An interesting article in the Great Falls Tribune the other day…it profiled Nurse Practitioners (NP). Many people still don’t know about non-physician healthcare providers, and the article gives a very cursory explanation about NPs. I’ve had the pleasure of working with NPs for many years, and I have always found them to be knowledgeable, considerate, and professional. In addition to NPs, another category of non-physician providers called “Physician Assistants” (PA) continues to grow. My experience with PAs is also very positive; they have treated me, my wife, and my daughters exceptionally well. I understand that some physicians — not all, but some — feel as if their “turf” is being invaded by non-doctors, but I think that PAs and NPs are a very good thing. I’ve got lots more to say about this topic — but I’ll save it for later.
Mar 8, 2005
Nurses learning new skills to help fill rural doctor void
By RICHARD ECKE
Tribune Staff Writer
Di Boland worried on a recent Sunday afternoon while her daughter coughed violently.
The Cascade-area woman began to wonder if the girl had whooping cough, so she called Chris Grotbo, her family nurse practitioner at the Integrative Medicine Clinic in Great Falls.
“She just said, ‘Bring her in,’ ” Boland recalled.
Grotbo saw the Bolands at the clinic and determined the youngster did not have whooping cough, all on a weekend evening.
“You just don’t see that nowadays,” Boland said appreciatively.
The Bolands are among a number of area residents to take advantage of the skills of advanced practice nurses, who have extra training that allows them to diagnose patients and write prescriptions.
“The rural areas really like us,” said Laurel Andrechak, an advanced practice nurse who works at the Cascade County detention facility. “Wherever the doctors don’t want to go, that’s where we go. I’m the only (full-time) provider at the jail. Just try to get a doctor to go to the jail.”
Nurse practitioners work from Cut Bank to Chinook, Great Falls to Lewistown, Fort Benton to White Sulphur Springs.
Medical doctors may not take as much time to listen.
“They’ve got so much on their plate,” said Boland, who describes Grotbo as “very gentle, soft-spoken.”
“I really like her bedside manner,” Boland said. “”She takes her time and she answers questions.”
Nurse practitioners “don’t have quite the education” M.D.s have, but they have been “right on” diagnosing her children, Boland added.
Nursing homes also may be a good, fit for nurse practitioners, said Katie Pellett, who practices at the Indian Family Health Clinic.
“That’s a perfect nurse practitioner position,” said Pellett said. “It’s no fun for doctors and they don’t make much money at it.” Many doctors cannot work nursing home patients into their schedules.
The United States has more than 200,000 nurses qualified for advanced practice, according to the American Nurses Association. Numbers soared in the 1990s, from 140,000 advanced practice nurses in 1992 to an estimated 196,279 nationwide in 2000, the group said.
Advanced nurses can provide most primary and preventive care for less money than a doctor, while emphasizing health promotion and disease prevention, the nurses’ group says. The northcentral Montana region has several dozen.
Diane Evans, a pediatric nurse practitioner at the Great Falls Clinic for a decade, was part of the 1990 boom in advanced nurses.
“We’ve had trouble finding pediatricians,” Evans said. “That’s how I got my job. They had two pediatricians leave. There’s a lot of nurse practitioners at the clinic now.”
Advanced practice nurses do not have admitting privileges at Benefis Healthcare hospitals in Great Falls.
“It’s one of the only hospitals in the state where you are required to have physician sponsorship,” said Elaine Becker, a certified nurse midwife at the Great Falls Clinic.
Brandy Solyst, manager of Community Relations and Marketing for Benefis, didn’t apologize for that.
“In many states across the country, advanced practice nurses are not allowed to practice independent of a physician,” Solyst said. “Montana is one of a few states that does allow this.” Although Benefis does not give nurse practitioners admitting powers, they are allowed to practice independently in the hospital, Solyst said.
In any case, relations between this new phalanx of health care professionals and the traditional mainstay — medical and osteopathic doctors — in the Great Falls area seem to be relatively good, according to several advanced nurses interviewed recently.
Squabbling over turf appears to be more common in the state’s other cities, such as Missoula, Billings or Helena, according to Deanna Babb, a family nurse practitioner who works with Grotbo.
That’s more common in cities with “an overabundance of docs,” where advanced nurses may be greeted less warmly, Evans explained.
There has been some friction in Montana cities between anesthesiologists, who are medical doctors, and nurse anesthetists, who are nurses.
“The battle continues to be fought,” Becker said. “Rural areas, that’s all we have, is nurse anesthetists.”
Whatever an area’s medical politics, advanced nurses are carving out a niche for themselves.
Becker believes the numbers of advanced nurses will grow, and may help to moderate medical costs that are growing by leaps and bounds in recent years.
All in all, physicians in the Great Falls area “have been good to us,” Andrechak said. “We’re feeding them plenty of business, too.”
In some ways, rural Montana has been more progressive than other states that have more traditional doctors.
“Montana is one of the most liberal states,” Evans said. Some states still debate the extent to which advanced practice nurses should be able to write prescriptions.
“Montana’s been doing that for 12 years,” she said.
Times have changed since a doctor asked Andrechak, “What are you?”
Since then, “It’s really exploded,” she said.
A future boom may be in advanced nurses treating older people, a field called geriatrics, and in the mental health area. And in heart care, Great Falls has two advanced practice cardiology nurses.
Training takes place at colleges and universities, including the MSU-Bozeman College of Nursing’s Great Falls campus.
Andrechak said her father, a retired surgeon in Spokane, at first was skeptical about having an advanced practice nurse care for his family. Then he saw how attentive the nurse was to his needs and questions, and how the nurse talked to him and paid close attention.
“I think people like to have a little control over their health care,” Grotbo said.
Insurance plans are more cooperative these days.
“There’s not many that are refusing (to pay) anymore,” Evans said. Some plans charge patients a higher co-payment out of their pockets to see Evans, however.
There are some professional advantages to being a nurse practitioner.
Midwife Becker said her malpractice insurance tab of about $8,500 annually “doesn’t even compare” to that of obstetricians and gynecologists, who may pay $300,000 each per year, largely because they do high-risk deliveries and caesarian sections.
Many area nurse practitioners read a Jan. 31 cover story in U.S. News & World Report, entitled “Who Needs Doctors? Your future physician might not be an M.D. — and you may be better off.”
At the same time, these “new healers” are not anxious to burn bridges with their better-paid colleagues.
“We have no desire to be in competition with the doctors,” Becker said. “That’s not the role or the goal.”
With so many baby boomers, Americans born after World War II, nearing retirement age, odds are heightened demands for health care will keep both the M.D.s and highly trained nurses busy.
Tribune Staff Writer Richard Ecke can be reached by e-mail at reckegreatfal.gannett.com, or at (406) 791-1467 or (800) 438-6600.