Important considerations, suggestions, tips and ideas on making a successful transition from

student to practicing as a licensed naturopathic doctor.

Collated and compiled by Dr.Jordan Morton, ND.

Table of Contents

1. Financial Planning.......................................................................................................... 2

2. End of college until board exams ...................................................................................... 5

3. After NPLEX ...................................................................................................................... 6

4. Licensing .......................................................................................................................... 8

5. BCNA/CAND: .................................................................................................................. 10

6. Malpractice Insurance: ................................................................................................... 14

7. Job Search and Getting Started: ...................................................................................... 15

8. Setting up your Business Finances................................................................................... 16

9. Before You Open Your Doors for Business or Begin Practice at a Clinic............................. 18

10. Continuing Education and Additional Licensing ............................................................... 22

11. Adverse Reaction Reporting ........................................................................................... 23

12. Repaying Student Loan(s) ............................................................................................... 24

13. Diagnostic Testing .......................................................................................................... 25

Starting as an ND in British Columbia

1. Before Graduation

a) Financial Planning.

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Where are you at financially? How much debt do you have? Do you have access to more funds? Do you need a part-time job before and after exams?

Determine your repayment start dates and amounts for student loan and line of credit.

You can apply for the Repayment Assistance Plan to defer loan payments in 6 months increments. Click here for more information.Speak to a financial advisor about extra funding options after graduation for business start-up.Make sure these funds are in place for after graduation if you need them to live on or for business start up.

Make a personal budget for the coming year and start sticking to it!

TIP: BCNA works with a financial advisor who will meet with you, at no fee, to discuss debt and repayment options.

b) Create a Vision of your Ideal Job.

• Write about it, draw it, visualize it, feel it.

• Decide if you want to be an associate with another ND, if you want tojoin a non-ND clinic, or if you want to open your own practice in yourown space.

o This requires a realistic evaluation of your financialsituation:what can you afford, what are you willing to take on interms of responsibility?

c) Create a Business Plan if need be: here are a few templates/resources.

d) Develop your Resume/CV and Cover letter.

• Cover letter: include what you can offer and also what you are lookingfor. Be specific.

1. Financial Planning

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e) Preceptor with doctors that inspire you and at clinics you may want to work at.Begin networking, making contacts and exploring possibilities of employment.See Point 7 on searching for clinics hiring if you are looking to start right away.

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2. End of college until board exams

a) Focus on Graduation and NPLEX preparation.b) Ensure you sign up for the provincial exams as well as NPLEX

TIP: Planning to transfer to Ontario? CONO uses proprietary entrance exams for graduates. However, NPLEX grads who are licensed in another province can transfer without rewriting entrance to practice exams.

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3. After NPLEX

a) Recuperation: take time off, relax, have fun, be a whole person again but dobegin to think about the next steps below.

b) Courses to complete:

• NALS and/or CPR is mandatory to complete before beginning practice.All registrants must maintain CPR for HCP (healthcare provider) withAED. Additionally, registrants with certifications (acupuncture,injections, IVs, aesthetic procedures etc.) must hold advancedemergency training (NALS) in addition to CPR for HCP with AED.

• NALS is currently offered through three providers: OHM Medical,Tamik Training and Dr. Michael Prytula.

• Prescriptive Authority (not mandatory), course offered by BINM.

• Prescriptive Authority is required for administering IVs, doing advancedinjections and writing prescriptions.

• BCCDC Immunization Competency Course (not mandatory).

• The BCNA strongly encourages all doctors to complete theimmunization course as it demonstrates our commitment to publichealth and our patients’ health. This course takes approximately 16-25 hours to complete; it is done online. There is no cost. Doctors whocomplete the course can get certification in immunization withCNPBC; unlike other certifications, there is no fee or renewal cost. Ifyou obtain certification, adjust your BCNA online profile so that youare keyword searchable online.

TIP: The BCCDC Immunization Competency Course qualifies for one hour Cat G ethics) continuing education and, Pearls for Immunization Practice qualifies or Category F CE hours.

TIP: The Immunization Communications course offers additional help in addressing this issue in a clinic setting. It also qualifies for Category G CE hours.

TIP: New grads who have completed the prescribing authority course do not need to get additional pharmacotherapy continuing education. The course counts as your initial CE.

