On Wednesday, I wrote about “scope of practice” – what health care providers, particularly nurse practitioners, who aren’t physicians are or are not allowed to do in their state. I provided several resources, reports and links to understand these fights, and the role nurses or physician assistants or other providers can have in providing primary care in underserved areas. Today I want to look at two stories:
The first was published earlier this fall online by Tina Rosenberg on The New York Times Opinionator section, part of a series called “Fixes” on solutions to social problems . She profiles a clinic in Indiana that provides full-service health care to 10,000 people – without any doctors. It’s one of about 250 clinics in the country run by nurse practitioners. Rosenberg reviews the reasons that there aren’t enough primary care doctors serving the poor or practicing in rural areas. She writes:
It might seem that offering the rural poor a clinic staffed only by nurses is to give them second-class primary care. It is not. The alternative for residents of Carroll County was not first-class primary care, but none. Before the clinic opened in 1996, the area had some family physicians, but very few accepted Medicaid or uninsured patients. When people got sick, they went to the emergency room. Or they waited it out — and then often landed in the emergency room anyway, now much sicker.
She says nurses are trained to do what many doctors do not learn – how to treat a patient more holistically, how to listen, how to “coach more, and lecture less.” All those skills are part of what’s needed to treat and manage chronic disease – which is what so much of primary care is about. Because nurses at the clinic are salaried, they aren’t stuck in the 15-minute-appointment hamster wheel of fee-for-service medicine. “At the Family Health clinics, appointments last half an hour — an hour for a new diabetic or pregnant patient.” Continue reading