Episode Transcript
[00:00:00] Speaker A: Sa.
Welcome to Vital Signs. I'm your host, Jen Goday and we're here to talk about up leveling your greatest asset, your health.
What if one of the biggest solutions to America's health care access crisis is already trained, licensed and ready to serve, but may be restricted by some outdated rules?
What if the future of accessible patriot patient centric health care isn't in a hospital room but in the hands of highly trained nurse practitioners who are often underutilized.
Today we're gonna pull back the curtain on that part of healthcare, the part that most people don't fully understand.
And it's something that directly impacts your appointments, your wait times, your insurance approvals and ultimately your health.
Joining me today is a leader who is shaping the future of nurse practitioner entrepreneurship and access to Dr. Lynn Rapsilver. She is the co founder of National Nurse Practitioner Entrepreneur Network. Welcome to the show.
[00:01:29] Speaker B: Thank you for having me, Jen. I'm excited to share the power of the nurse practitioner in the health care change that needs to happen.
[00:01:36] Speaker A: Oh, I'm really excited about this because you're absolutely right and access is everything. But most people really don't understand the difference between a nurse practitioner and a physician.
So can you kind of tell me what is it that patients should actually know?
[00:01:55] Speaker B: Nurse practitioners are actually trained as RNs first and then we go back to school for advanced degrees.
So we are learning how to assess, diagnose, treat common health conditions.
We provide treatment, medications, we can look at laboratory tests. We can provide a lot of care to our patients within a certain scope of practice, which is our education and training. And there are many outdated rules regarding scope of practice that actually hinder our ability to practice at the top of our education and training.
[00:02:34] Speaker A: So as we, as we think about this, what are the things that we should be thinking about in a nurse practitioner first for? Because what is it that you guys do and how is it different from what so many patients assume?
[00:02:49] Speaker B: Nurse practitioners provide whole person care which is really looking at the patient as the center of the healthcare delivery. So we look at the patient and we may diagnose hypertension, for example, and we educate them about their diet. We talk about prescription management potentially we look at whether they can afford their prescription, what kind of stress is going on, are they exercising things that in their diet that they can do to reduce salt, for example. So we look at that whole person and we tailor that treatment plan around that patient specifically.
[00:03:26] Speaker A: And so I immediately go to wow, personalized care. Because you're not just thinking about writing out a prescription and Expecting them to be compliant. What you're really doing is you're considering every aspect. Can they financially afford to fill that prescription? Because expecting a patient to be compliant with a medication if they can't afford the medication to begin with is setting it up for failure. So I really, what I'm hearing is holistic. Looking at every aspect of your life and addressing your health care situation as, as such. That's really fantastic. Now talk to me a little bit about some of these outdated rules, because I, I was a physical therapist by trade for 20 years and I moved from a direct access state to a state that was very restrictive. So I completely understand the challenges there where you're not able to do half of what you're trained to do. So talk to me about what is full practice authority and what does that mean for patients who are watching at home, people watching at home. Why should patients care about this?
[00:04:21] Speaker B: Let's go back to Covid.
When Covid happened, all the barriers to practice were waived during the public health emergency.
So what that meant is that when the call came out, we need providers, we need providers to go to Washington state, we need providers to go to New York. That was a call to action. And a lot of nurse practitioners took that call and we went to serve because that's where the need was greatest.
So for two and a half years we practiced without these barriers. And now when the public health emergency ended, the barriers go back in place. So what do I mean by barriers?
Every state has their own rules on how nurse practitioners are regulated to practice their craft in their state.
So some states, there's 27 and the district of Columbia that have a practice authority where nurse practitioners can provide that whole person care to the residents of that state. There are some states that have restricted practice and reduced practice where they have some level of physician oversight or a collaborative agreement or some prescriptive linkage between a physician and a nurse practitioner. Maybe it's a board promulgated medical board and nursing board. So there's some level of regulatory barrier that is happening in those states.
What I don't understand is when the public health emergency ended, we really should have just kept things going because telehealth is also very big. During that time, it was the only way some of us had access to patients.
And now with these barriers back in place, we can't freely deliver that telehealth care. We have to be licensed in every state that the patient resides in. So you can see how that can be a barrier to practice as well. And oftentimes because the way physician practices are happening now, a lot of them are being bought up by large institutions, organizations or hospital systems. And so the access to qualified physicians that can fulfill these collaborative agreements is also being limited and restricted. So it's becoming more of a problem and a barrier. So we can't provide that access to care that patients need.
