Where doctors are in short supply, pharmacists, nurse practitioners, physician assistants, and dental therapists are stepping up to the plate, providing a range of health care services to patients in need.
These days, there’s new a group of healthcare professionals, including pharmacists, nurse practitioners (NPs), physician assistants (PAs), and dental therapists who can diagnose and treat a range of diseases and health concerns.
What’s more, these licensed professionals are frequently trained to treat patients with chronic diseases, and many are willing to serve patients who live in medically underserved areas. Where doctors are scarce, these providers can save lives.
Some physicians are worried that these providers may lure business away from them. But, as the shortage of primary care doctors continues in the face of declining government reimbursement and an increased patient load, many doctors are welcoming these healthcare professionals with open arms.
In fact, the new arrangement appears to be a win/win for doctors and patients. Patients don’t have to wait long to get an appointment, and they usually find that they receive more personal attention as well as preventive education. Meanwhile, physicians are freed up to treat the most urgent cases.
Dr. Warren Filley, a board certified allergist at Oklahoma Allergy & Asthma Clinic, and a clinical professor at the University of Oklahoma College of Medicine, told Healthline that their two NPs are a boon to the practice.
“One NP has a doctorate of nursing, and she sees a broad mix of patients. Our other NP sees established patients, as well as our sick patients when they cannot be seen by one of our eight staff physicians,” he said. “Both of our NPs have had subspecialty training in allergy and asthma.”
Filley continued, “Our two NPs are an extension of our M.D. providers. We feel very fortunate to have them. They do not take business away from the practice. Instead, they add so much to the practice.”
Pharmacists are also taking the reins when it comes to providing patients with counseling for chronic diseases, such as diabetes.
Take the case of Jerry Meece, R.Ph., CDE, FACA, FAADE, and owner of Clinical Services at Plaza Pharmacy and Wellness Center in Gainesville, TX, who has incorporated diabetes care into his pharmacy practice.
Meece, who has been a certified diabetes educator for the past 15 years, offers a diabetes self-management training program, which includes one-on-one counseling and group education.
Meece teaches patients how to properly use blood glucose meters and test strips. “Self-monitoring of blood glucose is the cornerstone of understanding how you are doing,” he said.
As an example, Meece cited a patient who was recently diagnosed with diabetes and who was also taking more than a dozen medications for other conditions, Meece said, “It was a sit down, to say, ‘everything is going to be okay.’ We set up an appointment for the next day and I went through all of the medications he was taking to help him understand his medications and his new disease. The big job is to simplify what is an overwhelmingly complicated and mysterious disease to some people.”
While critics argue that pharmacists like Meece are cutting into their business, Meece said patients are culled from referrals from about 20 doctors in the area.
“We have a lot of good cooperation with physicians in the area that refer patients. I definitely see more physicians referring patients these days. In a lot of cases around the country, hospital diabetes education centers are going out of business at a rate of about one or two every month, due to poor reimbursement. We have been able to take something that wasn’t much income for a hospital and take the patients that they don’t have the personnel to accommodate anymore,” said Meece.
Finally, Meece said that there is a high cost associated with treating complications from diabetes that is not well managed. “An ulcerated foot may cost $30,000 to treat, and an amputation costs $50,000,” he said. “If you look at the cost of treating neuropathy, kidney diseases, and complications, having preventive costs up front is much less. It’s miniscule compared to the overall costs to patients, which include loss of work and quality of life.”
The newest healthcare providers on the scene are dental therapists, who can drill and fill cavities and treat patients of all ages.
Currently, Minnesota and Alaska are the only two states that have changed their laws to enable a wider scope of practice for dental therapists.
The University of Minnesota School of Dentistry launched its program for dental therapists in the fall of 2009. Sheila Riggs, DDS, DMSc, the chair of the department of primary dental care at the university, told Healthline, “Our patients really like the extra time and attention and education they get about their oral health.”
