Frequently Asked Questions
Although Dr. Zelfand provides many of the same services and treats the same conditions as a primary care physician, her practice is not a primary care home. She does not stock vaccines, does not do emergency care, and there is no on-call or after-hours way to reach her.
If you have an urgent matter, you’re welcome to schedule a visit if one is available, but we do not guarantee openings for acute or urgent matters.
You are certainly welcome to schedule physical exams, well child visits, and pap smears with Dr. Zelfand, but you are encouraged to have a separate primary care physician (PCP).
The main difference between patients and clients has to do with whether or not you’ve established care with Dr. Zelfand in person. This in turn determines how many services she can legally and ethically provide to you. Dr. Z cannot act as a physician or treat patients living in other states or countries unless they first come to Oregon for a visit in person. This rule is mandated by the governing board, so we cannot make any exceptions.
This type of business relationship is not a doctor/patient relationship, but rather health coaching and consultation. These clients do not need to be seen in person first, but Dr. Zelfand will not be able to order diagnostic testing, diagnose diseases, or prescribe pharmaceutical medications to these people.
Some of my clients have just one or two sessions with to help point them in the right direction. Other clients check in every few weeks to continue chipping away at chronic health issues. You’re also welcome to start out as a client and then decide you want to come see me in person and become a patient. Dr. Zelfand is here to support you as much or as little as you desire.
Patients enjoy the full range of medical services. Dr. Zelfand can order lab testing and diagnostic imaging on her patients, diagnose and treat medical conditions, and prescribe medications.
Many patients that live in other cities fly in to Portland for a short visit to establish care. (We recommend buying trip insurance, as inclement weather does happen sometimes.) After care is established in person with an initial appointment we can do follow up visits by phone/Skype.
Note that if Dr. Zelfand is managing hormone prescriptions, then she will also need to see you in person at least once annually for a physical exam.
(Please see the above answer under Patients vs. Clients)
Dr. Zelfand is out-of-network with all major insurance, and therefore does not bill health insurance directly for medical services. If you have out-of-network benefits, however, let us know and we will provide you with all of the forms you’ll need for reimbursement. Call your insurance carrier to see how much they’ll reimburse you for a visit with us. (For more details, check out our handy resource page before calling your insurance.) Do not bother calling if you have Medicare, Medicaid, or Tri-Care; those programs rarely, if ever, reimburse for out of network care.
Depending on your health insurance policy, blood tests and other studies may be covered by your plan in part or in full. When you call your insurance to ask about coverage, see if they have a preferred lab. We will happily accommodate your needs.
Depending on your coverage, the pharmaceutical medications prescribed may also be covered by your insurance. Please note that botanical and nutritional supplements are usually not reimbursed by health insurance policies, although some HSA or FSA accounts will cover them.
Health insurance is a private agreement between you and your insurance carrier – for further questions about coverage, please call your health insurance company directly.
Dr. Zelfand prides herself on her versatile knowledge of both conventional and holistic therapies, and will use the modalities best indicated for you. These may include nutritional counseling, botanical medicine, physical manipulative therapy (similar to chiropractic), reiki, massage, hydrotherapy, lifestyle counseling, homeopathy, over-the-counter medications, pharmaceutical medications (including bioidentical hormones), IV therapy, and/or referral for surgery or specialized treatment.
The goal of treatment is to address the root cause of disease. Although attention will be paid to relieving unpleasant symptoms, the ultimate goal will be to uproot your ailments at an even deeper level.
Many patients appreciate how gentle yet penetrating this type of healing can be, and how the medicine empowers the patient to take an active role in the healing process.
By addressing dietary and lifestyle habits and by prescribing herbal supplements, patients often can manage drug side effects more easily, significantly reduce their dosages, and even wean off some or all of their drugs. Through functional medicine, patients who were told by another doctor that they “had” to take a drug often are able to reclaim their health through nutrition and herbal medicine alone.
That being said, pharmaceutical medications are sometimes necessary for certain conditions. Dr. Zelfand therefore prescribes medications (including testosterone) as indicated.
