“So, how has your knee been?” Physician Assistant Diane Greenblatt asks Kathy Twitchell, who came to The Corvallis Clinic’s Philomath Family Medicine office for a follow-up exam on a slight tear in her meniscus, the cartilage that acts as a cushion between the shinbone and the thighbone.
Twitchell is among a growing number of Americans who over the past two decades have been going to either a physician assistant or nurse practitioner for their primary care needs.
“In the early 1990s, the public was not as familiar with nurse practitioners, which is very different from today,” says Ruth Palma, a nurse practitioner at The Clinic’s Family Practice Department in the Asbury Building.
Indeed, demand is increasing rapidly for physician assistants (PAs) and nurse practitioners (NPs). For the first time, NPs and PAs are listed in the top 20 of the most requested search assignments by Merritt Hawkins, which publishes an annual review of health professional recruitment and staffing. NPs and PAs rank 10th and 12th respectively on the 2013 list put out by the physician search and consulting firm.
And to highlight the demand for primary care providers in general, family physicians and general internists have been one and two on the list for seven straight years.
“In our Corvallis Clinic model,” says Dr. Dennis Regan, Medical Director at The Corvallis Clinic, “NPs and PAs are part of the physician care team for all patients. That means they have complete access to patient records and are integrated with our physicians’ practices. They have training in wellness and preventive care, as well as care for acute medical conditions. Because their practices are integrated with our care teams, they also have easy access to our physicians for more complex medical issues.”
Drawn to Family Medicine
When Palma was studying to become a nurse practitioner at the University of Miami’s master of nursing program in the early 1990s, only Adult or Family medicine was offered, unlike the many more options of today (see article at left). However, she said family practice for her seemed like the natural choice.
“It allows me to provide health care across the life span with a wide range of care to a diverse group of patients,” she says.
Since Greenblatt became a physician assistant in 1998, she has also worked in emergency medicine and been a surgical PA, but she has always found her way back to family medicine. “I like the variety of patients and the variety of medical conditions,” she says. I also love getting to know the whole person as well as their family. There is a special kind of relationship that develops between a patient and a provider that I just wasn’t getting in other specialty areas of medicine.”
And current patients are glad for the paths their providers have chosen.
“Ruth is the type of provider who takes the time to listen to her patients,” says patient Meghan McCausland. “Through her communicative style, she is able to gather essential information for a successful diagnosis. She is also cognizant of medical costs and works to provide patients with top care without ordering unnecessary tests.”
“She’s a nice person and very knowledgeable,” Twitchell says of Greenblatt. “She has been very helpful with my attempts to get my knee healed. She has guided me through physical therapy and finding an orthopedic doctor.”
Greenblatt and Palma say NPs and PAs bring an added dimension to primary health care.
“In general,” Greenblatt says, “a PA can spend more time with patients and really be another support system for all the patient’s needs.”
“Nurse practitioners often will have years of nursing experience, frequently in hospital settings,” Palma says. “As such, they bring a nursing perspective to the practice, which can differ from the physician perspective. Nurse practitioners often work in close collaboration with physicians, which can complement care provided by both the NP and physician. Nurse practitioners bring increased accessibility or less wait time for scheduling appointments.”
“Nurse practitioners, by virtue of who they are as nurses, went into nursing first because of their love of empathetic care,” says Dr. Regan. “They are driven by their relationship with their patients.”
With a Master of Public Health and Bachelor of Science in dietetics, Greenblatt has always been interested in health care. “I realized that I wanted to be able to talk to people and help them with more than just dietary changes,” she says. “I chose to become a physician assistant because it was a very direct path to my goal. The schooling is very practical and also very hands on.”
Palma’s desire to become a nurse practitioner was sparked in nursing school. “One of my classes required spending time observing nurses in nontraditional roles,” she says. “At that time, NPs were relatively uncommon. It was soon after shadowing a nurse practitioner that I felt inspired to pursue this career, as I liked the concept of working both independently as well as collaboratively within the health care team. Another result of this experience was the awareness that I much preferred the clinic setting over the hospital setting. I love the opportunity to work with patients on their health.”
Development of NPs and PAs and Their Roles
A major factor that spurred the development of the nurse practitioner and physician assistant professions in the 1960s was a lack of access to health care, particularly in remote rural areas as well as large urban centers. Part of this was brought on by the increasing specialization in medicine in the 1950s and ‘60s that led a large number of physicians out of primary care, creating a shortage of primary care physicians. In addition, the sudden availability of coverage offered by the new Medicare and Medicaid programs increased the demand for expanded primary care services.
“Nurse practitioners have traditionally provided care to the underserved,” Palma says, “but they currently improve access to primary care in all areas, including locations such as Corvallis. With the ACA (Affordable Health Care Act), there has been increasing focus on disease prevention and health promotion, which has always been a key component of the nurse practitioners’ role.”
The growth and acceptance of NPs and PAs are likely to continue. “The number of training programs has risen dramatically,” Greenblatt says. “PAs are much more accepted and integrated into medicine than 15 years ago.”“Since I began practicing, the numbers of nurse practitioners have increased fourfold and so has specialization,” Palma says. “There has been greater acceptance from the medical community as well as the community at large. It is expected that with the current and future changes in health care, nurse practitioners will continue to be a significant member of the health care team.”
And as great as it is to be part of a growing profession, Greenblatt says it’s even better when you love what you do.
“It is such a privilege to have patients trust you with their physical and emotional health,” she says. “I feel honored when patients share their concerns with me. I can honestly say that after 16 years of being a PA, I still think it is the greatest job in the world.”