I started this site when I was working as a nurse practitioner at a community health center. I stepped back from a clinical role almost a year ago and while I still have many tales to tell, was not motivated to write about them. Until now.  No, it’s not about the recent election. This is an issue that predates that by at least 10 years.

The clinic is broken. Well, health care is broken, especially when it comes to primary care.  And I don’t know who is more unhappy about that, patients or providers. I can’t speak for doctors, but I can speak about what my fellow nurse practitioners tell me.

It doesn’t matter if you work at a community health center, one of the new, streamlined, tech-driven companies such as One Medical or Forward, or  a private medical practice, whether or not is now owned by a hedge fund.  Although, at least in the New York Metro area, it seems that most of them are.

You might wonder why non-profits push nurse practitioners to see more patients. In the case of community health centers, the push comes from meeting quotas to get or maintain grants, and the need to bring in enough money to keep the place open. Since no one is turned away, unpaid visits have to be made up for by paid visits.

Wherever they work in primary care, nurse practitioners are stretched, pushed and pulled to see more patients. Complicated patients. Patients who in some cases, should be seeing an MD. Patients who deserve more than a 15-minute visit (which, by the way, is every patient). Many nurse practitioners are not receiving a fraction of the support doctors do.  And many do not have the support of doctors who are also too harried to answer questions or consult on a patient. And while it’s not just about the money, it is worth noting nurse practitioners make a fraction of what doctors do but are expected to carry the same caseload.

None of my nurse practitioner friends are happy in their jobs. Is it being a mid-level provider that’s the problem, or is it primary care?  Being in a specialty seems a better option but my friends are concerned about losing their skills, about doing basically just one thing, as they see it, if they worked in a specialty.  And they would miss their patients. They went to school, sacrificed, so they could become primary care providers. And they are needed more than ever, and not just in rural or poverty-stricken areas.

So what is the solution? Increased staffing would help, but it has to be more thoughtful than that. Most of the NPs I know prefer working collegially with doctors who are on site. Like all providers, including doctors, they would like more time per patient visit. And they would prefer to leave the medically complicated patients to the doctors who were trained to take care of them.

But where is the money to finance such a scenario going to come from? Certainly not the hedge funds, who are buying up practices and hospitals because they think, without knowing anything about health care, they can make practices and hospitals more profitable. They  “do it better” by squeezing the most productivity they can out of providers.  The result has been a mass exodus of providers in private primary care. In many cases, these providers (mostly doctors) go to concierge medicine, leaving the mid-level providers, the NPS and Pas, to pick up the slack. Until, of course, they are too burned out to do so. It’s a sad, dangerous situation. I wish I had a better tale from the clinic. Until I do. I’m signing off.