Health care experts see nurse practitioners as a boon to rural and inner-city areas that are “medically underserved,” but Goodman’s practice illustrates how they could fill critical gaps in Bethesda, Chevy Chase and Northwest D.C.—communities where doctors are plentiful but not always available.
Dr. Jennifer Abele, medical director of the Sibley Emergency Department, says she routinely meets patients without primary care physicians because local doctors don’t take their insurance or aren’t accepting new patients. “It’s kind of like finding a good hairdresser,” she says. “Word spreads, and all of a sudden everybody’s booked.”
Elderly patients on fixed incomes also represent a growing niche for nurse practitioners. “A lot of doctors aren’t going to take Medicare…whether it’s the city or in affluent areas,” says Sandra Nettina, a family nurse practitioner and co-chair of the Nurse Practitioner Association of Maryland’s legislative committee.
Though nurse practitioners say they are poised to deliver primary care to people soon to be insured under the federal health care law, inconsistent state laws governing their work raise obstacles.
Maryland is one of 21 states that require independent nurse practitioners to demonstrate an affiliation with a physician before becoming licensed. Nurse practitioners in Maryland must get an “attestation,” a document that identifies the physician and that replaces the more onerous “collaborative agreement” that they were required to have with a doctor before regulations were relaxed in 2010. The District and 17 other states don’t require physician oversight of nurse practitioners. The remaining states have more restrictive licensing requirements.
At the national level, physician groups are advocating for laws that restrict a nurse practitioner’s ability to practice independently. Concerned about disparities in education and training between nurse practitioners and doctors, the AAFP and the American Medical Association are pushing to limit nurse practitioners’ scope of practice.
Yet in reality, Goodman and Nettina say, most doctors don’t perceive nurse practitioners as a threat, but more as collaborators in getting patients the best care.
“Having an NP is a beautiful complement to what I’m doing,” says Dr. Jon Wiseman, an internist who practices concierge medicine in Northwest D.C. and has referred several patients to Goodman over fellow doctors because he “thought they’d get better care from her.”
Goodman recalls a striking image when discussing the moment she realized she wanted to be a nurse.
Her mother was one of a few nurses in the farming community of Hampton, Minn., where Goodman grew up. When Goodman was a kindergartner, her mother waited with her at the bus stop in a nurse’s iconic uniform—white nylons, starched white uniform, cape, and a hat bearing the logo of her nursing school—and told stories of heroism, including one about delivering a baby in a basement. Her mother made house calls to Hampton’s sickest residents, accompanying them when necessary on the 40-minute ambulance ride to the nearest hospital.
When Goodman was 10, she witnessed a nurse’s anguish at not being able to save someone. Family friends had come over for a pool party. Nobody noticed when Goodman’s classmate slipped into the pool and drowned. Goodman’s mother dove into the deep end and pulled the boy’s lifeless body to the surface. She fought desperately to revive him with chest compressions and CPR.
“It just reinforced the fact that I wanted to be just like her,” Goodman says.
Goodman spent her early career in acute care, leaving the field for two years to work in pharmaceutical sales for Pfizer, which she says taught her how to hustle for business. Upon her return to nursing, she pursued additional training in operating rooms before earning a master’s degree as an acute care nurse practitioner from the Georgetown University’s School of Nursing and Health Studies in 2006.
Three years later, primary care presented itself as a new challenge. She relocated her practice to Bethesda in 2012, and aspires to be the trusted primary care provider her mother had been. Living three blocks from her clinic, Goodman sends her sons, Bennett, 11, and Bryan, 10, to local public schools and counts neighbors as patients.
Goodman treats plenty of healthy people with nonlife-threatening emergencies or in need of a routine exam. Among her patients is Susan Larkin, 59, who suffers from chronic fatigue syndrome, an illness few doctors understand and many dismiss.
Over decades, Larkin gained a significant amount of weight and developed heart problems and fibromyalgia, a chronic condition characterized by diffuse pain. The Chevy Chase, D.C., resident was tired of doctors telling her to lose weight—without teaching her how—and prescribing drugs that didn’t help.
In March 2010, Larkin began seeing Goodman, and for two years didn’t say much about her previous diagnoses. After Goodman broke through Larkin’s guarded exterior, Larkin confided that she was miserable; everyday activities like kneeling down to tie her shoes or walking across the street from her apartment to Starbucks were too exhausting. She was convinced she was dying.
Goodman knew weight loss was a touchy subject, but integral to Larkin’s recovery. She prescribed an anti-narcoleptic drug to alleviate Larkin’s fatigue, gave her vitamin shots to boost her energy and helped her develop a sensible food plan. She scheduled checkups every two weeks.
Larkin says Goodman never pretended to have all the answers; her willingness to be Larkin’s partner in improving her health made the difference.
“She doesn’t just accept the status quo,” Larkin says.
A year and a half later, Larkin has shed nearly 70 pounds, lowered her cholesterol, and no longer takes blood pressure medication. She has resumed trips to Starbucks and ties her shoes without first having to find somewhere to sit.
“I can say with no reservations that this is the best health care I’ve ever gotten,” Larkin says. “I trust [Goodman] with my life. I absolutely do.”
Archana Pyati lives Silver Spring.