Physician shortage: New program trains nurse practitioners to meet the need in Stanislaus, Merced counties

Blake Hufford says the experience of working in the emergency department at Doctors Medical Center opened his eyes to the need for primary care in the Central Valley.

Many patients came to the ER with medical needs – a sore throat or a chronic disease – because they were not able to get an appointment with a primary care doctor.

Hufford, a registered nurse, realized he wanted to contribute to the solution when a new masters degree program was created at California State University, Stanislaus. The program is training family nurse practitioners to address the shortage of primary care doctors in Stanislaus and Merced counties.

Twenty-four nurses began the Masters in Family Medicine program in January to become nurse practitioners. Hufford is among the eight men who started the program last month.

The two-year degree program is supported by $1.6 million in grant funding from the Legacy Health Endowment, most of which will pay the tuition for students who agree to work as nurse practitioners in local health clinics and physician offices for three years. They can complete the requirement by serving patients in communities in Legacy’s territory with limited access to physicians, such as west Modesto, Ceres, Turlock, Hughson, Patterson, Newman, Hilmar and Livingston.

Nurse practitioners may handle routine examinations for primary care doctors, prescribe medication, treat chronic illness, suture wounds, put casts on broken arms, or focus on health promotions and disease prevention. In California, nurse practitioners must be supervised by a primary care physician.

“They see the generic cases, and the more complicated cases are referred to the physician,” said Debbie Tavernier, director of the School of Nursing at Stanislaus State.

The San Joaquin Valley has the lowest number of physicians per capita compared with any region in the state.

The Central Valley Health Policy Institute in Fresno, which has studied the regional shortage of physicians, said doctors are attracted to the higher-income markets in the coastal counties of California. Other factors that contribute to the shortage are lower Medicare reimbursement rates and a lack of resources for young doctors in the Central Valley.

Some positions are filled at community health clinics and hospitals in the valley by recruiting doctors from foreign countries and relying on nurse practitioners.

The Legacy endowment, created as a result of the 2014 sale of Emanuel Medical Center to Tenet Healthcare Corp., provided the grant to Livingston Community Health to support Stanislaus State in offering the masters program. The Stanislaus Community Foundation provided $300,000 for tuition relief for graduates of the four-semester program and for career outreach to high schools.

Tavernier said 15 of the 24 students in the first class have applied for the $20,000 forgivable loans from the Legacy endowment.

The students hold bachelors degrees in nursing and primarily work in hospitals in the Northern San Joaquin Valley, Tavernier said, so there’s a good chance many will serve patients in the local communities even after the three-year commitment.

Jeffrey Lewis, chief executive officer of the Legacy endowment, says the scarcity of primary care doctors has been discussed for years. But the new degree program is a step toward doing something about it.

A growing senior population is putting more pressure on physician offices and clinics. And the Affordable Care Act extended health coverage to millions of California residents who have medical needs.

“By starting with a program to educate nurse practitioners, we can work toward ensuring that every person in this community has access to medical care professionals,” Lewis said.

Tavernier said the first semester includes a difficult class to learn what medications are effective for treating illnesses and disorders. Two classes in the fall will focus on diagnosis of common health problems and the issue of health disparities in the Central Valley.

The nurses must complete an internship as a requirement of graduation and will learn to care for patients from children to seniors, Tavernier said.

Nurse practitioners can expect to earn from $98,000 to $118,000 a year, according to the Health Workforce Initiative.

Safety-net clinics such as Golden Valley Health Centers in Stanislaus and Merced counties and Livingston Community Health hire nurse practitioners, and the health care providers are also in demand at private medical offices.

Nurse practitioners have met with resistance from the medical profession and from purists who claim they can never replace physicians with their years of medical training. Hufford said he hopes the degree program can help change some perceptions.

“It will be interesting to see how we are received,” Hufford said. “We have the bedside experience in hospitals. We know how to work with patients and communicate with patients. If we can get out in the clinical setting and show what we are all about, we should be well received in the community.”

This story was originally published February 11, 2018 at 4:49 PM with the headline "Physician shortage: New program trains nurse practitioners to meet the need in Stanislaus, Merced counties."