Dr. Zelfand does not prescribe DEA scheduled pain medications such as oxycontin, but has other strategies to help patients living with chronic pain.
In many cases, functional medicine can absolutely cure disease. Functional medicine can often be used instead of conventional medicine.
When used in conjunction with conventional therapies, natural approaches may increase the efficacy of conventional therapies, minimize the side effects, and address concomitant ailments.
Dr. Zelfand can diagnose and treat diseases, as well as offer counseling to help prevent them. Like conventional MDs, Dr. Zelfand can order and interpret blood tests, imaging, and other diagnostic procedures. She can likewise prescribe pharmaceutical medications when they’re truly necessary.
Dr. Zelfand treats patients of all ages, from newborns to elders.
Dr. Zelfand is a licensed naturopathic physician (ND) – NOT a lay naturopath.* Licensed NDs are graduates of four-year, accredited medical schools. ND candidates complete an average of 224.50 credit hours in basic clinical sciences – compared to 64 hours required for family nurse practitioners and 184 hours for MD candidates.
Like MD (medical doctor) and DO (doctorate of osteopathy) students, ND candidates are required to complete supervised clinical rotation hours (an average of 84 weeks). Both an attending physician and a resident oversee these rotations.
ND candidates are required to complete coursework in pharmacology during medical school. A naturopathic doctor completes an average of 72 pharmacology hours upon graduating from an AANME-accredited program – compared to 45 course hours completed by family nurse practitioners, and no specific pharmacology course requirements for MD students.
ND candidates are also required to complete 250 hours of clinical field observation. These hours are comprised of preceptorships not only with practicing and licensed NDs, but also with MDs, DOs, and DCs.
NDs are further required to pass two national board examinations, as well as a state licensure exam. Like MDs, NDs are required to complete continuing education coursework, including hours in pharmacology, ethics, and pain management.
In addition to completing all of the above requirements, Dr. Zelfand was also selected for a competitive teaching residency position after graduation, where she supervised medical students on their rotations at the teaching clinics of the National University of Natural Medicine (NUNM).
After completing her family practice residency, Dr. Zelfand then completed four years of post-doctorate training in pediatrics, under the tutelage of Paul Thomas, MD (acclaimed author of The Vaccine-Friendly Plan). This allowed her to deepen her skills in treating children, using both conventional and natural approaches to care.
*NOTE: In states where ND licensing is not required by law, any person can technically call themselves a “Naturopath,” whether or not they completed medical school. This is a serious threat to the public’s health and safety. We therefore encourage you to support the efforts to pass ND licensure in your home state if you live in an unlicensed state!
With increasing demand for more patient-centered, holistic medicine, some MDs have broadened their scope of medicine to include herbs, nutrition, and other natural therapies.
Many of these alternative-minded practitioners draw on naturopathic philosophy and nature cure strategies to offer their patients better care. These MDs and DOs often refer to their integrative approach as “functional medicine.”
“Functional medicine” is essentially a re-branded, re-marketed, and somewhat watered-down version of naturopathic medicine.
Whereas holistic MDs and DOs undergo independent study in natural medicine in a piecemeal fashion after graduation in order to specialize in functional medicine, NDs are taught this integrative approach from day one of their medical training in addition to all the same sciences as MDs.
In other words, an ND is like an MD plus plus – a doctor who has a working knowledge of conventional diagnostics and pharmaceutical management and is also trained in natural therapies and functional medicine.
What all of these providers have in common is a working knowledge of conventional diagnostics and pharmaceuticals in addition to a deep appreciation for the body to heal itself. Holistic MDs and functional doctors also know much more about herbs and nutrition than the run-of-the-mill MDs, but their knowledge is inconsistent from provider to provider, and there is no standardized exam for these doctors to demonstrate their skill. NDs are well versed in herbal medicine, nutrition, homeopathy, and orthomolecular medicine, as the naturopathic medical program mandates these subjects be included not only in the medical curriculum, but also assessed during clinical rotations and tested in the national naturopathic medical board examinations (NPLEX I and NPLEX II).
For naturopathic physicians, integrative medicine – or functional medicine, as it’s more commonly called nowadays – is the “first language.”