It’s Not Just Doctors

Front Page / Feb. 17, 2011 12:19pm EST

And Nurses Anymore

Across the nation, a growing number of so-called "mid-level" health care providers—nurse practitioners and physician assistants—are filling hospitals’ and physician practices’ ranks.

Gifford Medical Center is no exception. Today, "mid-level" providers work throughout the medical center, caring for patients in a variety of settings.

Patrick Kearney is a physician assistant (PA) at Gifford.

"Mid-levels are highly-trained, highly-qualified members of the medical community who practice quality health care in the communities they serve," explained Kearney, both a family medicine and hospitalist (in-patient) provider.

"As physician assistants, we are trained in both family medicine and all subspecialties under the supervision of a MD (doctor of medicine) or DO (doctor of osteopathic medicine) and are licensed by the state of Vermont, as well as nationally certified by the National Commission on Certification of Physician Assistants."

Similarly, nurse practitioners are specially trained and board certified through the American Nurses Credentialing Center or American Academy of Nurse Practitioners in specialized areas and are licensed by the state.

Filling a Gap

Nationally and locally, PAs and nurse practitioners are essential to ensuring access to health care amid a known physician shortage, especially in primary care and women’s health.

"Mid-level providers are typically seen as ‘physician extenders,’ in that they provide access to high-quality medical care as part of a health care team, so as to expand the capacity of a limited physician workforce," explained Dr. Joshua Plavin, a medical director at Gifford.

At Gifford, mid-levels work as part of the family medicine, pediatrics, and internal medicine teams. They also work in the inpatient setting, as hospitalist physician assistants and as specialists in areas like urology and surgery. Certified-nurse midwives are also often considered mid-levels, and are a big part of women’s gynecological, prenatal, and birth care.

Nurse Practitioner

Megan O’Brien joined Gifford in 2009, after earning her advanced degree at the University of Vermont and completing her training in family, children’s and women’s health to become a family nurse practitioner.

She works with Kearney and three veteran physicians—Drs. Ken Borie, Marcus Coxon, and Jonna Goulding—in Gifford’s Randolph family practice.

"I work very autonomously," O’Brien said.

Like any health care provider, O’Brien and mid-levels like her order labs and diagnostic imaging, write prescriptions, serve as patients’ chief caregivers and make referrals to specialists. But O’Brien’s also not shy to ask questions and get second opinions from her colleagues, she said.

Patients choosing mid-level providers often find increased access to a female caregiver. Mid-level caregivers additionally provide outpatient appointments on Saturdays at Gifford in Randolph.

Saturday Diagnosis

In fact, it was a nurse practitioner working on a Saturday at Gifford who gave patient Brooke Paige of Washington a lifesaving diagnosis.

Paige was feeling increasingly sick. He called Gifford on Saturday, made an appointment for that very day and was diagnosed with congestive heart failure. His cardiologist later told him he wouldn’t have lived another week without care.

"This place saved my life," said Paige, who has since undergone cardiac rehabilitation at Gifford.

Dr. Plavin, who calls mid-levels "invaluable to the provision of high-quality primary and specialty care," adds that physician assistant and nurse practitioner numbers will surely grow with this demand for care.

Ultimately, it is up to patients to decide which type of caregiver best meets their health needs.

"The varied backgrounds and training we have allows for patients to select what style of care fits them best," commented nurse practitioner O’Brien.

Plavin wholeheartedly agrees.

"The provider-patient relationship is unique, and being able to find the right ‘fit’ is very important," he said. "Providing a diversity of providers improves the likelihood of finding that fit, while a team approach ensures high quality care through collaboration, as well as reliable access."

A list of caregivers at Gifford is available at Choose the "Medical Staff" tab to learn more about providers’ backgrounds, training and interests.

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