The Quiet Revolution

Nov. 2, 2005

There’s no doctor in the office at Sixth Street Family Practice in Traverse City. Instead, patients see nurse practitioners Gabrielle Walters, FNP, and Tish McGuire, FNP, who are on the leading edge of a new wave in family health care.
It’s a quiet revolution in the field of medicine as nurse practioners step into the roles of physicians at medical practices across Northern Michigan. But it’s still rare to find nurse practitioners staffing a practice completely on their own.
Yet that’s the case here at 1020 Sixth Street across from Munson Medical Center where Gabrielle and Tish joined forces as independent health care providers last March, working with approximately 1,800-1,900 patients.
It’s a trend you’re likely to see more owing to the specialization of medicine, the scarcity of physicians, and the need to cut health care costs. Currently, about 20 states grant nurse practitioners the power to write prescriptions for their patients. The trend toward nurse practitioners is especially strong in progressive states such as Illinois, Wisconsin and Washington. There are still some stumbling blocks for nurse practitioners accepting Medicaid patients as independent providers in Michigan, but even that is likely to change as the trend continues to find acceptance.

COMPLEMENTARY EVENT
“We don’t think of what we’re doing as taking over the doctor’s role,” says Walters. “We see it as a complementary event. There are some things we don’t do here at our practice that require more of a specialist. For instance, I might send a patient with a laceration to Urgent Care because I might only see a laceration twice a year; so I’d rather send the patient to someone who handles this sort of problem 40 times a year.
“But for the most part, we offer every service that a family practice physician might do, but in a different way,” Walters continues. “Because we’re nurses, first of all we’re patient advocates. Because nursing is different than the medical model of care, nurses are often seen as being better able to help their patients with lifestyle changes.”
Those changes might include everything from birth to the life of a young child, adolescence, young adulthood, childbirth, parenting, middle age, the elder years and facing the end of life.

MORE WOMEN
Women patients tend to be drawn to female health professionals.
“Any time you’re a woman healthcare provider, you tend to see a larger percentage of women patients,” Walters notes. “Maybe 20 percent more than the average practice.”
“When we see women for their health problems, that leads to seeing their children and husbands as well,” McGuire says. “And some men feel a lot more comfortable talking with us about their health concerns than with another man. We laugh a lot here and that puts patients at ease.”
Walters had been in practice for five years when McGuire came on board. “In fact, she was my nurse practitioner,” McGuire says with a laugh.
The two come from diverse backgrounds. Both earned their Masters degrees in nursing from Michigan State University, but McGuire went into the community mental health field while Walters specialized in high-risk obstetrics.
McGuire has also done some work in the field of orthopedics, and is perhaps the only family practice provider administering joint fluid therapy for arthritis in the region. It’s an injection of a solution called hyaluronan which eases arthritic knee pain.

COMPASSIONATE CARE
“I was a high-risk OB nurse for 10 years and then had an injury to deal with,” Walters recalls of her decision to become a nurse practitioner. “I knew I had to keep being helpful and was inspired by the example of Stephen Hawkins (the British quadraplegic author and physicist). I made a decision to go to grad school and become a nurse practitioner”
While working at Kalkaska Memorial Healthcare Center, her path crossed with that of McGuire’s, who had a case load of 126 developmentally-disabled patients at the time. McGuire was impressed that Walters went out of her way to provide compassionate care to her patients, who weren’t always well-received elsewhere.
It made an impression on her own approach to care. “Working with the developmentally-disabled, I saw the need for practitioners who are compassionate,” McGuire says. “I also feel that way about working on my own as an independent provider. I want to see my patients treated with the kind of care I’d like to receive myself.”
It’s not hard to develop those kinds of feelings at a family practice.
“We get an opportunity to enjoy the full spectrum of health care from birth to death,” Walters says. “We get to know people in a very intimate way.
“You never know what you’re stepping into in family practice,” she adds. “You go from seeing patients with cancer to babies to broken fingers; it always keeps you on your toes.”