Growing numbers of advanced practice providers play a critical role in rural health care


Along the way, she began to consider another path that would require fewer years of training and offer personal and professional benefits.

Brooks decided to pursue a career as a medical assistant and enrolled in the medical assistant degree program at the University of North Dakota.

As part of her degree requirements in the program, which emphasizes family medicine and rural health care, Brooks completed a two-month rotation at the Nelson County Health System in McVille, ND. She obtained a master’s degree in 2018 and joined this health system in July that year.

“I really like the flexibility that comes with being a childminder,” she said. “PAs have this great ability to have the flexibility to enter any specialty they want. … It was something that was very important to me.

And there are benefits to family life, Brooks said. She and her husband welcomed their first children, twins, in February.

“I also like the flexibility in the sense that I can have a family and be present at home, but also have a full-time career at the same time.”

She is one of three advanced practice providers who work with the sole physician, Dr. Erling Martinson, at the Nelson County Health System, based in McVille, ND. The healthcare system includes a clinic, hospital, emergency room, and long-term care facilities, and operates a satellite clinic in Michigan, ND

Growing field

Brooks is one of a growing number of medical professionals joining the ranks of physician assistants and nurse practitioners in North Dakota and Minnesota.

These professionals – commonly referred to as “advanced practice providers” – fill a significant health care need, many of them in rural areas where it is often difficult, if not impossible, to attract and retain physicians. .

In North Dakota, to date, 890 medical assistant licenses have been issued, according to the state Board of Medicine. The board cannot report the number of active licenses at certain times, said Sandra DePountis, executive director, and the number of licenses issued does not match the number of licensees actively practicing in the state. By the end of 2001, a total of 274 had been issued, and by the end of 2011, 472 had been issued.

In addition, in North Dakota, the number of registered nurse practitioners stands at 1,464, according to the North Dakota Board of Nursing. This compares to the 812 listed in the board’s 2019-2020 annual report and 329 in 2006-07, said Stacey Pfenning, executive director.

According to the Minnesota Department of Health, the number of healthcare professionals licensed as advanced practice nurses has more than doubled since 2010, from 4,846 to 10,312 today. These health care professionals are licensed as registered nurse midwives, registered nurse practitioners, registered registered nurse anesthetists, and clinical nurse specialists.

The number of registered nurse practitioners in Minnesota has increased from 2,682 in 2010 to 6,061 in 2020, according to the Minnesota Board of Nursing.

The number of PAs authorized in Minnesota increased from 305 in 2000 to 1,209 in 2010. Today, that total is 3,682, according to the Minnesota Board of Medical Practice.

This growing pool of advanced practice providers is a trend that rural health care leaders are pleased to see.

“The pool of applicants has grown significantly,” said Gabriel Mooney, CEO of Kittson Health Care in Hallock, Minn. Four years ago, when he was an Altru employee, “we were begging for COVID physician assistants and nurses, things have changed; now there are some who are looking for work. The terrain has changed. I attribute most of this to schooling; there are more schools (and they) are removing more providers than before.

Kittson’s health care system serves the whole of Kittson County. Its service area has a population of about 4,300 people, some from outside the county, Mooney said.

Kittson Health Care employs five advanced practice providers – two nurse practitioners and two physician assistants who provide family medicine care and a psychiatric nurse practitioner, whose practice focuses solely on behavioral health in areas such as anxiety. , depression and bipolar disorder.

Employing a behavioral health professional “has been a great addition for us,” Mooney said.

The primary role of these advanced practice health professionals is clinical practice, he said, and as “extension physicians they can do a lot of what a physician can do.”

The system employs a 24/7 physician for emergency room monitoring and another full-time physician for the clinic.

The advanced practice providers, who provide “a great opportunity to be able to see someone faster than a doctor and (can take care of) some of those less serious and less complex patients than a doctor would see,” said Mooney said.

They fill the role of the primary care provider – the patient’s first contact with the system – so the more complex cases would go to the doctor, Mooney said. “And we just don’t have the doctors like a larger system would. “

While their knowledge base, education, training and scope of service are similar, NPs can act more independently than MAs, Mooney said. “It’s really bloated over the last few years that I’ve seen, in a positive way, (and MAs) can act more independently, which really takes the weight and stress off doctors.”

In Minnesota, MAs and NPSs can now practice independently, without physician supervision, and can be lead practitioners in clinical practice, according to a spokesperson for the Minnesota Department of Health.

Recent changes in North Dakota law have also allowed greater independence in the way a PA operates.

Motivated to “give back”

At the Nelson County Health System, which serves a population of nearly 3,000 people, advanced practice providers are driven by a desire to “give back to the community,” said Chris Haseleu, CEO. “There’s a lot more personal involvement with (health care). The people who work here want (to make sure) that the people they know here are well looked after.

The system operates the only hospital – a level 5 trauma hospital – in Nelson County; the others closest are to Northwood and Cooperstown.

The advanced practice providers “are truly improving the state of healthcare and the quality of life for the people in the community we serve here,” Haseleu said, “and with this commitment to individuals, they advance medical services. and are aware of (new medical developments and technology). ”

The presence of these providers on the front lines of health care delivery has been vital for many small rural communities.

“Without advanced practice providers, the rural healthcare landscape would change dramatically for the negative, and this would impact patient care – and that’s where I focus and my role is: what’s the point. better for our patients and the care they receive. We have to have these intermediate levels there, ”Mooney said.

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