Riggs went on to explain that the law requires dental therapists to work in a ‘health shortage area’ or in a practice where 50 percent of patients are in a public program or are uninsured.
“Public program reimbursement is so low that having a dental therapist is a win/win. The salary of a dental therapist is not as high as that of dentist, but they can see public program patients. It’s an economical formulary that works better for the dental office. This is a way for a dentist to keep seeing his or her patients, but meet the needs of the community,” Riggs said.
Katy Leiviska, who has been working as a dental therapist for two years at HealthPartners’ Midway Dental Clinic and Como Dental Clinic in St. Paul, Minn. told Healthline, “My main purpose is to help increase access to care. Everything I do is covered through Medicaid state-based programs and it is a lot less expensive for me to provide these services than to have a dentist see these patients. It also helps to increase access because the patients have another provider that can see them.”
Noting that many dental offices don’t treat children, Leiviska said that she treats many children so dentists can focus on difficult and emergency situations, such as tooth extractions, and high end work like dentures, crowns, and root canals.
Leiviska also works with translators to treat many non-English speaking patients who are visiting a dental office for the first time.
Treating the medically underserved is also high on Toni Pratt-Reid’s priority list. Pratt-Reid, MS, APRN, C-NP, FNP is owner of Family Healthcare & Minor Emergency Clinic Inc. in Oklahoma.
Pratt-Reid opened the first independent NP practice in Oklahoma in 2001. Now she has three clinics and employs seven NPs.
“My goal was to work with the underserved and uninsured because I felt there was a real need there,” she said. “We still see anybody and everybody that needs to be seen. I have so many patients that come in and say, ‘I turned 65, my primary care physician for the last 15 years no longer sees Medicare patients.’”
In addition to seeing patients on the day that they call for an appointment, Pratt-Reid is also busy serving the developmentally disabled population at Southern Oklahoma Resource Center, which is in the process of being closed.
Every Wednesday and Saturday morning, Pratt-Reid drives an hour and a half each way to take care of patients, before heading back to work at the clinic. “The one thing I love is providing continuity of care with these patients who have been in this institution for 20 to 50 years,” she said. “As they trend to move to group homes, I follow them on the outside.”
Finally, Pratt-Reid said, “Patients tell me the most important service I provide is listening and teaching them what they don’t know, whether it’s side effect of medicine, or expected outcomes of healing.”
Many providers are carving out new niches for themselves in today’s healthcare landscape, including Jennifer Chan Marcelo, PharmD., a clinical pharmacist and ambulatory care pharmacy clinical assistant professor at the University of Illinois (UI) at Chicago College of Pharmacy.
Marcelo, who calls herself a hybrid pharmacist, works at CommunityHealth, a nonprofit organization that partners with UI Health. She provides medication therapy management services and sees ambulatory patients who have major diseases, such as diabetes, hypertension, hyperlipidemia.
Because the pharmacy’s formulary consists of drugs that are donated, if a prescribed drug is not available, Marcelo may have to select an alternative drug that has the same efficacy, but which may have different dosing. “You have to counsel patients through a medication list or paper reminder to make sure they don’t forget their second dose, if that’s what the medicine dosage requires,” she said.
Marcelo also provides medication reconciliation for patients at Wood Street/PCC Pharmacy.
“I look over patient profiles to see if there are discrepancies with the medication list, as well as if there are any interactions and adverse effects. I make sure we continue care for patients when they leave the hospital and that their medication list is updated. When they come for refills, I make sure that the medication is constantly reviewed and that medication is working safely and effectively,” she said.
It’s Marcelo who perhaps best summed up the benefits of this new breed of healthcare professional, both for patients and physicians. “With Obamacare we are trying to figure out what roles we should take on, too, in terms of relieving burden of physicians, such as wellness visits, vaccinations, and medication reconciliation,” she said.
“We provide a lot of services at no charge. We are doing it for the benefit and quality of life for patients. We want to let people know with pharmacists’ intervention we do help patients and make a difference.”