• If you have been hired by a clinic, can you practice as a non-licensedND in your clinic?

o No. You cannot “practice” as an ND without being licensedas an ND. Only an individual licensed by CNPBC canpractice as an ND and only a licensed ND can issue areceipt for extended health. However, there are manyways you can work with, for, and alongside licensed NDs.

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Consider the time between NPLEX and getting your license an opportunity to begin honing your clinic skills.

• Working in a lab, IV lounge or with admin can be a great way to get asense of the clinic.

o Discuss with your clinic owner/team if this is an optionprior to being licensed as it can be a good way to make anhourly wage and begin to get a feel for your workspace.

• Other work? Be sure to relax but do reassess your finances andmaybe find a way to make some money.

• Continue to preceptor and work with mentors.

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4. Licensing

a) Expect your NPLEX results in approximately 1-2 months in the mail. These results will also be sent directly to the college. CNPBC boards and jurisprudence results usually come quicker and are emailed to you. The letter will contain the “How to apply” link below.

b) If you have passed everything and are good to go, visit the CNPBC website tolearn more about the college.

c) Click here to apply to register with the college:

• There is a registration application, testament to moral character formand statutory declaration form (Form 3) to fill out. Do them all. Eitherprint out and send in hard copies or save all documents as a PDF andsubmit together.

• If you have any questions, call the college: (604) 688-8236 or emailquestions@cnpbc.bc.ca

• BINM grad? Boucher will automatically send your transcripts to theCNPBC.

• Have your university send your transcripts directly to the CNPBC.

• Fill out the Criminal Record Check form here.

• Send in your Forms and the Application Fee: $250 (this is just forprocessing your application, this is not your licensing fee).

• Note: if you are planning on starting your practice ASAP, you can doall this before you get your NPLEX results and have it ready to sendimmediately to the CNPBC once you receive your results.

• If your application is approved, CNPBC will send you a PreliminaryConditional Approval Letter (used to apply to the BCNA/CAND) and aPracticing Registrant Registration form to fill out. This will include alicensing fee (see below). You will need to send in your registrationform along with proof of insurance (see Point 6).

• Once this is received by the college, you will receive yourConfirmation of Registration along with your license number and yourForm 8 (Certificate of Registration). Congratulations!

• An online account will be created for you with the college- theRegistrant Online Self-Service (ROSS). Log in and explore, familiarizeyourself with the system. This is where you will upload yourcertifications, CE and pay your dues.

d) Licensing Fee

• $1810/yr., several payment options.

• This fee will be pro-rated depending on when you start practice.

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• Additional yearly fee for each extra modality: acupuncture, chelation,hyperbaric, ozone, prescribing authority, prolotherapy etc.See Schedule C on Page 66 of the CNPBC Bylaws.

TIP: Continuing education hours are accumulated in cycles. New grads often get licensed in the middle of a cycle. Enquire with CNPBC to see how many hours you will need in each category, if any.

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5. BCNA/CAND:

a) You need to be licensed (i.e., have your licence number) or be able to supplyyour Preliminary Conditional Approval Letter from the CNPBC in order to apply.

• Click here to begin learning about the BCNA membership and applyonline.

• Send Preliminary Conditional Approval Letter to admin@bcna.ca.

• BCNA collects the membership dues for both the BCNA and CAND.

b) You do not have to apply to the CAND after applying to BCNA. Once yourapplication has been approved, the BCNA automatically completes yourregistration with the CAND on your behalf.

c) BCNA information: www.bcna.ca, (604) 736-6646, Glenn Cassie (ExecutiveDirector), bcna@bcna.ca.

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BCNA dues as of 2019:

Status Definitions for CAND: CAND has dues categories for full-time, part-time, new graduates and associates.

FT: Any member who is in clinic for 16 hours (or more) per week.

PT: Any member who is in clinic for less than 16 hours per week.

New Grad “A”: Any member who is within their first year of practice since their date of graduation.

New Grad “B”: Any member who is within their second year of practice since their date of graduation.

Non-Practicing Members: To retain member benefits while not practicing BCNA / CNAD dues $39 per month.

