A Nurse Practitioner's View

This post was written in response to the WSJs article, " Should Nurse Practitioners Be Able to Treat Patients Without Physician Oversight? " As much as some would like you to believe that this is not about turf protection, make no mistake, it is exactly about protectionism and nothing in the interest of the patient. The latest buzz words are now “team-based care” where nurse practitioners, physicians, and other members of the health care team, are working for the common goal of better health outcomes while the inefficiencies of today’s healthcare system vanish. The problem with this presumption is that there is no defined model of team-based care. So what then is team-based care? If you ask a physician what team-based care is, they would say it is where they are in charge of the team and tell what the other members to do. They hold the most hours of in-patient training and in doing so can care for every patient and every condition without anyone else telling them how...

I was recently contacted by a member of the National Health Services Corps (NHSC) and asked to highlight their program here on my blog. It certainly sounds like a wonderful opportunity for NPs regarding loan repayment. So here it goes: The NHSC is a federal program that offers primary care providers financial support in the form of loan repayment or scholarships so they can practice in underserved areas of the country without the burden of educational debt. The NHSC is currently expanding to help meet the need for primary care professionals. The current application cycle for loan repayment closes on May 26th and applications are now being accepted for the NHSC scholarship program . As the country faces a shortage of primary care providers, the NHSC plays a critical role in bringing primary care medical, dental and mental health professionals to communities in which people would otherwise have to travel miles for health care, or go without help. In return, the NHSC offers hel...

On my snowy commute into work this morning for what seemed like 100th snow-laden car ride of this winter, I chuckled when the radio newscaster urged people to stay home. As a healthcare professional, we rarely see a "snow day." Hospitals and clinics don't close. So to all of my healthcare, EMS, police and fire (and anyone else needing to get to work) colleagues: Please stay safe out there when Mother Nature throws this nasty weather our way. Some people must get to work whatever the circumstances are.

The healthcare system of today is so complex yet so dysfunctional that I believe the time has come to educate and train the NP providers of tomorrow in a way that is reflective of that complexity. We have done a good job up to this point but need to bring that to the next level. Residency. I'm not necessarily referring to the typical residency training of physicians which takes place in hospitals but a residency-type of program in an out-patient setting (ironic that we use the term residency). We realize that healthcare is not exclusively delivered in hospitals. It takes place in independent providers offices, in community health centers, in mobile health vans, and in retail settings. It takes place in people's homes and places of employment. It takes place in many of the health decisions that we make on a daily basis. I found this NP residency program in Connecticut that claims to be the first NP residency in the US. The programs admits 4 NPs each year and trains them to ha...

Here is an op-ed piece that I wrote some time ago that unfortunately didn't get published. However, this blog is a great place to put it! Patient-Centered Health Care Patient centered. To the average health care consumer, the notion that they themselves are the main focus of the care received is a no- brainer . However, the reality that exists in health care today is quite the opposite. More often, interacting with the current health care system is often a deeply dissatisfying and frightening experience, fraught with errors, miscommunication and waste. As a community-based nurse practitioner for 10 years, I practice within the fragmented confines of an inefficient and costly system and know how this current system is too often harming people. Fundamental reform is needed. According to the Institute of Medicine, care is often delivered in silos producing poorly coordinated and overly complex care. The current healthcare system is fraught with opacity and is unnavigable for most o...

Here are some of my top read posts from the past. I hope you enjoy reading them. Collaboratus Provider Ratings Your Chart: Do you know what's in there?

Here is an article that refers to the NP led clinics that are flourishing in Canada. Canada established NP run clinics in 2007 and is continuing to add more as they are filling an important void in primary care. The article wonderfully points out that this initiative is collaborative an is not looking to supplant anyone else (for those worried about that). Great read. I'm hopeful that people are paying attention.

Wonderful job by Dr. Apold, Chairperson of the Board of Directors of the Nurse Practitioner Association, New York State ( The NPA ). Dr. Motta of the Massachusetts Medical Society also did a good job for making the case for fully utilizing NPs in the health care system and couldn't give any evidence-based reasons not to.