[00:06:34] Speaker A: Right. And add to that that we're losing probably, I think I saw 11 to 10 to 11% of our physicians per year to early retirement because of burnout. And I know nursing has high numbers as well, but so what I'm hearing is let's talk about what we care about. We want faster access to health care. That's why we're in America, that's why we're here. So if we have full practice authority, does that give you faster access to health care, fewer delays? Does it allow for better community based care? Like really give us the nuts and bolts of why if I'm in a state that maybe doesn't have full practice authority, I should be talking to my legislators to say, hey, we need to do something about this.
[00:07:20] Speaker B: Absolutely. I mean, patients need care. And a lot of times the nurse practitioners are going to the rural areas.
They're serving the Medicare, Medicaid population underinsured.
Some nurse practitioners are doing street medicine, going to nursing homes. There's just so many ways that nurse practitioners can fill those gaps in care by going to where the patients are, which is a different type of model of care delivery. Instead of having a pop up clinic at the end of every exit ramp, we can actually go out to patients homes and provide care there or wherever the patient's at for that matter. We can go to an employer and provide employee based healthcare to keep the employees on the job and that makes them more productive. We're opening practices which allows us to increase the economic value to the community because we're hiring people to work for our practices. We're impacting the health by keeping them healthy and well and out of the hospital.
And then we're using the resources within the community to help get the word out that these are ways that we can help our patients.
So there's a lot of ways that having a nurse practitioner providing care in your community has so many other technical benefits, even from an economic perspective that actually help to overall reduce ER visits, urgent care and hospitalizations. And those are high costs.
[00:08:38] Speaker A: Absolutely. So what I'm hearing is it absolutely impacts. Are we able to access this? It improves access, especially in rural areas. It improves access to people who maybe don't have access to transportation to get to where they need to go to actually receive care and so much more. And I'm going to ask you a follow up question because we've seen a shift towards community based care. I've seen in allied health, many of allied health services have moved away from hospital systems towards more community based care. I'm going to speak specifically to physical therapy because we've had someone on to speak to that in the past, really addressing the population, where the population is in their schools, in their health clubs and gyms.
What do you see as the trajectory moving forward with regards to that community based care and why is that more powerful?
[00:09:28] Speaker B: Community based care is really how I think healthcare is going to transform. It's going to transform from the ground up because every community is different, everybody's community has different needs. And what I think our NP colleagues are doing is seeking out those types of needs and building practices around that. And that makes it sustainable, sustainable for a community to, you know, be able to have quality health care delivered right where the people are so they don't have to go outside of the area to get that care. And the nurse practitioners know the community so they're going to be invested in the community as well and that will add value overall.
[00:10:07] Speaker A: Oh, I couldn't agree more. And when we strengthen our communities, when we actually meet the healthy parts of our community as well as those who require care access from the health care system, what we're able to do is we're able to have earlier detection, earlier prevention and we're able to catch things much, much faster. And as, as we've talked about on this show many times earlier access to care often improves outcomes altogether. So I think it's a win, win, win situation.
[00:10:37] Speaker B: And now there's such delay in getting access to care. I mean wait times have. If anybody's tried to access a primary care provider, I'm sure you at how long it's going to take you to be seen, we're not talking months, we're not talking a year, we may be talking two years before you can have access.
And also, you know, the immediate needs of the population, it's better to keep them healthy and utilize the other community resources as well. One of the great things that's happening now is the Rural Health Transformation grants.
Each state has received one of these and it's allowing the states to start looking at how can we implement different types of health care delivery models in these rural communities so that we can improve outcomes. And that's really kind of the goal of the Rural Health Transformation Grants.
[00:11:23] Speaker A: That's fantastic. We do have to take a quick break, but when we strengthen nurse practitioner practices, folks, we're strengthening community health. Access is not political. This isn't about politics. It's personal. It's about can I access the care that I need and deserve when I need it? So after the break, we're going to talk insurance coverage barriers and why reimbursement rules impact what care you can actually get. Stay tuned. We'll be right back.
Foreign.
Welcome back to Vital Signs. Want more of what you're watching connected to this show and every NOW Media tv favorite live or on demand, anytime, anywhere. Download the free Now Media TV app on Roku or iOS and unlock non stop bilingual programming in English and Spanish. On the move. Prefer the podcast version.