Both BCNA and CAND have an associate status: Any member who is not practicing and not in clinic at any time per month (e.g. leave of absence, maternity leave, etc.).

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6. Malpractice Insurance:

TIP: You do not need to purchase malpractice insurance through the BCNA/CAND plan. However, the association plan has the lowest premium in North America for the broadest coverage.

• You can obtain your malpractice insurance through the associationgroup malpractice insurance plan with Partners Indemnity.

o CNPBC requires proof of insurance before confirming yourlicence.

• Call 1-877-427-8683 or email Kendall Wooding(kwooding@partnersindemnity.com) for information and theapplication form.

• You will be sent an enrolment application form, a commercial generalliability form and information about the type of coverage you need,which is also linked to here.

• It is unlikely that you will need general liability insurance unless youare opening your own clinic. Speak to your clinic owner/managerabout this and if you need to supply your own.

TIP: A side benefit of Partners malpractice is free legal advice for non-malpractice issues.

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7. Job Search and Getting Started:

a) BCNA classifieds, Craigslist, Naturopathic Doctor Sanctuary on Facebook,Indeed, word of mouth.

TIP: BCNA members get free classifieds on bcna.ca.

b) Research clinics you’d like to be a part of and make cold calls.

c) Contract Negotiation: There is contract information on the member resourcespages at the BCNA website. Contact the office if you’re not a member.

d) Website: vital to have a web presence.

• Hire a developer? Make it yourself?

• Start writing your content, even if you don’t have a contract yet.

• Get the basics going because you can still market yourself even if youdon’t have a place to practice yet!

• Facebook, Instagram, Twitter, Pinterest may all be beneficial.

TIP: Make sure your online marketing confirms with the advertising and inducement policies at CNPBC. If you are hiring a third party to do your marketing, make sure they understand your obligations to CNPBC.

e) Brainstorm and set up marketing opportunities.

• Networking groups, talks, print advertising, social media, etc.

f) Business Cards.

• Vista printing is good quality and inexpensive, simple designs.o Research local print-shops as well.

• Consider developing a logo or more professional business cards.

g) If you are becoming a sole proprietor or incorporating, you will have to submita business name request to the BC Government and provide it to the CNPBC.This takes roughly one week. You can name your business Dr. John Doe, ND oranything else so long as nobody else has taken it. If you use ND in the title, youwill be asked by the government for approval from the CNPBC.

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8. Setting up your Business Finances

a) Business Chequing Account.

• Order cheques.

• You usually have to pay for all transactions in business accounts (adeposit or a transfer is considered a transaction).

• Usually have a monthly fee - make sure you always have money in theaccount to cover this fee.

b) Business Savings Account.

• Put your GST, CPP and tax payments in here until you remit them tothe CRA.

• Consider starting a savings account to pay for continuing education,clinical tools (laser, ultrasound, etc.), coaching and anything else.

c) Business Credit Card.

• Cannot qualify for a business credit card until you have been inbusiness for 6 months.

o Start out with a separate personal credit card that you useonly for business transactions.

• Keep your personal and business transactions as separate as possible(not always easy as a sole proprietor) – if your business is audited,you don’t want your personal finances intermingled so that yourpersonal finances also have to be audited.

d) Apply for a business loan/line of credit/grant if you need one.

e) Interview an accountant or bookkeeper if you don’t want to do all your booksyourself.

• Set up your expense records spreadsheets and develop abookkeeping system.

TIP: New grads who join BCNA in their first year of practice are eligible to take a one-day course called Colour Accounting which simplifies accounting practices and enhances an understanding of financial statements. Here is a testimonial from a recent BINM grad:

“Speaking from personal experience, accounting and bookkeeping is never something I've learned or had an affinity for, and it is obviously an integral part of being a business owner, no matter what type of practice you have. I used to find the topic rather confusing and intimidating, but Colour Accounting does a really amazing job of breaking down the concepts into very easy-to-understand steps. I did Andy Bellanger's accounting course in the past, and while I got some

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good tid-bits from him, I think this course is more approachable and gives you a better foundation of understanding.

“Even if you've had some accounting training in the past, I still think it will be valuable to you. For context, my classmate and ND friend, who did his undergrad in business/commerce with a focus in accounting, did this Colour course with me and said it was the FIRST TIME a teacher had broken down accounting concepts so clearly and concisely, and he was just as happy with taking the course as I was.

