Nurse practitioners could solve health care dilemma

School of Nursing striving to help meet growing health care demand with primary care providers

SAN ANTONIO (Sept. 19, 2012) — With millions of people gaining insurance coverage due to federal health care reform, physician shortages are expected to worsen. The School of Nursing at The University of Texas Health Science Center at San Antonio is doing its part to close the gap.

Julie Novak, D.N.Sc., RN, CPNP, FAANP, vice dean and professor in the School of Nursing, said that, by the time most health care reform provisions take effect on Jan. 1, 2014, the country will need many more primary care clinicians. Those can include primary care physicians, nurse practitioners, physician assistants and certified nurse midwives.

“This past year we’ve grown our family nurse practitioner program from 40 students to 60 students admitted annually. In this program, 100 percent go into primary care where the need and demand are the greatest,” she said.

Novak said because less than 10 percent of doctors go into primary care nationally, nurse practitioners will need to fill the primary care needs. At the UT Health Science Center, the past two years of medical school graduates saw approximately 18 percent go into family medicine. The majority will practice in internal medicine specialties or surgical specialties. At the nursing school, 85 percent to 90 percent of all nurse practitioner graduates will go into primary care.

Overall, the School of Nursing has grown its enrollment from 500 to 823 students over the past three years. Dr. Novak says 85 percent of graduates remain in Texas – a significantly higher percentage than at most other schools.

Another way the nursing school is working to address the increasing need for primary care is the creation of nurse-managed clinics. “We are part of a national movement with 250 Nurse Managed Health Centers. This movement began as a way to respond to the primary care shortage by admitting more students, creating faculty practice opportunities and gaining access to research populations while meeting a community need.”

Headed by Novak, the UT Nursing Clinical Enterprise manages four clinics: the Student Health Clinic, the Employee Health and Wellness Clinic, and two clinics from school-based partnerships through Early Head Start, Head Start and the local school systems. The enterprise has a strong community focus with close affiliations with local agencies through the faculty practice of 45 nursing faculty members, community board membership and service-learning projects.

“We are seeing tremendous growth at these clinics. There is incredible acceptance from patients, and we are getting calls from rural communities wanting clinics,” she said. “The clinics allow us the opportunity to study what is working, areas for improvement and cost effectiveness.”

Novak said the local clinics and the ones throughout the country have proven that nurse-managed clinics are a very cost-effective answer to the primary care shortage. “We can provide accessible, high-quality primary care in a nurse-led model for one-third the cost of a traditional medical model staffed by physicians,” she added.

The nursing school program received a $300,000 grant from the federal government to fund an electronic health record system to link all the clinics. The electronic system is imperative with the number of patients being seen at such clinics, Novak said. From 2011 to 2012, these clinics had 15,032 total visits.

“Our goal is to grow and develop our clinics, to provide excellent care, and to offer our students and faculty an integrated, interprofessional model in which to learn, discover and engage. We want our students to know that they can truly make a difference in the health of our patients, their families and our communities. To sustain these high-quality patient- and family-centered models, we must develop providers who understand cost and value.

“Nursing was born in the church and raised in the military; historically, cost and value analysis was not a high priority in nursing education or practice. With finite resources, it must be a priority now and for the future,” she said.


The University of Texas Health Science Center at San Antonio, one of the country’s leading health sciences universities, ranks in the top 3 percent of all institutions worldwide receiving federal funding. Research and other sponsored program activity totaled $231 million in fiscal year 2011. The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced approximately 28,000 graduates. The $736 million operating budget supports eight campuses in San Antonio, Laredo, Harlingen and Edinburg. For more information on the many ways “We make lives better®,” visit

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