Check us out at www.nowmedia.tv. from business and news to lifestyle, culture and beyond, Now Media TV is streaming around the clock. Ready when you are. Okay, folks, let's dive back into our conversation. We are here with Dr. Lynn Rep. Silber from the National Nurse Practitioner Entrepreneur Network. Because access is not just about the providers, it's also about how the system is built and how insurance can decide what's next for us.
So, Lynn, I'm going to dive right in. In a system where patients often wait months, maybe years for care, how are nurse practitioners helping to close that access gap?
[00:13:20] Speaker B: One of the great things is nurse practitioners are opening up practices and some of them are starting small. They may be working their regular job and developing a practice and allowing it to grow organically. Some are diving right in full on to the deep end to get their practice up and running. But one of the things that we're doing is because we can start to look at our schedules and see if we can incorporate health to the community in a faster, more efficient delivery system. And one of the things by having that whole person care is that you're establishing a partnership with your patient that's going to last for a long term. And from that, actually, then you start seeing other members of the family and you can see how the tentacles can start to spread.
When it comes to how nurse practitioners can fill those gaps in healthcare, there's so many opportunities. And I think if you just find a problem in your community you want to solve, there could be a practice model that we could help you develop.
[00:14:18] Speaker A: And I immediately go to rural and underserved communities because it's opening access, it's opening education that access even exists. Because a lot of times we're left wondering, well, how Do I get the care that I need? Where do I go? How do I even start the process?
And so I think it's really powerful and cost effective, quite frankly, because now care is where you are and you don't have to try to find a way around big cities such as this. I'm in Houston. And just the traffic it costs alone can be a huge impact. So let's focus now because you guys are experts in reimbursement and documentation.
Most of the viewers here and most patients really think that all that is is billing, but it's so much more than that. It actually can impact the care that they receive. So talk to me a little bit about why payer rules and direct reimbursement matter so much, especially for independent nurse practitioner practices.
[00:15:22] Speaker B: That's a great question, and it's very interesting because I don't think the public realizes that nurse practitioners are not paid the same as physicians.
When it comes to Medicare, we're paid at 85%. So if we're going to start a practice, we are already at a 15% shortfall in opening our doors. We pay the same for an electronic health record, for our band aids, for our rent, for our heat, utilities, all of that.
So try to try to do that with 15% less in a budget. It becomes more of a challenge. So what a lot of the nurse practitioners are doing is taking, taking care of our Medicare, Medicaid, vulnerable populations, rural. But we're also adding in support services that will help to enhance our bottom line. One great example is the veterans have disability ratings that they have to have, which are specific exams. And nurse practitioners are doing those so that the veterans can actually start to get those disability benefits and impact their lives.
And that backlog is huge. So we can do quite a bit for the veterans to help in that regard. And that's just one example of many others.
But the insurance companies also can give us a hard time because they would say, your panel is full. We do not need another nurse practitioner. And the reality is they don't keep their directories up to date. So they may have a listing of 30 providers, but out of that, 30, maybe 10 are the only ones that are listed in that plan at that particular time. So it does a couple of things.
It tells the nurse practitioner that, you know, we don't need another provider when we know that's not true. The other thing is it gives the patients a false sense of security that all these providers are going to be there when they need care, when they're not. So anytime a Nurse practitioner is denied impanelement or being allowed to be on an insurance panel. I always tell them to question that because chances are the panel is not full. As we know, there's primary care and psychiatric mental health service provider shortages, which, those are the gaps that we're actually filling.
[00:17:25] Speaker A: Talk to me about, about this because we know there's gaps. We know there's gaps as patients. We know there's gaps because we can't see, there's wait times, etc. And then there's the, the question of whether or not it's going to be covered on the other end, denials, et cetera. So we know there, there are barriers. But talk to me about what are the biggest barriers now. Is it state policy, is it actually the insurer contracts, or is it more public awareness?