“The class was composed of people of all ages (high school kids, to bookkeepers, to small business owners, to CEO's). Apparently, the course leader is often hired by CEO's for private training/lessons as even many top end execs don't truly understand accounting! XI can't recommend this course enough, and the fact that the BCNA pays for this for first years is amazing; this is one of the perks of your membership, so in my opinion it's a no-brainer to sign up.”

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9. Before You Open Your Doors for Business or Begin Practice at a Clinic

*If you are joining an existing clinic, much of this may already be in place.

a) GST number and Business Number general info.

• GST is 5%.

• Set up account under “Voluntary Registration” (for business who earn< $30,000/year. We need this because we charge GST on ourdispensary products and want to be able to claim the GST we pay forour business purchases. This reconciliation results in an “input taxcredit” or what accountants call ITCs; an important consideration forowners in particular).

• Click here to register for your business number (this is NOT yourbusiness licence!) and your GST number or contact the CanadaRevenue Agency directly at 1-800-959-5525.

• You will likely submit your GST yearly at first, once you start makingmore money, then you must do it quarterly. Can be paid throughonline banking.

• Naturopathic consultations, treatments, dispensary items and labsare PST exempt, but you should check with the CRA to determine ifyou sell any other products that may not be PST exempt.

TIP: A good way to think of GST is “in clinic” is exempt (consults, tests, therapies) and what “leaves the clinic” (dispensary, product) is taxable.

b) Business Licence and Zoning.

• Your town/city/municipality may require a business licence tooperate, unless you are an employee. See your municipal body fordetails.

• if you are developing your own clinic, consult your municipal body forzoning restrictions.

TIP: Vancouver does not permit running a medical clinic from your home. Burnaby does allow it. Municipal rules vary widely.

c) MSP Registration.

• Hard vs Soft Opt out (it is advisable to opt out of MSP. If an ND optsinto MSP they are legally required to see patients at the rate of $23per consultation):

o Fax letter etc. for opting out to 250-405-3592o Do this so that your premium assistance patients can be

reimbursed for some of their visit.

• Form for Patient Reimbursement.

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TIP: Just to clarify MSP, opting in requires an ND to see patients on the government determined fee schedule. Opting out allows an ND to set their own fee schedule. Regardless, if an MSP-eligible patient sees an ND, the doctor must complete the reimbursement form in the link above to allow that patient a refund against fees paid.

d) Incorporation (optional).

• If you decide that you want to incorporate, you must incorporate as ahealth profession corporation and apply to the CNPBC for this beforeincorporation.

TIP: BCNA members have access to a 15-minute master class on incorporation; when to incorporate, how, why, etc. The video is on the member resources page at www.bcna.ca.

e) Emergency Kit MSP Registration.

• Office Checklist.

• Pharmacies and medical supply companies such as Stevens canprovide you with much of what you need.

f) Set up accounts with suppliers and order what you need.

• Purchase your dispensary or look into other options (Fullscript,relationship with a health food store / natural pharmacy, herbaldispensary).

o Don’t forget to use your Grad Discount Packs and don’t beafraid to ask for deals as new practitioners. Meeting with thereps for product education sessions is a great way to get toknow a line, refresh your knowledge and get to know yoursuppliers.

TIP: Don’t be afraid to ask for full bottle samples. Some companies give full samples to MDs but not NDs even if the opportunity for promotion through an ND dispensary is much greater.

• Who will you run your labs through? Set up your accounts and havethem send you some kits for tests you will use (you don’t have to payfor them until you sell them to your patients and are sent in): RockyMountain (RMA), Doctor’s Data, Meridian Valley, Precision Analytical,etc. Pharmacies and Stevens Medical can supply you with much ofwhat you need.

• Set up your account with Lifelabs if you are planning on using RMAlabs and having Lifelabs draw your samples.

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o They will email you a personalized requisition form that youmust use.

• Will you be doing blood draws? You may need a centrifuge.

TIP: The BCNA office sells ABO reagents, if you’d like to do a simple, in-clinic test with a lance and slide.

• Acupuncture supplies?o Eastern Currents.

