U of M nurse practitioner clinic aims to help fill doctor void

One of the first clinics in the state fully operated by nurses will start scheduling patients Wednesday in what University of Minnesota officials hope will be a solution to the state's looming shortage of doctors.

The University of Minnesota Health Nurse Practitioners Clinic is an outgrowth of a law passed last year that gives autonomy to nurse practitioners. Previously, they needed to collaborate with supervising doctors to treat patients.

Marquee goals of the clinic, a block from the Vikings' stadium in Minneapolis, are to improve medical access for downtown residents, tourists and commuters and to provide hands-on training for aspiring nurse practitioners who will now enter practice with more independence.

But its creators also hope the nurse-run clinic will provide cheap, quality primary care that can be replicated in low-income urban and sparsely populated rural parts of Minnesota that lack doctors.

"This is very much in line with the national call to action and, frankly, the all-hands-on-deck approach" to solving the primary-care shortage, said Connie White Delaney, dean of the U's School of Nursing.

Experts predict a severe shortage of doctors in Minnesota by 2025, when the need for care in the aging population will increase more than 20 percent but a surge of retirements will stunt growth in the number of physicians.

Nurse practitioners — who receive additional medical training beyond nursing school — already make up 27 percent of the state's primary-care providers, according to a December report from the Legislative Health Care Workforce Commission. But, as with doctors, 3 in 10 are older than 55 and near retirement.

"We have to be looking at what practitioners who may be in greater supply can do to help meet health care needs in underserved areas," said Steve Gottwalt of the Minnesota Rural Health Association.

Nurse practitioners have limits to their scope of practice that are loosely outlined in state law. The Minneapolis clinic will primarily provide wellness exams and sports physicals, acute treatment of infections and rashes, and care for minor sprains and wounds.

Delaney said the weekday clinic also can manage chronic diseases such as diabetes when they are under control, but will refer patients to specialists if they are struggling. "This could be your sole source of health care as long as you are relatively healthy," she said.

'Such a need'

Minnesota became the 19th state last year to grant autonomy to nurse practitioners, who have been promoted under the Affordable Care Act as a way to reduce costs, because they typically cost less for routine care than doctors.

Now there are a half-dozen nurse-led clinics in Minnesota, and providers such as the Mayo Clinic are testing team approaches in which nurse practitioners provide more primary-care services.

Dakota Child and Family Clinic in Burnsville consists of nurse practitioners and dropped its physician oversight when the law changed, said Gretchen Moen, a pediatric nurse practitioner at the clinic.

"We're operating the same way we've always operated," she said. "But now we don't have that extra bill to pay to the doctor."

Dawn Tope left clinical nursing after more than two decades to pursue a doctor of nursing practice degree at the U. Working at outreach clinics in northern Minnesota, Tope saw the need for health care and believes independent nurse practitioners can be part of the solution. "There is such a need out there," she said.

Whether the university's nurse-run clinic model can be copied outstate is unclear, though. The Minneapolis clinic will have advantages that start-up nurse clinics in remote parts of Minnesota might not — including the university's electronic medical record system and nearby medical expertise.

Doctor reactions

The Minnesota Medical Association, the trade group representing the state's doctors, is skeptical that nurse-run clinics will address the doctor shortage.

Studies nationally have shown that nurse practitioners are unlikely to set up practice in areas lacking doctors, said Dr. David Thorson, president-elect of the association. "Only a small number of advanced practice nurses are comfortable practicing in that type of solitary environment," he said.

Solutions beyond nurse-run clinics to the caregiver shortage include expanded loan-forgiveness programs for doctors who agree to practice in underserved areas, greater recruitment of foreign doctors practicing under work visas and education programs to inspire rural high school students to earn health care degrees.

Growth in nurse-led clinics would be an important part of the solution, said Mark Schoenbaum of the Minnesota Department of Health's Office of Rural Health and Primary Care.

"Minnesota needs all the creative approaches available to respond to our expected health workforce shortages, and it's good to have this model in the mix here," he said.

Jeremy Olson • 612-673-7744