[00:17:51] Speaker B: It's all of that. One thing that's impacting a lot of individuals is the ACA subsidy in a way. And people's reality check is happening. They're finding that these costs of their premiums are rocketing and they can't afford to pay for that. So how can you balance trying to stay healthy, feeding your family, paying rent, and then, you know, trying to manage a large health care bill that you didn't have previously? So it becomes more of a challenge for a patient to find that care. One of the things our MPs are trying to do is to help that patient get the care that they need by maybe looking at a subscription model where we're having the family pay a modest fee to have access to that nurse practitioner, but have them be able to have access to comprehensive care at a price point that they can afford, because that's the problem right now. You can't afford the health care. So how can we keep people healthy? So we do work with labs, we work with X ray, we work with pharmaceuticals to get the supplies that we need to help care for patients. So we're very resourceful in a lot of ways that we do this to help manage our patient populations.
[00:19:03] Speaker A: So what you're describing sounds very similar to the direct primary care model. It's a subscription based. You can come when you need, when you get sick, you can go because you're paying like you're spreading the cost, basically.
I can predict it, it's predictable, there's a budget. And then are you like, when you're doing these subscription models, these are outside of traditional insurance, correct?
[00:19:24] Speaker B: Oh, yes, they're definitely outside of the norm.
But it's interesting because I know that there's a lot of Physicians who are opting for that concierge mod. And unfortunately, it's cost prohibitive for a lot of families. You know, they can't afford the high cost. Where the nurse practitioner is actually an alternative. We're more cost effective. So we're really looking at budgets. We have budgets ourselves. So we have to make sure that we're able to work within our budget to get the services and care that we need.
So a lot of times nurse practitioners will opt for that as well.
Many of us do insurance and go through that process as well. Again, you have to be empaneled. And oftentimes the rates that the nurse practitioner reimbursed are significantly lower than a physician who has the same similar type of practice.
And what happens sometimes is if you're a small practice owner, you have no negotiating power with the bigger insurance companies to say, hey, you know, I'm keeping people out of the er, urgent care and hospital, you should pay me more.
But, you know, if you're an N of 1,000 patients, you know, you're not going to have that much leverage.
But if you are an N of 500 practice owners with 500,000 patient lives. Whoa, that has power now.
[00:20:38] Speaker A: Absolutely. Power in the numbers. So tell me, what are the questions patients should ask when they find out that something isn't covered? Because that's a big question we get.
[00:20:48] Speaker B: I'm glad you asked that, because even myself personally, I received a bill from a company that I had in a visit with. It was. It was an eye exam and they were going to bill me for the whole cost of the visit. And I looked at it and there was no sign that they ever submitted it to my insurance.
So I called them and I said, you need to submit this to the insurance. The next thing I know, I'm getting another statement saying I still owe them money. I went in to check my insurance and they paid them already. So there I had to call them back and argue with that. And most people don't know to do that. I mean, I'm in the healthcare system, so I know to ask those questions. And I wonder how many people would have paid that $120 bill. So my, my lesson to the listening public out there is question everything if it doesn't look right. If you had services and, you know your insurance is supposed to cover them, question that, look at your explanation of benefits, make sure it lists the provider you actually saw. Make sure that the service makes sense to you. So definitely scrutinize those EOBs that you do get. Because that tells you what's going on as far as how you're being billed. And sometimes people do make mistakes, but sometimes these can be significant, impacting you from a financial perspective. And we want to make sure that you're not paying out of pocket for something that should be covered by your insurance.
[00:22:13] Speaker A: Absolutely. Question everything. And we know that errors occur all the time.
We know in even as things can become more and more automated, there's more errors. And so it's really important that we advocate for ourselves. If you're watching, be your own best advocate. If you get a bill and you're like, wait a minute, I have insurance and that should be covered always. Look, so this has been really fantastic. How can those who are watching who maybe want to learn a little bit more about what we're talking about or maybe find a nurse practitioner in their area, how can they get in touch with you?
[00:22:44] Speaker B: Or find that we actually have what's called Destination np, It's a nurse practitioner directory.
And that actually will provide linkage between patients to find nurse practitioners, nurse practitioners to find each other, and students to find preceptors.
We also have the National Nurse Practitioner Entrepreneur Network, which is a member service organization specific for nurse practitioners who are thinking about a practice or have a practice or have a practice that's struggling to grow. We have all the resources available to help you be successful. We want to make sure that we keep the doors open because our patients need us.
[00:23:23] Speaker A: Absolutely. And healthcare affordability isn't random, it's structured, folks. Understanding the structure helps give you leverage. We do have to take a brief break, but coming up next, why independent nurse practitioner led practices are growing, how that model can change prevention, continuity of care and your experience, experience as a patient. After these messages.
