Nurse practitioners (NPs) are having a moment across the U.S. They represent one of the fastest growing career fields in the country with a projected growth rate of around 45% through 2030. An estimated 29,400 job openings for nurse anesthetists, nurse midwives, and nurse practitioners will be created every year, according to the Bureau of Labor Statistics.
NPs provide a range of healthcare services and can operate with full autonomy in many states. And now “The Good Clinic” in Minneapolis is the country’s first primary care group to be staffed only by nurse practitioners. The clinic uses a unique NP-model of care to emphasize patient engagement, continuity of care, and an emphasis on wellness and convenience through a unique nurse practitioner-driven model, says Larry Diamond, CEO of Mitesco Inc., which oversees the clinic’s brand.
According to the American Association of Nurse Practitioners (AANP), more than half of all states, 26, have adopted Full Practice Authority (FPA) for NPs, which gives patients full and direct access to care from these providers.
NPs in these states have the authority to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments under the exclusive licensure authority of the state board of nursing. They do not need a physician to sign off on their work, unlike NPs in states that do not have FPA.
The growing need for nurse practitioners coincides with a decline in the number of physician-run primary care clinics, mainly due to low reimbursement rates for primary care physicians. Doctors tend to make considerably more for their time pursing specialties.
“What’s happened over time is because reimbursements are low, physicians graduating from medical school with these huge student loan bills can’t afford, even if they wanted to, to go into primary care, and so the number of new docs coming out of medical school who want to go into primary care has been waning,” Diamond says.
The country is currently facing a shortage of about 25,000 to 35,000 primary care providers, according to the American Medical Association, “which is one of the reasons why all of these urgent care centers have popped up, because in America today, it’s typically two to five weeks’ waitlist to get in to see your primary care provider for just a normal visit, a physical, or just a follow-up,” Diamond says.
“So, America learned, ‘Oh, if I have an earache, a sore throat, or a cut, let me run over to the urgent care clinic,’ and the challenge there is that we stopped providing care and just started fixing problems.”
But patients need access to more than just urgent care clinics if the healthcare industry is going to do more than just fix problems. Reducing the rates of chronic illness often rests of the shoulders of primary care physicians – and now NPs.
“Diabetes is at an all-time high, and pulmonary issues, well, they all start somewhere and it’s typically because they’re not addressed earlier in their disease process,” he says. “And the government finally has recognized that if you focus on prevention, you can avoid a lot of the costs associated with people developing chronic illnesses, and then deteriorating with them, where it always costs more to address a problem later in its cycle.”
Nurses are better suited to this role than physicians trained in medicine, Diamond argues, because they spend the bulk of their time caring for patients one-on-one. They know how to explain risks and complex health issues to patients in a way they can understand.
“Nursing is about working with a patient over time, to help them overcome some of the challenges that they’re experiencing, where medicine has evolved to be much more about ‘one and done. Let me do something and solve the problem,’” Diamond says. “And with chronic illness in America, it’s not typically a ‘one and done’ type of solution.”
The Good Clinic came about after the physicians that created Minute Clinic, which has since been sold to CVS, added Diamond to their team to create a model of care that focused on the whole patient, including environmental factors, behavioral issues, stressors, and other personal factors that can affect a person’s health and wellbeing.
“The concept is about, ‘How do I take care of a person soup to nuts?’ [by] considering complementary and alternative medicine or whatever the person is interested in—yoga, meditation, supplements, vitamins, standard medicine—and to have a relationship where we co-develop a wellness plan with that person.”
For example, many teens and adolescents have been struggling with depression and anxiety following COVID-19, and doctors have been prescribing antidepressants to solve the problem, but this method fails to consider the person’s unique background and experience.
“No. 1, they’re not looking at their physical health to understand ‘How is their nutrition?’ because nutrition in adolescents really is the start point of how you feel mentally, behaviorally. We were finding thyroids that are not operating at the levels they should be, and we’re finding that their vitamin D and vitamin B levels are not the adequate level,” Diamond says. “Nutrition is the first starting place when you’re trying to address behavioral health issues, and unfortunately, so many of the behavioral health services operate in isolation of primary care.”
The first Good Clinic opened in February 2021, and now the company operates six clinics across Minnesota. This year, it plans to open 12 more facilities across Minnesota, Colorado, and Arizona. Diamond says the company may even expand into states without Full Practice Authority.
“Nurse practitioners pretty much in every state have the ability to practice; what changes as you go state to state is they often have to practice under the tutelage, from a quality control perspective, of a physician,” he says. “There are different levels—a physician [may have to] review chart review or they may have to sit in on a certain number of patient visits with a particular nurse practitioner. So, you can operate our model in all 50 states; it just becomes a little bit more expensive.”
