During the summer months, Sullivan County’s population swells as seasonal residents abandon the city and travel upstate. Since 2011, Refuah Health Center has been serving this rural community year round, helping shore up the healthcare infrastructure in an area that is already medically underserved. Offering primary medical care, Refuah employs high-quality physicians and mid-level practitioners at the rural site.
Nurse practitioners (NP) are a good fit for this community, effectively bridging the gap in an area often characterized by physician recruitment and retention challenges. National trends indicate a steady rise in NP graduation rates, and it is estimated that by 2025 the number of practicing NPs will double. Refuah recognizes the importance of supporting NPs through quality training opportunities and employment. In partnership with Columbia Presbyterian’s School of Nursing, Refuah Health Center offers a six-day intensive preceptorship at its satellite site in Sullivan County. Every week during the summer, Refuah welcomes five new students, houses them onsite, and incorporates them into its team of providers. This summer boot camp is intense, with Refuah providers seeing an increased number of patients per day. Students are thrown into the mix, gaining invaluable hands-on experience during their non-traditional clinical rotation in Sullivan.
“Students are highly integrated with our providers,” says Michael Kaplan, NP, coordinator of Refuah’s NP preceptor program. “On the mobile, there is no place to hide,” he jokes. “Students must participate as a part of the medical team—they are doing exams, and working in-step with the provider to diagnose and prescribe.”
Students spend their days traveling aboard the mobiles through camps, bungalow communities and local townships, providing primary care and urgent care services alongside Refuah practitioners. In a safe environment and under the supervision of a qualified provider, students hone their ability to evaluate and assess patients. “This is more than shadowing,” adds Kaplan. Students also rotate through Refuah’s South Fallsburg clinic, or “basecamp” as Kaplan calls it.
On any given day, these NPs-in-training see patients at all stages of life, from pediatric to geriatric. According to Kaplan, this full-spectrum family practice is unusual in most clinical rotations and as an NP himself, he recognizes the value.
“At our basecamp, students get to participate in an integrated family practice,” he explains. “Students are getting the benefit of practicing medicine in an intimate environment and in a culturally diverse community.” As a Columbia graduate who has experienced the NP job market first hand, Kaplan adds “The daily—hourly—hands on experience will make them more marketable and get them better placement after graduation.”
Kaplan describes the program as a “win-win.” Students get first hand experience, and Refuah is able to add registered nurses to each mobile where they act as knowledgeable physician extenders. Kaplan also explains that this is an “ideal audition” for future employment, giving Refuah the ability to assess and flag NPs for potential job offers.
As the first summer of the NP clinical program draws to a close, Refuah is working with Columbia to become a clinical site for the Doctorate of Nurse Practitioner (DNP) rotation. In the coming year, Columbia’s School of Nursing will transition from a Master’s program to a Doctoral program, with students receiving two additional years of schooling. DNP students will participate in clinical rotations for a full semester at Refuah’s service sites in Spring Valley. As with the NP program, DNP students will be closely integrated with Refuah providers and will have the opportunity to benefit from participating as providers in the full spectrum of primary care services.