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Welcome back to Vital Signs. We are going to shift the conversation a little bit, but before we do, right before the break, we were talking about an example of a a patient visit with billing that was received by the patient. They received a bill, but it was something that insurance should have covered.
And I'm here with Dr. Lynn Rapsilver and I want to dive into that a little bit more because this is a very murky aspect of insurance medicine and health care. So talk to me a little bit more about this because especially in emergency medicine, maybe I'm unconscious, I'm getting care. I really don't have any idea of what happened while I was receiving care because it was an emergency, a medical emergency, maybe it was a heart attack, a stroke, whatever. And then a couple of months later, all These bills show up. 50 bills, 50 different providers and EOB that's a mile long. Like, can you demystify that a little bit? Is this something that you can help with?
[00:25:18] Speaker B: I think the biggest thing is making sure that you start to keep track of things. Have a nice little folder together that lists all your EOBs and your bills and all the things that you get and look at them and make sure they all match up. If something seems askew, you know, take it back to your provider and question that because you have insurance for a reason. The insurance is supposed to cover stuff and make sure that you're not being taken advantage of or paying bills that you should be covered by your insurance. So ask questions, but have that folder and put everything in one specific area. I think that's going to help you a lot to kind of, you know, get yourself organized about this. But don't hesitate to question honestly.
People make mistakes that we know that happens, but sometimes, you know, these errors can be costly and we want to make sure that you're getting the care you need and not having to pay for things that you should have covered by your insurance.
[00:26:11] Speaker A: Absolutely. So I want to switch gears just
[00:26:13] Speaker B: a little bit now.
[00:26:14] Speaker A: Thank you for that. You co founded the National Nurse Practitioner Entrepreneur Network.
Why are more nurse practitioners launching independent practices? What's the driving that?
What gap are they filling and how does this impact us on the patient side?
[00:26:33] Speaker B: Nurse practitioners are becoming more disenfranchised with the medical model of care delivery, the current healthcare system, because they're getting crunched to see patients in a shorter period of time and provide that care and try to document, get everything done and, you know, get out the door in an appropriate time. And our brains are hardwired to deliver care in bigger chunks because we do that whole person care. So that 15 minute visit does a couple of things. It puts pressure on us, it makes us fragment the care a little bit more because our brains are hardwired not to do that. And if we do stay with the patient and see them for the time we need to, then we're paid for on the end of the day when we're taking all that documentation home with us and it's interfering with our family time. So you can see that that kind of system can burn people out pretty quickly. The way around that is for a nurse practitioner to start their own practice where they create their own idea of what that whole person care looks like. They can give the kind of care their brains are hardwired to deliver to the patients that they want to see in a method that's going to be successful because you're partnering with your patient. It's not your, the heart disease, you're the diabetes. It's you're the patient who's dealing with the diabetes. And how can we get you to your optimum level of wellness? What do we need to do to work together to keep you healthy and out of that hospital?
[00:27:53] Speaker A: Yeah, you know, and that's so important. And so folks who are watching like this is about truly your experience.
If you've ever been to the doctor or nurse practitioner and they're rushed and it feels like you sat there and you waited for six hours only to be seen for three minutes. Like it is definitely a challenge in the modern health care system.
And when we take, when we step back and we have that longer length of time with patients, I'm a prior caregiver myself, practitioner myself, but you know, when, when we have that full time, we can actually get to the root cause and the, the solution happens faster. It happens in a way that makes sense and we co create that treatment plan so that you're going to be able to actually deliver on that and do your part in that partnership while we're able to better offer you what we can offer.
And so truly it gives you a better experience, it'll give you better outcomes, it'll improve your health. And honestly, I believe this is the future of preventative care because if we hit things at the root cause from the very beginning, we can prevent some of those heavier hitting diagnoses later on.
So I'm going to ask you a question because I've seen this in other areas of health care and now you're here to speak about nurse practitioner. How does the entrepreneurial side allow innovation to occur in patient care? Because I think there's a lot of talk about innovation right now, but I believe that entrepreneurship has been a part of that. How is that working in the nurse practitioner practice?
