Veteran doctor, rookie nurse practitioner share office and insights at West Duluth Clinic

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Nurse Assistant - West Duluth Clinic

Photo from Duluth News Tribune

With about 1,300 patients and Tuesdays off, Dr. Stephen Carlson isn’t always available.

“Right now, people have a hard time getting in to see me,” said Carlson, 65, a family doctor with 39 years of experience, most of them at Essentia Health’s West Duluth Clinic.

All the more so because many patients want to see him.

“He’s a very popular physician because of the people that know him here and the great experiences they’ve had,” said Julie Newman, Essentia system’s director for primary care.

But now, Carlson’s patients can see him without really seeing him.

Carlson explained recently, holding up an 8-by-4-inch sheet of heavy-stock paper — labeled “My team” — that includes photos of himself, Dr. Rhett Bonner and nurse practitioner Mark Wiita.

“When I show this to patients I say: ‘This is me, and these are the two people who are going to be offered an appointment if you can’t see me,’ ” Carlson said. “Because I’m not always here.”

It’s called “Primary Care Home,” and it’s a model Essentia has put into place not only in West Duluth but in all of the sprawling health system’s clinics across parts of Minnesota, Wisconsin, North Dakota and Idaho.

NOT ENOUGH DOCS

It’s a response to a reality that is true virtually everywhere: There aren’t enough primary care doctors to go around, and the shortage will grow even more apparent as the population ages.

“We can’t recruit enough primary physicians out there for the aging population,” Newman said. “There aren’t enough coming out of school to meet our demand.”

The numbers back that up. Two years ago, the Henry J. Kaiser Family Foundation published a report contending that only 60 percent of the need for primary doctors in the U.S. was filled as of April 28, 2014, and more than 8,000 physicians were needed to fill the gap. Minnesota was just less than 60 percent of the need met; Wisconsin was at about 71 percent.

The Robert Graham Center, in a 2013 report, projected Minnesota would need nearly 1,200 additional primary care providers by 2030 to meet a demand that’s growing because of population growth and aging.

“We are in an acute shortage of primary care physicians,” said Terry Hill, senior adviser for rural health leadership at the Duluth-based National Rural Health Resource Center.

Meanwhile, most medical schools continue to funnel their students toward specialties, Hill said — although the Duluth campus of the University of Minnesota Medical School is an exception.

The only way to fill the gap, Hill said, is for primary care doctors to work “at the top of their licenses,” allowing nurse practitioners, physician assistants and health educators to handle more basic care.

Essentia Health reached that conclusion in 2007, Newman said, and during the past two years has vigorously implemented its plan for primary health care homes.

‘ABILITY TO BANTER’

At the West Duluth Clinic, that meant recruiting Wiita and a physician assistant, said Nancy Dettle, the clinic’s administrator. Dettle was the matchmaker for the clinic’s four teams, each consisting of two doctors and either a nurse practitioner or a physician assistant.

Carlson, the longer-established doctor, has a heavier patient load than Bonner, so Wiita is more likely to see Carlson’s patients. And Carlson, who used to have a small office to himself, now shares a small office with Wiita. Each works at a computer facing opposite walls and has just enough room to swivel around in his chair and talk with the other.

The tight quarters don’t bother him, Carlson said.

“For me, it was easy,” he said. “Now I have the ability to banter.”

They’ve only been office partners since August, but Carlson and Wiita have a history.

Wiita, who is 50 but looks like he’s in his 30s, had an earlier career as a pharmaceutical representative and got to know Carlson when he would pay visits to the West Duluth Clinic.

He felt that he was called to a different line of work in the health care field, Wiita said.

“So with my wife’s support, which is really important, I went back to school,” said Wiita, who is the father of three children. “It was the best move I ever made.”

Wiita first earned a degree as a registered nurse at the College of St. Scholastica and later returned to complete his advanced practice training. A rookie when he was paired with Carlson in August, Wiita said it has been a good start to his career as an NP.

“I’m really happy I’m here with this guy,” Wiita said. “He’s a great teacher. He teaches, and he’s willing to share.”

TEAMWORK

They don’t see patients together, and much of the time that Wiita and Carlson are together is when they both happen to be in their office, filling out reports. But there’s a lot of talk back and forth between the two men. Carlson might fill Wiita in on a longtime patient he’s about to see. Wiita might ask Carlson to look at an X-ray with him, or ask what to do with certain lab results, Carlson said.

Recently, Carlson said, a man came into the office after his wife expressed concern about a growth on his leg. Wiita looked at it, then asked Carlson what he thought.

“And I looked at it and said: ‘That’s got to come off,’ ” Carlson related.

It turned out that the patient had a malignant melanoma and will need additional treatment, Carlson said.

If Carlson’s experience is one part of the equation, Wiita’s fresh perspective is the other.

“I try to keep up with the fresh stuff,” Carlson said. “But Mark doesn’t have the old stuff behind him to be interfering with the new stuff.”

Wiita is particularly good, Carlson said, in chronic disease management.

“When we’re dealing with chronic disease, for example, hypertension or diabetes, there’s a lot of expectations on how to get patients to a healthy lifestyle,” he said. “And so I can’t do it all, and so we kind of team play. Mark helps me and I help him and between the two of us we try to get these patients managed.”

It sometimes can be a matter of hearing the same message from a different messenger, Wiita said.

“Sometimes I just might have a different way of delivering something that he’s told them 100 times, and they might just hear it different from me,” Wiita said.

‘THERE’S A LIMIT’

Carlson, old enough to retire but with no plans to do so, said he doesn’t feel threatened about sharing his practice.

“I’m at that place of realizing there’s a limit to what I can do,” he said.

The camaraderie is true of all the recently formed teams at the West Duluth Clinic, Dettle said.

“I just this clinic overall is a happy group of physicians,” she said.

The goal at the West Duluth Clinic, as it is at others in the system, is to see every patient who wants to be seen on the same day, Dettle said.

Given that the average patient sees a primary care provider 2.5 times a year, that couldn’t happen without the primary care home model, Newman said.

But the model also provides consistency in a patient’s treatment, she said. “There’s a lot of advantages when patients know they have that team there taking care of them. It’s not going to be random who they’re going to see.”

The partnerships respond to something that’s present in many doctors, Newman said.

“I think physicians like to teach,” she said. “And they like to share their knowledge and experience. I think it gives you job satisfaction. There’s a lot of studies out there that show teamwork, working collaboratively with someone else, gives you job satisfaction.”

Although he doesn’t care for the behind-the-scenes paperwork, Carlson still finds his job satisfying, he said. But he’s happy to share the load with Wiita.

“And patients are good with coming in to see him,” Carlson added. “I said his job is to steal every one of my patients.”

Originally posted at the Duluth News Tribune here.

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