258 November/December 2013 | Bethesda Magazine HEALTH
the nurse practitioner is in
Dan Hellie woke up with excruciating
lower back pain. The timing was terrible for the WRC-TV sports reporter and
anchor since he was due in Richmond to
cover the Washington Redskins training camp and the highly anticipated
return of quarterback Robert Griffin III.
Moreover, the next two days were to be
Hellie’s last at the station and he didn’t
want to call in sick.
Fortunately, Hellie, 38, had a physical scheduled that morning with Kelly
Goodman, a Bethesda nurse practitioner. The exam was required for the new
job he was starting in August at the NFL
Network in Culver City, Calif. Hellie, who
would be moving from Bethesda to Los
Angeles with his family in the coming
weeks, had put off scheduling a physical
with his doctor. Now, he figured he’d have
to wait a month for an appointment.
His wife, Anne, saw Goodman for primary care and adored her empathetic
approach. She had suggested he call to see
if the nurse practitioner might be able to
fit him in. That Monday, he was told there
was an opening the next morning.
By Tuesday afternoon, Goodman had
completed Hellie’s physical, given him
medicine for his back, and referred him
to a colleague who was both a doctor
and a chiropractor. By evening, Hellie
was en route to Richmond for his farewell assignment.
“It made all the difference in the
world getting in to see her as quickly as I
could,” Hellie says.
The ease with which Hellie was able to
see Goodman underscores why some peo-
ple are choosing nurse practitioners over
doctors for their primary health care.
Nurse practitioners say they’re a cost-effective solution to the rising demand
for primary care providers, performing many of the same tasks handled by
family physicians: routine physicals,
referrals to specialists, surgery preparation, chronic disease management, and
preliminary diagnostic work. Offering
an alternative to time-pressed doctors,
nurse practitioners are gaining a reputation for prompt appointments, longer
visits and a focus on prevention.
“In this day and age, doctors don’t
really have a lot of time for teaching
and explaining, for putting a pathway in
place to live a healthier life,” says Goodman, one of the few nurse practitioners
in Montgomery County who practice
According to the Kaiser Family Foundation, 180, 233 nurse practitioners were
licensed in the U.S. and 3,493 in Maryland
in 2011. Nationwide enrollment in nurse-practitioner programs increased by 60
percent from 2006 to 2010, says the American Association of Nurse Practitioners (AANP). Meanwhile fewer medical
students were pursuing family and internal medicine due to the lower salaries and
quality of life issues associated with these
specialties, according to Kaiser.
Due to insurance requirements of the
Affordable Care Act, 30 million peo-
ple are expected to enter the health care
system in January. Nurse practitioners
will likely play a role in meeting their
primary care needs, says Dr. Kenneth
Miller, AANP co-president and associ-
ate dean for academic administration
at The Catholic University of America’s
School of Nursing.
Though primary care doctors and
nurse practitioners often work in tandem,
organizations representing both groups
are debating how independent nurse
practitioners should be. The American
Academy of Family Physicians (AAFP)
envisions nurse practitioners playing a
vital but ultimately supportive role to
doctors in a team approach to health
care, according to a recent AAFP study.
Nurse practitioners, meanwhile, continue
to lobby for greater autonomy.
FROM MONDAY through Friday, Goodman, 42, sees patients at her clinic in
a shopping mall off Sangamore Road.
She says her practice has grown steadily
since it initially opened in Northwest
Washington, D.C., in 2009. In July, she
hired a nurse practitioner who specializes in family medicine, and she plans
to hire another soon so the practice can
treat children. The clinic serves roughly
By contrast, the average patient load of
a primary care physician is 2, 300, according to a 2012 study in Annals of Family
Medicine. Having little control over insurance reimbursement rates, doctors are
forced to see a high volume of patients to
stay in business, says Michael Faulkender,
associate professor of finance and director of the master’s program in finance at
the Robert H. Smith School of Business at
the University of Maryland.
With higher malpractice insurance
premiums, bigger salaries, larger staffs
and greater student loan debt, doctors
are shouldering increased costs, Faulk-
ender says. “They’re going to have to gen-
erate more revenue to cover those higher-
The cost pressures can translate to less
time with patients. Several of Goodman’s
patients say they’ve come to her out of
frustration over the lack of personal inter-
action with their primary care doctors;
they praise her listening skills and time-
On a Tuesday morning in July,
ACCORDING TO THE KAISER FAMILY FOUNDATION,
180, 233 NURSE PRACTITIONERS WERE
LICENSED IN THE U.S. AND
IN MARYLAND IN 2011.