I need to start this column by saying I am so grateful for my job. I am a nurse practitioner in Rocky Ford. I own my own medical practice. I am honored to be a part of the lives of my patients, their parents and grandparents, and sometimes even their great grandparents.
I needed to start out with that positive statement, because a clinic in rural Colorado often feels to its owner like a small ship in a big ocean, an ocean with some pretty nasty waves.
I’ll start with the challenge of getting help. Not only is it hard to attract medical professionals to rural spots like ours, finding enough funds to pay them competitive salaries is difficult too. The Colorado Rural Health Center (CRHC) has done much to help on this front; the two physician medical directors I’ve recruited since opening the practice in 2003 have come due to CRHC recruitment.
I’m not just concerned about the practice now; I’m actually more worried about how my patients will be cared for in a few years. I’m 57 and can’t run this clinic forever. Who will replace me or take care of the approximately 2,400 patients I care for when I retire? This worry keeps me up nights.
Part of our challenge out here is getting the government and insurance companies to really understand that care in rural areas is often delivered via advanced practice nurses like me.
Many insurance companies slot me as a specialist, when I’m decidedly not. The confusion leads to patients being stuck with big medical bills and ultimately me not getting paid.
Without going into all the technicalities, there’s trouble on the electronic health record front too. These new systems are amazing, and I’m embracing the efficiency and quality improvement they can bring. While the government is wisely paying doctors for their large investment in these systems, many nurse-run practices like mine can’t get reimbursed for their conversion from paper records to electronic ones.
I’ll close with a word about health care reform. While much debated and criticized, much in the health care reform law approved by Congress is good, especially when it comes to pre-existing conditions and allowing parents to continue to insure their children to age 26. The issue that worries me about reform is the number of newly covered patients it creates. Don’t get me wrong; more covered people is definitely a good thing, I just worry about my, and our, capacity to care for significant numbers of new patients. Also, I worry about how the state, which is required to pay for half of all Medicaid charges, is going to find the funds to accommodate the increased cost of thousands of new patients?
Since I started on a positive note, I’ll end on one. We’re an innovative and generous state and country. I’m confident we can address these challenges, but also appreciate the time to get to work on them is now!
Doug Miller is a family nurse practitioner and owns the Rocky Ford Family Health Center. EDITOR’S NOTE: This is an online-only column and has not been edited.
