Changes in healthcare|New clinic catching on to trend with sole nurse practitioner

Published 12:00 am Wednesday, March 10, 2010

A new medical clinic in Vicksburg is reflective of what appears to be a trend in patient care.

Vicksburg Special Care Clinic employs one certified family nurse practitioner — and no physician — and its aim is to become a certified Rural Health Clinic, a program to increase the availability of primary care services for Medicaid and Medicare patients in rural communities.

“Our ultimate goal is to become a Rural Health Clinic,” said Chad Barrett, a pharmacist and owner of the clinic and Vicksburg Special Care Pharmacy, located in the same building. “It’s mandated that a midlevel nurse manage the clinic.”

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Mid-level practitioners can be nurse practitioners, physician assistants or certified nurse midwives.

Family nurse practitioner Debbie Hoover provides care at Vicksburg Special Care Clinic, located behind the Murphy Express gas station at Pemberton Square Boulevard and U.S. 61 South. The clinic and pharmacy opened Nov. 1. Since, Hoover has seen 25 to 35 patients a day.

“Whoever walks in, we take care of them,” said the 21-year medical care veteran.

To gain RHC status, a clinic must be in a non-urban, rural area designated by the U.S. Census Bureau. The area must also be designated by the Secretary of the Department of Health and Human Services as under-served, meaning there is a shortage of health professionals.

The clinic is up for Rural Health Clinic status in 2011, once the U.S. Census Bureau completes data collection this year. That means the clinic will be eligible for enhanced federal reimbursement rates for Medicaid and Medicare.

Though the business of patients seeing nurse practitioners instead of physicians has caught on locally — at Vicksburg Medical Associates, River Region Medical Center and at Mission Primary Care  — the clinic is alone in having no physician on staff.

“We see patients of all age groups,” Hoover said, and “we treat all types of chronic diseases as well as acute diseases, minor injuries, lacerations. Most of my patients consider me their doctor.”

Internal nurse practitioner Kathy Corbin, who works alongside Dr. Daniel Edney at Vicksburg Medical Associates, said, “I have a certain set of clients who are my clients.” And, “I have a great provider working with me. We always have that input available to us.”

Corbin acknowledges nurse practitioner-run clinics are more common in rural areas.

In Mississippi, there are about 1,800 certified nurse practitioners — a number that has increased in the last decade due to higher salaries and the independence nurse practitioners have, said Dr. Linda Sullivan, director for Advanced Practice at the Mississippi Board of Nursing. According to a report by ADVANCE for Nurse Practitioners, the average annual salary for nurse practitioners is $86,750 depending on specialty, location and experience. A licensed practical nurse, or LPN, and a registered nurse, or RN, earn $39,000 and $57,000, respectively, depending on specialty, location and experience.

The salary for family nurse practitioners, such as Hoover, who account for 23 percent of certified NPs, grew 9 percent in the last decade.

“A great deal of rural areas are being served by nurse practitioners,” said Sullivan. “They are working in rural areas where there are no physicians. It’s a growing trend because of the lack of family physicians.”

In Mississippi, there are 138 Rural Health Clinics, some with more nurse practitioners on staff than physicians and some with no physician.

At the Family Medicine Clinic, operated by River Region, one nurse practitioner and two family medicine physicians are on staff. River Region also operates the Street Clinic, where there are eight physicians and two nurse practitioners with RHC status, and the hospital employs four pediatricians and a nurse practitioner with RHC status. In St. Joseph, La., Franklin Medical Center, a Rural Health Clinic, employs a physician and nurse practitioner. The Claiborne County Rural Health Clinic in Port Gibson has two nurse practitioners and seven physicians.

Barrett, who also owns a clinic-pharmacy in Sterlington, La., that has reached Rural Health Clinic status, said, “You will see in some surrounding areas of Vicksburg — the more rural the area, the more (nurse) practitioners there are.”

Also, the number of medical students opting to study family medicine has dwindled in recent years, Sullivan said, because they don’t make as much as doctors who specialize in other areas. Since 1998, there has been a steady decline in the U.S. in the number of students choosing to study family medicine. According to a report published by the American Academy of Family Physicians, from 1998 to 2005, 2002 produced the lowest number, 47.2 percent, of family medicine residency positions filled by graduating college seniors.

“Unfortunately, it’s…market-driven,” Sullivan said. She said students are opting for the more advanced fields, such as diagnostic radiology which has an annual salary of around $300,000 compared to the $150,000 family doctors bring home.

There are benefits of a career as a nurse practitioner, there are some limitations.

By law, he or she must maintain a collaborative relationship with a physician in the same field. For Hoover, that person is Dr. Hildon Sessums Jr., a family medicine doctor practicing at Mission Primary Care.

“I’m her physician adviser,” Sessums said, adding that he does not see or treat Hoover’s patients. “I get with her and we go through her charts. I make suggestions. I’m a resource for her.”

Also, nurse practitioners are limited in writing prescriptions. But Hoover is licensed with the U.S. Department of Justice Drug Enforcement Administration, thus making her able to do so.

Vicksburg Special Care Clinic accepts private insurance and Medicaid and Medicare, and payment plans are also available.

“Our costs are much cheaper than an emergency room visit,” Hoover said, adding that a patient needing stitches might pay around $1,100 at an emergency room, but around $300 at her clinic.

The price differences can be attributed to patient-assistance programs, she said. “You just have to take a few minutes to fill out some paperwork.”

Low overhead is also a factor.

“Hospitals have so much more overhead, much more administrative people,” Barrett said. “We’re like a small business. Essentially, less overhead means less cost.”

The clinic has two treatment rooms and five exam rooms. Services include annual checkups, X-rays and EKGs. If Hoover can’t provide treatment, she will refer the patient to a specialist. The clinic employs a nurse, an X-ray technician, a receptionist and a medical assistant, and is looking to hire another nurse practitioner as demand grows.

“We take walk-ins, so I get new patients every day,” Hoover said.

The last “walk-in” clinic in Vicksburg was Quick Quality Care, which opened in 2007 inside Walmart. It was operated by New York-based CheckUps and has since closed.

Hoover previously worked at The Street Clinic. She works one weekend a month as a contract nurse in the emergency room at River Region Medical Center, and a couple of weekends a month at Crossgates River Oaks Hospital in Brandon. She also teaches a nursing course at Hinds Community College’s Vicksburg campus. “I’m the clinical instructor for the bridge program.”

Hoover is set to receive a doctorate in May from Samford University in Birmingham, Ala. She has a bachelor’s degree from Mississippi College and a master’s from the University of Mississippi Medical Center, both in nursing.

Contact Manivanh Chanprasith at