Nurse practitioners have been a part of Missouri’s health care scene for the past fifty years. The state has a shortage of primary care doctors, but state laws restrict nurse practitioners from filling that void.
Few nurse practitioners find a way to open their own practice with these restrictions in place, but Pat Bauer, who opened her practice in Wildwood, Missouri last May, found a way.
When she finished her schooling, Bauer applied to more than 30 jobs. She heard back from just two.
One of the interviews particularly sticks out in Bauer’s mind.
“The question was posed, ‘You have a collaborating physician don’t you?'” Bauer recalled.
That puzzled her.
"No, I don’t,” she recalls replying. “'Don’t you offer a collaborating physician with the job?’"
“Oh no,” she was told. “'You have to have your own collaborating physician.'”
By Missouri law, nurse practitioners have to collaborate with a physician within a certain radius of their jobs -- 30 miles in an urban area or 50 miles in a rural one. Collaborating physicians must read and sign patients’ charts and prescribe certain medications.
It took Bauer about eight months to find a physician who would collaborate with her, but he was too far away from where she wanted to work originally.
“Long story short, I worked with the collaborator, and he said, ‘Anywhere else you want to work, I'll collaborate with you.' So I opened my own practice.”
Now, Bauer is about 24 miles from her collaborating physician and sees about six to ten patients a day. She says she can spend more face-time with them, which isn’t something all nurse practitioners can do.
Patty Lacross-Arnold came to Bauer’s practice per her doctor’s recommendation.
“I was seeing her a few weeks ago and since I have health problems that don’t seem to be getting better,” Lacross-Arnold said, “I looked into it. And I’m here now.”
Many of Bauer’s patients drive an hour to see her because seeing a nurse practitioner like Bauer offers certain advantages they can’t find at a doctor’s office--like more face time, and some alternative healing practices.
But it’s not always so simple for nurse practitioners to set up their own practice.
Marcia Flesner, a clinical instructor at MU’s Sinclair School of Nursing, said those restrictions affect patients the most.
“Access, plain and simple,” Flesner said. “If I want to go to a nurse practitioner, I should have the choice to do it. But I don’t.”
Not everyone agrees with her assessment, pointing to the relatively fewer clinical training hours nurse practitioners receive compared to physicians. And in 2014, the state created a new medical classification to address the doctor shortage in underserved areas – “assistant physicians” who have completed medical school but not residency programs.
But other states have more expanded legal bounds for advanced practice nurses, and both Flesner and Bauer hope Missouri will join them.