Carol Warren, of Winooski, had been going to Appletree Bay Medical Center for almost a decade when she heard it was changing from a traditional doctor-run facility to one fully staffed by nurse practitioners. It’s a significant change for the Burlington practice’s 3,000 patients -- and, as the only nurse practitioner-run facility in Vermont, a significant shift for health care in the state. But Warren, for one, is happy with the new model. “I went the first week it opened and absolutely loved it,” she says. “The care was excellent and just as good as what a doctor would provide."
The brainchild of Rosemary Dale, clinical professor of nursing and chair of the Department of Nursing, Appletree Bay Primary Care officially opened in August. Beyond being a new model in the state, it’s also one of the only primary care practices in the nation staffed by nurse practitioners from a college or university. Seven nurse practitioners (NPs), who are also faculty members in UVM’s College of Nursing and Health Sciences, provide all of the professional health care at the clinic, which is expected to help offset a shortage of primary care doctors in the area, many of whom are not accepting new patients.
In addition to Dale, the facility’s NPs include Jennifer Laurent, Margaret Aitken, Deborah Norton, Ellen Watson, Barbara Rouleau and Jennifer Allaire. Fletcher Allen Health Care supported the unique model and is providing administrative, billing and electronic records services.
“We opened the clinic to help meet the needs of patients in the community and to provide a venue for students to gain valuable clinical experience under the supervision of a faculty member,” says Dale, who spent 25 years as chief nursing officer at Fletcher Allen Health Care and a decade as dean of the School of Nursing. “It also allows faculty to practice and maintain their certification as nurse practitioners. We’re hoping to become a national model for how to run a working and teaching facility of this kind.”
The new model could not have existed only a few years ago if not for regulatory change in 2011 allowing nurse practitioners to operate a facility without a signed partnership with a licensed physician. When the last of the two physicians who used to run Appletree Bay Medical Center moved away, Dale, who brings 12 years of experience working at a private practice, jumped at the chance to launch the new practice.
Well aware of the potential fiscal challenges, including a lower reimbursement rate from Medicare and private insurance companies for the same services provided by physicians, Dale remains confident that current and new patients will appreciate the more preventative, holistic approach to patient care provided by nurse practitioners. Some of the services they provide include wellness visits, routine physical exams, sick visits and lab testing, management of chronic health conditions and most other medical issues not requiring emergency care. "We're running a business just like any other, so we have to make ends meet if we want to survive," Dale says.
The ideal teaching and training ground
UVM’s Nurse Practitioner Practice Group has a dual focus on providing quality health care services while introducing students to primary care and the patient-provider relationship. Appletree Bay was created to advance these goals. Elizabeth Saxton, who is in her final semster of the Nurse Practitioner program, had accumulated the majority of approximately 700 clinicial hours needed for graduation at clincis with doctors. Working at Appletree Bay has been especially helpful in terms of seeing the day-to-day routine of a nurse practitioner.
"My preceptor (Rouleau) gives me a lot of flexibility, so I've been able to watch and learn from her, but also gain experience by seeing partients on my own," says Saxton. "Clinical really solidifies what you learned in class and vice versa."
Rouleau says the experience of practicing and working with a student is mutually beneficial.
“By practicing and teaching you really stay on top of new trends and guidelines in the field,” says Rouleau, who has 25 years of clinical and teaching experience. “The new clinic is a huge advantage for faculty because now we can show students how the lessons we teach in the classroom actually play out in practice. Anything can come through the door at a family practice, so they will see a little bit of everything.”
Laurent, who conducts research on the influence of food on eating behaviors in obese children, says the new facility is an ideal training ground for future nurse practitioners. “It can be intimidating initially for students to work with patients, so having them work one-on-one with a professor in a practice setting that we’re familiar with is the perfect way for them to learn about patient care,” she says. Laurent joined UVM’s nursing faculty in 2011 after working as a practitioner in rural Vermont.
Patricia Prelock, dean of the College of Nursing and Health Sciences, professor of communication sciences & disorders, and professor of pediatrics in the College of Medicine, sees the clinic as an opportunity for faculty, staff and students to gain professional, educational and practical experience. “It also increases access to high quality primary care for Vermonters,” Prelock says, “supporting those patients with chronic health conditions.”
Prelock and Dale credited Fletcher Allen Health Care for their support of the clinic and for providing technical and billing support.
“As an academic medical center, Fletcher Allen aims to be an innovator in new models for health care delivery,” says Dr. John Brumsted, president and chief executive officer of Fletcher Allen Health Care and Fletcher Allen Partners. “In partnership with the College of Nursing and Health Sciences at the University of Vermont, we are working to explore new models of primary care that are of high quality and affordable. The nurse practitioner-led practice at Appletree Bay is an example of our collaborative efforts.”