The NP Will See You Now: Clinic Staffed by Nurses Provides Primary Care

Risa Kerslake, RN, BSN

September 23, 2022

A chain of primary care clinics in Minneapolis, Minnesota, is likely the first of its kind to be staffed entirely by nurse practitioners (NPs). The Good Clinic offers patients 40-minute exams, as opposed to the 10- to 15-minute appointments typically allotted for physician-staffed clinics, as well as a 1-day wait time instead of 2 weeks.

The chain of six primary care clinics, owned by healthcare holding company Mitesco, Inc, seeks to address the shortage of doctors, particularly among primary care physicians, which results in longer wait times, delayed care, and shorter patient visits.

"As the nation seeks solutions to the challenges of healthcare access and the rising incidence of chronic disease, it is no surprise that NPs are increasingly the provider of choice for patients," said April Kapu, DNP, APRN, president of the American Association of Nurse Practitioners (AANP).

NPs are in a prime position to address healthcare disparities and ensure quality and equitable healthcare access for millions of people in the United States, she said.

According to 2021 data from the US Bureau of Labor Statistics, a 40% increase in the number of NPs is expected over the next 10 years.

Currently, 26 states and Washington, DC, have given full-practice authority (FPA) to NPs, according to the AANP. FPA, as defined by the organization, gives NPs the authority to evaluate, diagnose, and treat patients, as well as order and interpret diagnostic tests under the state board of nursing. This eliminates the need of a collaborative practice agreement between an NP and a physician to provide care.

NPs in Minnesota have FPA, which allows them to see patients and prescribe without doctor oversight.

In a report released last year by the Association of American Medical Colleges, it is projected that there will be a shortage of between 37,800 and 124,000 physicians within 12 years.

Dr Kishlay Anand

Not only is there a dearth of qualified providers, but also there is a significant lack of primary care providers, said Kishlay Anand, MD, founder of Apricus Health in Arizona, which manages health systems. With more physicians choosing to specialize, there are not going to be enough primary care providers, he said. "We have definitely compensated specialty care, but we have not paid adequate compensation for primary prevention," Anand told Medscape.

Dr Peter Hahn

The pandemic has accelerated this shortage by causing physician burnout, said Peter Hahn, MD, CEO of the University of Michigan Health–West. Healthcare systems, especially in rural areas, are already experiencing this severe shortage, he said. It results in delayed patient care, and as a result, more significant healthcare needs that trickle down.

It's what makes primary care, with an emphasis on health promotion and prevention, a great niche for NP-led clinics to address the physician shortage, Hahn told Medscape. NPs can optimize patient outcomes with fewer resources compared to a physician, he said.

Growth of NP Field

Improving patient experience and making healthcare less transactional were priorities for The Good Clinic founder and chief nurse practitioner officer Kevin Lee Smith, DNP.

"The bottom line is we truly wanted to take that nursing perspective where you look at the bio-psycho-social-spiritual being. What is unique [about NPs] is the patient education focus, experience, and holistic care. And NPs are more inclined to take that time because that's part of our education," he said.

Teal Foster, NP

Nurse practitioner Teal Foster owns Refine Wellness, an independent practice in Stillwater, Minnesota, which is not affiliated with Mitesco clinics. One reason she started her company was that she was seeing that patients couldn't get an appointment to see their provider, sometimes for weeks to months. Foster said she sets her own appointment times, spends more time with patients, and has a greater opportunity to take a more holistic approach to care.

"As nurse practitioners, our education is largely based on prevention and chronic disease management. With that being the focus, it's seeing the big picture, rather than individual parts of the patient," Foster told Medscape.

Doctors See Need for NPs — With Caution

"Nursing education is focused more on health promotion and prevention — tenets that prevent ED [emergency department] costs specifically in underserved populations," said Hahn. "In these rural areas or medically underserved communities, NP-led clinics support positive patient experience scores, a sense of security, feelings of trust and respect, and have been shown to help patients gain insights into their own health."

With the physician shortage, advanced practice providers are a crucial part of the solution for patients, as well as healthcare systems, Hahn said. But one challenge to NP-led clinics is the variability in practice regulations from state to state. "Standardization should be considered a high priority to utilize these advanced practice providers effectively and to enable them to consistently practice at the top of their license," said Hahn.

The concern of many physicians is that not having physician supervision for early-career Nps can lead to problems, Anand said. Physicians train much longer than Nps, and it's what lends to their credibility and their qualification to deliver quality care, he explained. "Patients in rural communities can be very complex and have multiple comorbidities. Sometimes that quick training is not able to do justice to that."

It's why Anand said meeting qualifications and having physician mentorship opportunities would bring a "much-needed safeguard" and regulatory aspects to delivering care in those settings. Even experienced physicians can improve their skills if they have a good coach and mentor, he said.

Continuing to Collaborate

At The Good Clinic, collaboration operates similarly to at an MD-led clinic, Smith said. Computer messaging between the six clinics puts NPs in touch with each other instantly.

"Curbside consults" are common. "For example, we'll have someone who has 20 years of women's health experience, and the person who has 5 years as an NP might run into a case where they need that person. We'll do a lot of consulting internally," explained Smith.

A partnership with a nearby radiology group lends radiologists who are happy to consult with an NP over the phone about what type of x-ray would be most beneficial, he said. For cases that require a higher level of care, The Good Clinic maintains an extensive referral list.

"We are here to advocate for our patients," said Smith. "We have best practice guidelines in-house, and there's also that professional accountability and ethics, that you're not going to go into the territory of managing something that you're not comfortable with. It takes a village to provide the appropriate care for an individual."

Risa Kerslake, RN, BSN, is a freelance writer living in the Midwest. She specializes in health, parenting, and education.

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