[00:29:32] Speaker B: That is a great question. And everybody is looking for how can we improve patient outcomes and reduce cost to care, get that value out of what we can provide. And nurse practitioners, by and large our outcomes are excellent. We are cost effective when it comes to healthcare delivery because we are looking at those root causes going back and figuring out how can we get that person to their optimum level of wellness so that they can stay out of the er, urgent care and hospital. But one of the other things that's fascinating and is that technology, nurse practitioners are great at embracing new technology and different ways to provide patient Care and what I'm finding, because our organization is getting outside of nursing, we're meeting people who have software, apps, medical devices that really want to look at nurse practitioners as the test run to see is this something that's going to be beneficial. And they're trying to do it in a way that will help those rural health communities, the underserved and underinsured, in a way that can make us to be more efficient as clinicians out in the community so that we can see more patients, because we're utilizing that technology to help us be better clinicians. So I think it's an exciting time for us to be nurse practitioners and the state of this healthcare climate is just really ripe for us to really make that plea that we can change the trajectory of healthcare from an illness model to a wellness model. You know, just let us do our job.
[00:31:02] Speaker A: Yeah, and I couldn't agree more. I mean, there's so many wearables, there's so many diagnostics, there's real time data analysis.
And I mean we've had, we've had cardiologists on, we've had other specialists on, have talked about the amazing technologies that are available and literally you can have the data of your client, your patient at your fingertips and you can catch things so much sooner now. So I really, I really can appreciate that, that innovative side of medicine and how easily it is for you guys to, to integrate that into your care.
So earlier you said that there are some states, almost half of the states, that still restrict nurse practitioner practice from a patient perspective and then from a practitioner perspective, why does that matter? And, and what should we be advocating for? Or how do we know if we're a patient? How do we know if it's restricted or not? How do we find that?
[00:32:00] Speaker B: So there is a map that the American association of Nurse Practitioners has that really details the different states and who has full practice, who has restricted and who has reduced practice. And I can certainly get that to you so you can have that out for your viewers.
But basically it's really going to see that visit with that nurse practitioner.
We will do workarounds to try to get the care for that patient no matter what. But I think what is helpful is the public needs to be aware that there are regulatory barriers that have nothing to do with how I care for you as a patient that prevent me sometimes from practicing to the top of my education and training. And this would be having to be tethered to a physician for a collaborative agreement, for example.
And oftentimes the collaborative agreement is nothing more than a piece of paper that fills that regulatory requirement that sits in a drawer. And it really doesn't impact that patient care aspect or providing that safety clause that the collaborative agreement supposedly gives to the public, that reassurance that there's a physician that's behind the scenes helping out. And the reality is they're not.
And it's a cost sometimes for that nurse practitioner because we have to pay for that collaborative agreement oftentimes, and that's an added expense where we could put that money towards doing something to help our patients. We have to pay that money to keep our doors open. The other problem with the collaborative agreement that people are not thinking about is that independent practice owner who has her own business if she still is under that collaborative agreement. And that collaborating physician decides, hey, I don't want to do this anymore, retires or dies, that door closes until that nurse practitioner can get another collaborating physician. She can't see people, she can't refill your prescription. You can't get an emergency visit. You can't even call on the phone. So it can profoundly impact patient care delivery.
That has nothing to do with patient care delivery, if you know what I mean.
[00:34:03] Speaker A: Absolutely.
And it's that way with a lot in some states, with a lot of allied health as well. And the reality is it's a gap between the education of what it actually is doing or what it actually is meant to do versus what is actually happening. And so what I'm hearing is it's time to start advocating for ourselves. If you happen to be in a state that has full authority, don't be afraid to go to a nurse practitioner. I know that there was an old school kind of thought, and I still hear it from time to time, that, oh, no, it has to be a doctor. But nurse practitioners are trained to do many of the same things. And so it's really important that we take our health into our own hands. And ask yourself, how do you want your care to be delivered? So when you choose independent access, forward practices that are innovative, you're not just booking an appointment, folks. You're supporting a care model that's built around you, your individualized care. So if you're feeling rushed in your traditional systems, explore independent practices, ask how patient continuity is handled, and understand that prevention doesn't scale in Rush systems. It thrives when you have a relationship with your provider. We do have to take a brief break, but coming up, we're going to dive into what you can do as a patient and community member and what the future of NP led care looks like over the next decade. See you soon.
