Pioneer practitioners


The independent nurse practitioner with her or his own business is a rare breed. Though most of these professionals work for others, change is looming. Large numbers of baby-boomer-aged family physicians are poised to retire in coming years. The Physicians

Foundation says nearly half are over age 50, so a shortage of primary-care doctors is predicted.

It seems that nurse practitioners may step up to fill the gap. Luckily their numbers are rising. In the past five years the yearly number of NP licenses issued has increased from 946 to 1383.

For five years Linda LaRocco, who has a master’s and a doctorate in nursing, has been seeing patients at her Pine Bush office. She has five examining rooms, a staff of two and a collaborating physician who reviews her patient charts quarterly. While insurance billing first had to be done through the collaborator as well, now it goes directly to her office. It is also performed now by an outside billing company rather than staff, which streamlines paperwork further.

Many people still aren’t sure what a nurse practitioner is exactly. “People don’t know how it works,” LaRocco told me, “who we are and what we do.” She’s trying to change that. “I’ve spent five years trying to get the word out,” she added. “I’m a doctor but not a physician.”

She has a doctorate, a Ph.D., not unlike other advanced medical practitioners who go on for advanced study, such as nurse anesthetists or nurse midwives. “One patient calls me ’noctor,” she said. By state law, she told me, she can’t just put “DNP” on her shingle. She has to spell it out: Doctor of Nursing Practice.

The profession began in the 1960s in Colorado, initially to treat medically underserved children. Dr. Loretta Ford and Dr. Henry Silver, a nurse and a pediatrician, started the first educational program at the University of Colorado.

These professionals start with a registered nurse license, and then go back to school for a master’s degree before they are eligible to sit for the NP licensing exam. Some, like LaRocco or those required to do so for teaching, return yet again for a doctorate. Once licensed they practice with a philosophy that stresses prevention, care and cure, and can perform physical exams, diagnose and treat illnesses both acute and chronic, interpret lab tests, prescribe medications, counsel patients on health and illness issues and refer them to specialists.

“I’ve developed relationships with them,” said LaRocco. “I’m colleagues with many specialists. I refer people to them and they are just a phone call away.”

The degree of physician involvement varies state to state. In a minority of states — 11 to 19, depending on the source — NPs can practice absolutely autonomously with no collaborators needed. New York is not one of these states, hence the quarterly reviews by LaRocco’s collaborator.

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