• Medical Equipment supplier?o Stevens Medical and/or Henry Schein also have safety supplies

and oxygen tanks.

TIP: The least expensive portable, refillable oxygen tank is available from St. John’s Ambulance.

g) Office Supplies.

• Who has good prices? Delivery as an option? Fast turn over forprinting? Rewards Plan?

h) Reception.

• Get to know them, find out what their expectations are of you (andvice versa), get them to show you where things are around the clinic.

• This person can make or break your practice, so you want to havethem on your side!

i) Take advantage of the BCNA’s offer to record a personal video on the healthtopic of your choice. This is a high-quality recording that you can use at yourclinic, on your website and on your social media platforms.

j) Review the loaded cost model supplied by the BCNA. Are your fees appropriate?How much should you be charging for visits, IV’s and injections? (*Note: youmust be logged in to the BCNA website to view).

k) Review the BCNA Member Resources Page. This is full of information includinginfographics, practice management, professional advice and much, much more.Take your time going through the pages here as there is lots to be learned.

l) The CAND Member Resources (ND Portal) page has lots of helpful itemsincluding patient handouts, office forms and business plan templates.

m) Set up your patient tracking form(s).

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• Track where they heard of you? What they are coming in for?Demographic?

• Keep track of who you see, what treatment you do (acupuncture, Bowen,etc.) and what you sell them.

• Do this even if you are an associate so you can make sure your booksmatch the statement you get from the clinic owner each month and theyaren’t missing something they should be paying you!

• Keep track of patient visits as well to fulfill CE hours. 50 treatments of acertain modality can count as your 2 hours of needed CE credits.

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10. Continuing Education and Additional Licensing

a) Learn about the requirements and timeline.

• Hours are pro-rated in 3-month periods depending on when you licensed.

b) Proof of CE hours.

• Hang onto receipts, certificates and whatever else proves you did thecourse (take pictures and save).

• Need to submit your notes from your CE hours and the verification formbefore the end of the CE period (keep copies for yourself of everythingyou submit to the CNPBC).

c) You must complete a peer review and a self-review every CE period and you maybe subject to a random practice review.

d) Additional Licensing and/or Training to consider: All invasive certificationsrequire prescribing authority and NALS; there are no exceptions.

• Chelation: IV, chelation (plus prescribing and NALS).

• Hyperbaric: hyperbaric license (plus prescribing and NALS).

• Ozone: requires IV certification, ozone licensing (plus prescribing andNALS).

• Prolotherapy (i.e., advanced injections): requires IV certification,advanced injection therapy certification (plus prescribing and NALS).

• IV training requires certification from a number of approved instructors(plus prescribing and NALS).

• Immunization: There is no cost for training and there is no cost tomaintain or renew your certification.

• Once you have completed the training, you send in your certificate andpayment to the college to be approved to provide the service.

• Many courses are listed on the BCNA website.

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11. Adverse Reaction Reporting

• Applies to both prescriptions and non-prescriptions. Know where toreport this and be prepared.

• MedEffect Health Canada reporting system.

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12. Repaying Student Loan(s)

a) Contact BC and Canada Student Loan for Repayment Assistance if you are notmaking much money.

• You have to wait until your six months grace period is over to apply, but Itis recommended to send in your application the first day after the graceperiod is over to make sure that your application is processed beforeyour first payment is due.

• Canada Student Loan.

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13. Diagnostic TestingSet up your Lifelabs and Rocky Mountain Analytical accounts before starting practice. You can do this by emailing info@rmalab.com and they will send you the appropriate paperwork. This will register you for both Lifelabs and RMA so don't worry about searching for two applications. If you practice in the Okanagan, you can set up an account through Valley Medical. (If you practice elsewhere, say the Kootenay or Squamish, there is no local lab for your patients.)

BCNA also has information on contacting and setting up accounts with other labs such as Doctor’s Data, US Biotek, Meridian among others.

Excelleris- https://www.excelleris.com/ is a system that permits doctors to have their patients' Lifelab/Valley results sent to them electronically.

TIP: Encourage patients to sign up for My E-Health, a provincial system that allows them to access recent diagnostic tests from any licensed provider (e.g., MD, ND, dentist, midwife) and save those files to PDF for future reference and or bring into their patient visits.