting for me to bring it to the surface, for many years.
I recently made the decision to officially offer a sliding scale for my naturopathic services. I’m not the first ND to offer this, and I won’t be the last, but I wanted to take a minute (or 5) and I explain why I came to this decision.
I’ve always been a highly empathetic person. I knew I had this trait as an adult, but it wasn’t until I came across one of my report cards from kindergarten that confirmed that this has always been one of my stronger traits. I realized this is just me. When I was studying nursing, I really resonated with our lessons on the social determinants of health. One of the strongest social determinants of health is income and social status. In general, those who have more money are healthier. Learning about these types of concepts are what inspired me to become a public health nurse. I wanted work with marginalized populations, offering education, tools and resources to prevent and manage disease. As a public health nurse I was so blessed to work with amazing clients. I worked with different populations. Some with addiction challenges, some who were underhoused, many who barely had enough money to keep themselves and their families fed.
As much as I loved my job, I had always had an equally strong desire to study naturopathic medicine. To dive much more deeply into the body and all the natural ways to support health and healing. I wanted a career where I had more creativity and autonomy, and where I could use some of the modalities that naturopathic medicine offers. I knew, however, that I was getting into private health care, and this was something that I struggled with regularly. I remember when I toured CCNM (the school I attended) I asked my tour guide how she felt about the fact that our services aren’t accessible to the general population. She said that we work hard for 8 years (true! we have to do a 4 year undergraduate degree and then CCNM for 4 more years) and that we invest a lot of money into our education (very, very true), and so we deserve to charge those rates for our services. The truth is, I don’t disagree with this. I don’t think naturopathic doctors overcharge for their services. In fact, based on all of the research and effort that is put into our work behind the scenes, we are realistically probably under charging a lot of the time. Most people who become NDs don’t do it for the money. They do it because they are passionate about the career. You see the power of the medicine and you want to share it with others. But then you graduate and you realize that now you need to be a doctor, a business person, an accountant, a social marketing expert, a top notch researcher, oh and maybe also live your everyday life. It’s not easy.
But the reality is, many people can’t afford our services. There are more and more private health insurance companies that are covering naturopathy, and yes there are people who can afford the services no problem, but many can’t. I will argue that some people could choose to prioritize their health care more, financially, and maybe spend less in other domains. But there are also many people who, no matter how they prioritize their money, wouldn’t be able to afford it. Most of my best friends are artists: singers, dancers, actors, etc. They are my favourite people in the entire world. They feed my soul and make my heart sing. Most of them will never see an ND. They don’t have private health insurance, they probably never will, and their financial stability is up and down.
So, I had to ask myself. Where do I stand? What feels right for me? A sliding scale feels right for me. I want to be able to service artists. I want to be able to service single Moms. I believe that alternative health care should be accessible to everyone. One of my favourite teachers from CCNM, Dr. Chris Pickrell, ND, has been offering a sliding scale for years and it has been very successful for him. I recall him telling me that some of his patients who couldn’t afford the full rate finally got a job where they were making more, and they felt proud and excited to be able to offer the full price for their visits. I believe people don’t take advantage of these options, they use them because they need to.
When I finally came to this decision I immediately felt lighter and more like myself. When you are trying to do what you think you are supposed to do, and it doesn’t align with your deepest ethics, it weighs you down. I encourage my patients to listen to their deepest and truest self, so if I’m not doing the same, how can I ever expect anyone to heed my advice?
Is my decision the smartest business decision I could make? Maybe it is, maybe it isn’t. Maybe I will be wildly successful. Maybe I will fail miserably. But I’d rather listen to my heart, try and fail then to have never tried at all.
I have a fixed rate for all of my standard appointments, however, if the rates do not match your current financial situation, please speak with me and we will work together to find an appropriate rate.
When I registered my business with CRA I called it Metta Health Services. I learned the word Metta when I did a ten-day silent meditation retreat. It means “loving kindness”. It’s a meditation practice where you send yourself loving kindness, and then you extend the circle and send it out to your friends and family, and then finally to all sentient beings. This is my way of practising Metta.
May you be happy. May you be well. May you be safe. May you be peaceful and at ease.
Sincerely and from my heart,
Dr. Madeleine Elton, ND