Clinic consultation

A nurse-led clinic provides primary care

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 right clinic offers patients 40-minute exams, as opposed to the 10-15 minute appointments typically allotted to manned clinics, as well as a one-day wait time instead of 2 weeks.

The chain of six primary care clinics, owned by health care holding company Mitesco, Inc, is seeking to address doctor shortages, particularly among primary care physicians, resulting in longer wait times , delayed care and shorter patient visits.

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

Nurse practitioners are in a unique position to address health care disparities and ensure equitable, quality access to health care for millions of people in the United States, she said.

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

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

Minnesota NPs have an FPA, which allows them to see patients and prescribe without the supervision of a physician.

In a report published last year by the Association of American Medical Colleges, there will be a shortage of 37,800 to 124,000 physicians within 12 years.


Dr Kishlay Anand

Not only is there a shortage of qualified providers, but there is also a significant shortage of primary care providers, said Kishlay Anand, MD, founder of Apricus Health in Arizona, which manages health systems. With more doctors choosing to specialize, there won’t be enough primary care providers, he said. “We definitely compensated for specialty care, but we didn’t pay adequate compensation for primary prevention,” Anand told Medscape.



Dr Peter Hahn

The pandemic has accelerated that shortage by causing physician burnout, said University of Michigan Health–West CEO Peter Hahn, MD. Health systems, especially in rural areas, are already experiencing this severe shortage, he said. This leads to delays in patient care and therefore greater health care needs that reverberate.

That’s what makes primary care, with its focus on health promotion and prevention, an excellent niche for nurse practitioner-led clinics to address doctor shortages, Hahn told Medscape. . NPs can optimize patient outcomes with fewer resources compared to a physician, he said.

NP field growth

Improving the patient experience and making healthcare less transactional were priorities for The Good Clinic Founder and Chief Nurse Practitioner Kevin Lee Smith, DNP.

“At the end of the day, we really wanted to take this nursing perspective where you’re looking at bio-psycho-social-spiritual being. Which is unique [about NPs] is the emphasis on patient education, experience and holistic care. And NPs are more inclined to take that time because it’s part of our education,” he said.



Teal Foster, IP

Nurse practitioner Teal Foster owns Refine Wellness, an independent practice in Stillwater, Minnesota, which is not affiliated with Mitesco Clinics. One of the reasons she started her business was because she found that patients couldn’t get appointments to see their provider, sometimes for weeks or even months. Foster said she sets her own appointment times, spends more time with patients, and has more opportunities to take a more holistic approach to care.

“As nurse practitioners, our training is largely based on chronic disease prevention and management. With that focus, it’s about seeing the big picture, rather than individual parts of the patient,” said Foster at Medscape.

Physicians see need for nurse practitioners – with caution

“Nursing education is more focused on health promotion and prevention – principles that prevent erectile dysfunction [emergency department] costs specifically in underserved populations,” Hahn said. “In these rural areas or medically underserved communities, nurse practitioner-led clinics support positive patient experience scores, feelings of safety, feelings of trust and respect, and have been shown to help patients to better understand their own health.”

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

The concern of many physicians is that not having medical oversight for early career Nps can lead to problems, Anand said. Doctors train for much longer than Nps, and this is what gives them credibility and qualification to deliver quality care, he explained. “Patients in rural communities can be very complex and have multiple co-morbidities. Sometimes this rapid training is not able to do that justice.”

That’s why Anand said meeting the qualifications and having mentorship opportunities for doctors would bring “much-needed safeguards” and regulatory aspects to the delivery of care in these settings. Even experienced doctors can improve their skills if they have a good coach and mentor, he said.

Continue to collaborate

At The Good Clinic, the collaboration works the same way it does at a doctor-led clinic, Smith said. Computer messaging between the six clinics puts the IPs in touch instantly.

“Curbside consultations” are common. “For example, we’ll have someone who has 20 years of experience in women’s health, and the person who has 5 years as a nurse practitioner might find themselves in a situation where they need that person. We’ll do a lot of internal consultation,” Smith explained.

A partnership with a nearby radiology group allows radiologists who are happy to consult with an NP over the phone to find out 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,” Smith said. “We have best practice guidelines internally, and there’s also this professional responsibility and ethics, that you’re not going to get into running something that you’re not comfortable with. .It takes a whole 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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