Welcome back to Vital Signs with Jen Godin. We don't miss a moment of this show or any of your other NOW Media TV favorites, streaming live and on demand whenever and wherever you want. Be sure to grab that free Now Media TV app on Roku or iOS for instant access to our bilingual lineup for podcasts. So do I listen anytime at www.nowmedia.tv. from business to lifestyle to culture and more. Now Media is here 24. 7, ready for you.
So we are here, and we have been deep in a conversation all about what is a nurse practitioner really? How does a nurse practitioner differ from a physician? What does it look like if we were to work with nurse practitioners as a part of our care?
And we've really dove deep the last three segments. But I'm here with Dr. Lynn Rap Silver. And Lynn, I want to ask you, how do patients interact with nurse practitioners? What does that look like? If I were to, say, initiate a practice, initiate a patient interaction with you?
[00:37:06] Speaker B: I think the biggest takeaway, and I heard it a lot as a practicing clinician, is you took the time and you listened to me. And I think that's the biggest compliment that we get as NPs, is that we listen to our patients. That's the first step in patient engagement, by the way.
The other thing is that I want to make sure patients understand that I'm not practicing in a silo. We are part of a healthcare team, which means that I'll utilize any of the resources that we need to provide the best care for the patient. So if there's something that I'm detecting that requires another provider, whether it's a nutritionist, whether it's a cardiologist, whether it's a surgeon, whether it's the radiologist, you know, we will make those referrals as appropriate for the patient because the overall is what's best for the patient.
And we want to conserve healthcare dollars, too. So when you listen to your patient, they tell you what's wrong with them. Nine times out of ten, we can figure it out and we can provide that care. But the biggest thing I hear from patients is that we listen.
[00:38:10] Speaker A: That's fantastic. And so you take the time, you listen, you're interacting, you're part of an interactive healthcare team.
I think that it's really important that those of you watching understand that quality of care starts with your practitioner listening to you. No matter who your practitioner is, if they're not listening to you or you don't feel heard today's the day or your next appointment. Address that. Make sure you come with a list because I want to ask you this too, Lynn. A lot of times I get questions, especially when we have specialists on. I don't feel comfortable bringing this up to my practitioner.
What would you say to the person? And I see it a lot with perimenopausal and menopausal women.
I see it a lot with men who are having issues, especially with sexual dysfunction.
There's specific issues that patients traditionally have a hard time talking or advocating for yourself. So what would you say to them from your lens, since you are that whole person practitioner?
[00:39:12] Speaker B: It oftentimes because we make that patient engagement, they're willing to talk to us about issues that they normally wouldn't talk to other providers about.
For example, in gi, I've had many patients who were younger adults who are having issues with potential, you know, sexually transmitted diseases, or they might be gay or have some other health condition that is not being addressed because they're too embarrassed to engage in that conversation with that provider. But when you make them feel comfortable, then that door opens and then they can actually get the kind of care that they need.
One person in particular didn't know anything about prep, which is an HIV prevention. And to me, nobody had asked that question. And I was the first person that did and was able to get them referred to, you know, a specialty clinic that dealt with that. And to me, I felt that that was very fulfilling because I'm speaking saving somebody's life by giving them the preventative care that they truly needed. It wasn't something that I did, but I was able to refer them to a resource that was able to do that.
[00:40:19] Speaker A: Yeah. So it comes down to communication, folks. If you don't feel comfortable communicating with your practitioner or your provider, there's no today might be the day to think about who will pay attention, who will advocate and listen. So I want to shift gears a little bit because we've talked a little bit about advocacy, you know, from a patient standpoint in the clinic.
Now talk to me about a little bit about what you are doing with, with National Nurse Practitioner and Entrepreneur Network. How are you guys able to advocate for NPs while really, really while you're running your own practices? How does that translate into real world access?
[00:40:59] Speaker B: I'll tell you, the policy aspect of healthcare is, is some areas that I think we really need more hands on deck. And by that I mean we need us as clinicians to be more vocal to our legislators. About how healthcare is impacted by the current legislation, especially the barriers to practice and talk about it from not only the practical practice implications, but what are the economics associated with it. We talk in data. We have to talk in data because that's what people understand.
Our patients can be advocates for us as well because they can go to their legislator as well and say, hey, I have had a hard time finding a provider in my area.
What can you do as a legislator to help improve access to care for me? And then that could start the conversation with the nurse practitioner. And really, I think the more people that shine a light on this, that it's a problem can be very, very helpful.
