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The nurse practitioner team at Lake Serene Clinic: (front row, left to right) Carolyn Freed, NP; Andrea Friesen, NP; Jessica Webb, NP; (back row, left to right) Greg Lind, NP; Josh Webb, NP; Marty Couret, NP
By Jill Rollet
When Greg Lind, NP, earned his doctorate in nursing in 1987, he thought he would love moving from clinical practice to a teaching job at the research-oriented University of Washington. He didn't.
"It was a very challenging 2 years," Lind told ADVANCE. He found the pace of discussion slow, and he missed seeing patients. So he asked for permission to go back to practice 1 day a week.
He quickly realized why the university didn't want research faculty out in clinical practice: "because that was what I really enjoyed," Lind remembers.
Lind left the university and worked for 9 months in a clinic setting. But he soon wondered why he was working for someone else again. He knew that Washington's laws allowed nurse practitioners to own their own practices, so in the summer of 1990, he found a prime location, "I took a banker out for lunch and had a loan that afternoon."
Soon after, he opened the Lake Serene Clinic in Lynnwood, Wash. With no business background to draw from, Lind called on the expertise of local business owners and knowledgeable acquaintances. "I've since become a fairly astute businessman," Lind acknowledges.
The Vision
Washington has some of the country's most favorable laws for nurse practitioners. Since 1973, NPs have been allowed to practice almost completely independently, with no rules mandating supervision or discouraging insurance reimbursement. Today, nurse practitioners can prescribe scheduled drugs without a joint practice agreement, a formality previously required by state law.
Lind observed that although a number of NPs in the state owned their own practices, most had physician partners. Lind's goal was zero physician involvement, and his strategy was to provide a completely different kind of care.
"At that time, there were no walk-in clinics unless they were urgent care-type clinics," Lind explains. "I wanted to go back to pre-World War II practice, when there were no appointments in primary care. It was first come, first served, and you brought a chicken if you didn't have money to pay."
Although Lake Serene Clinic never took payment in livestock, it did provide walk-in primary care from 9 a.m. until 8 p.m. every day of the year, including weekends. Lind's wife would allow the clinic to open for only 5 hours on major holidays.
"There were Christmases that I had people traveling 60 miles because we were - and still are - the only clinic for some 5 million people that's open on Christmas," Lind adds. "And I had people doing physicals on Christmas because they didn't have any other day off."
Lind saw enough patients that his receipts paid all the clinic's bills and his salary only 3 months after opening.
Hospital Privileges
Lind found that his business model worked well until a patient needed to be admitted to the hospital. Although there were plenty of nurse practitioners in the state, hospital bylaws required patients to be under the care of a physician. Other NPs got their patients admitted under the name of a physician employer or partner.
The situation irked Lind because he had no access to his patients when they were in the hospital, and, perhaps worse, "there was no documentation that said that a nurse practitioner had made this assessment or saved this person's life." Lind complains, "I'd look at the discharge note, and it would say that this person just walked in off the street with a bad appendix and a doctor took care of him! I wanted some documentation that a nurse practitioner did this."
It took him 3 years, but Lind convinced the local hospital that he wasn't going to go away and that he could actually make the hospital money. He persuaded 200 physicians to support his case, and the hospital changed its bylaws to allow staff privileges for independently practicing NPs.
NP Owned and Operated
Today Lind has a nurse practitioner partner, Andrea Friesen, and they employ four other NPs, seven medical assistants, six receptionists, a CEO and two staff members for billing. The clinic is still open every day of the year, and its providers are available by phone 24 hours a day. They still see walk-in patients, but they also offer appointments to approximately 350 patients a week. Lake Serene Clinic saw 15,000 patients and billed more than $2 million in services this year.
Lind and Friesen offer their NPs profit sharing and productivity increases, and provide bonuses for other staff members based on initiative, critical thinking and hard work.
Jill Rollet is senior associate editor at ADVANCE for Nurse Practitioners. Reach her at jrollet@merion.com.
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