[00:41:56] Speaker A: And.
[00:41:56] Speaker B: And you should know who your local legislators are and take them up for coffee and just have a conversation with them. They don't bite. They work for us. So we really need to engage that opportunity to tell them what some of our concerns are. As a matter of fact, I'm having a meeting with our new mayor coming up this week, and I'm excited because I want to meet and find out what their needs are for the community and how we can help as nurse practitioners to move things forward. So it's really those connectivity pieces within our community that makes it very helpful and oftentimes for the NNPENN members, because we're a nationwide organization, we also do federal advocacy. So one example was when the government was going to shut down.
I said, hey, this is what's going to happen. The government's going to shut down. These are the things that it's going to impact. This is how you insulate your practice. And I got so much good feedback saying this was a call to action that I truly benefited from with your assistance. So that's kind of what we do at the practice level for, you know, across the country to help our practice owners as well. So any way that we can get our voice heard, that we become visible within our communities, that has power.
[00:43:08] Speaker A: That's fantastic. So if you're watching, folks, one of the best things that we can do is to have the conversation with our legislature legislators. We voted them in, maybe we didn't vote them. It doesn't matter if you didn't vote for them or not. If they are representing you, they have to understand what are the top issues. And if we don't reach out to them about health care and maybe access or whatever our concerns are, then they don't know. They're not mind readers.
They're like, I was very politically active for several years in the realm of PT and It's amazing how little people reach out or how little they actually know. You have to bring that to their attention. So that's one of the best ways that we can advocate for our health. It's by communicating with the legislators that were elected into our local area so they know the concerns that our local area has, that our community has, that we have, instead of just waiting for them and hoping that they guess the right answer.
[00:44:01] Speaker B: Well, one example I can share is that oftentimes we'll have town halls. So there's a great opportunity that the local legislators, when they're not in session, will have these town hall meetings, go and attend one of those. I attended one with a colleague of mine, and we were able to talk about the issues of access to care and the barriers that nurse practitioners were having with these regulatory barriers that were preventing us from being able to open up practices and provide that access to care. And they, it was interesting because there was a room of about 50 people and I said, how many of you have had care by a nurse practitioner? And 3/4 quarters of the people raised their hands. So they were actually very surprised to hear that there was this barrier to practice that they hadn't, hadn't heard of before. So again, getting out there from either the patients, going out to these town hall meetings and getting their voices heard, to us as clinicians, getting out there informing and educating our community leaders, what's going on, it has value all the way around.
[00:45:01] Speaker A: Absolutely. I couldn't agree more. And folks like you're watching this because you're, you're, you care about your health care about peak human performance, you want longevity and you want quality of life while you're living longer. So if you think about it from that perspective, access is health policy is not abstract. Policy shapes whether your child gets seen, whether your mother waits months, whether your preventative care happens on time. When we, when we come together, when we advocate for ourselves, when we strengthen nurse practitioner practices, we're not just strengthening their businesses, we're strengthening our communities.
And that's, after all, how we all are able to improve our greatest asset. So this has been an amazing conversation. I really appreciate you being here to shed some light on this for us.
How can people reach out to you?
[00:45:50] Speaker B: They can reach out to us through the directory www.mpdirectory.org or you can go to our website, www.npnnpen.org.
so if you are a patient that's looking for care, the directory is where you want to go find those nurse practitioners. If you're a student, the directory is where you want to go to find a preceptor. And then if you're a practitioner who wants to start their own business, has their own business, wants to be seen and start working together as a larger voice for the entrepreneurs, then www.nnpen.org, the National Nurse Practitioner Entrepreneur Network, is the key.
[00:46:31] Speaker A: Thank you so much for your insights today. In one or two words, what is the biggest takeaway you want our audience to have today?
[00:46:38] Speaker B: I think the biggest takeaway is nurse practitioners put the patient first in healthcare and we are a growing workforce that's out there ready to help fill the gaps in care so that people can stay healthy. And we support the communities where you live.
[00:46:53] Speaker A: Thank you so much for being here today.
[00:46:56] Speaker B: Thank you.
[00:46:57] Speaker A: And you. Yes, you. Unfortunately, all good things come to an end, including this show, but the good news is is we'll be here same time, same station next week. I'm Jen Mudote. This is Vital Signs. See you next time.
