MCE sits down with nurse practitioner Kerry Palakanis, DNP, FNP-BC, who has opened a health clinic in Crisfield to serve a chronically underserved community.
Tell us about your background. Are you a local? How did you end up in Crisfield?
I have been a nurse for over 28 years and a family nurse practitioner for 20 years. I graduated from Georgetown University’s first nurse practitioner program and spent the first four years as an NP in the Navy.
I’m originally from Olney, Maryland. When I lived in Olney it was a very, very small town with just a blacksmith shop, a hardware store, a BP station and a pharmacy that had an original soda fountain in it. My parents moved to Los Angeles when I was 11 and I recall telling them that I was going back to Maryland as soon as I grew up.
I have lived in so many places that it is hard to say where I am from. After leaving the Navy in 1995 I worked in Salisbury as a Family Nurse Practitioner for a year and taught the first class of nurse practitioners at the University. We left the area after I was recruited to run a group of rural health clinics in the panhandle of Florida.
Since then I have held a variety of nurse practitioner positions as well as administrative healthcare positions.
My husband and I were looking to return to Maryland and I was in the process of completing my doctoral degree so I applied for a position at Salisbury University and began teaching there again in 2011.
I like to say that Crisfield found me and my family. We rented a home the first year back and we were looking for an area to relocate permanently with the intent to someday retire. Both my husband and I wanted a few acres in a quiet small town.
The building that is now the Crisfield Clinic was run for over 20 years as a doctor’s office but had been closed for over 9 years. The bones were there but a substantial interior renovation was needed to bring it back to life. My entire family chipped in and after purchasing the building we spent three months updating the interior and bringing it up to code in order to reopen it as a clinic.
During the renovation process we fell in love with the area and were fortunate enough to find a home in the neighboring town of Marion Station. Our home includes the acreage we were looking for and now houses not only our family but alpacas, miniature donkeys, goats, chickens, pheasants, peacocks and ducks.
Having grown up in a small town,Crisfield/Marion Station reminds me of the Olney from my youth. A small town atmosphere but commutable to larger town amenities if you need them.
What is the primary need for health care services in Crisfield? How do you find your patients?
While teaching I worked at Your Docs In both in Salisbury and Pocomoke part-time. When I referred patients back to their “primary care provider” the ones in Somerset would tell me over and over again that “there were no providers that were taking new patients” or that they “couldn’t afford the fees” that the local providers were charging.
I remember driving by the clinic site several times over the year and seeing the for sale sign. Whenever I would see the clinic I would think that it was a shame that there was such a need in the area, a building just sitting there and no one stepping forward to provide the care.
Somerset County is one of only 5 counties in Maryland in which 100 percent of their area is designated as medically underserved.
According to the Health Indicator Rankings of 2011 produced by the Maryland Department of Health and Mental Hygiene, Somerset County ranks in the bottom quartile for life expectancy, obesity, hypertension, high cholesterol, smoking, diabetes, asthma, and anxiety disorder prevalence. These same rankings placed Somerset County last in affordability of health care while simultaneously having the largest percentage of the population living in poverty. The poor economic state, poor health of the community, and lack of availability of services made it the most logical place to consider a primary care practice.
One day while passing the clinic I called the listing agent and on a whim asked to see the property. When my husband and I entered the building and the listing agent told me about the desperate need for care in the area my husband looked at me and asked, “Why wouldn’t you do this?” I could think of a million reasons why not to (most of them financial) but my heart has always been in providing rural and underserved health care and so it won out. If it were not for the support of my husband, financial gifts from my mother and mother-in-law, and the loan from MCE the clinic would never have become a reality.
The Crisfield Clinic is located on Rt 413, the main highway into Crisfield. The location’s street visibility lends itself to recruiting new patients. Additionally, I am the only provider in the area that offers Saturday hours and that has attracted a good number of patients. Since opening, every day we are seeing new patients and the volume has been steadily increasing.
Being in a small town the patients have found us through word-of-mouth referrals. I’m a firm believer in the benefit of good customer service and care in creating business through buzz and satisfied patients. At least once a day I have a new patient tell me that they heard “so many good things” about the clinic that they wanted to become our patient. Satisfied customers/patients are the best advertising!
Do you take walk-ins? What if a patient doesn’t have health insurance and can’t afford to pay?
Yes, we do accept walk-ins but now that business is picking up we encourage patients to make appointments. If a patient doesn’t have insurance we offer a discounted flat fee for services. We try to make every effort to help people get assistance from available local and state resources.
The Somerset County Health Department has been wonderful to work with and we often collaborate with them to find services for the uninsured patients or connect uninsured patients to service programs that they did not know they could qualify for at the time we see them. Women between the ages of 40-64 years old without insurance can receive no-cost Pap smears and Breast exams through the state funded Breast and Cervical Cancer Program. We participate with the program through the health department and provide exams for them as well as connect patients to the program. Somerset County Health Department offers several health promotion and disease prevention programs and we have been able to refer the uninsured patients for colorectal cancer screening, tetanus shots and many other much needed and otherwise cost-prohibitive services.
How will Obamacare affect your health clinic?
It is still too soon to tell what the effects of Obamacare will be on healthcare in general. In the short term it looks to be supportive to primary care as the government Medicare and state Medicaid programs have offered increased reimbursements starting in 2013 to primary care providers.
The Obamacare initiatives and the legislation in the state of Maryland are very conducive to nurse practitioners and other primary care providers who might want to consider starting their own business, especially in areas of need.
The most beneficial aspect of Obamacare for me will be the additional 25% of the population that will be eligible for health insurance. These individuals are currently uninsured and missing critical health care services that can prevent disease in the future. The increased number of patients will directly impact the need for more primary care providers throughout the country but especially in areas such as Somerset County that are already underserved.
What services are you not able to offer? Do you see children?
We see patients of all ages and provide primary health care services both acute and chronic. Because of my ER/Urgent Care and Navy training I also perform procedures that are not traditionally done in family practice such as joint injections, stitching, splinting, and minor dermatologic procedures. We do not offer psychological counseling although there is an enormous need for these services.
Patients with complex health care needs are referred to area specialists for coordinated care. The goal of primary care is to be the patient’s medical home where we address both preventive, acute and chronic health needs as well as coordinate care with specialists.
Do you see your business expanding over time? Where would you like to be in 5, 10 years?
Absolutely! There are still so many gaps in services in the area that we cannot help but think about expansion. I have offered space to a Podiatrist who comes to the clinic one morning a week and am in the process of setting up a similar arrangement with a physical therapist from Salisbury.
My short-term goals include hiring another nurse practitioner and offering developing interventional pain management services.
My patient population has to travel anywhere from 45 to 120 minutes to get to pain management services and the wait for acceptance into programs is very lengthy. Other short-term goals include continuing to grow our home visit service which provides much-needed care to homebound patients especially due to the transportation issues that we face in Somerset county.
I would love to have the resources (or a generous donor) to purchase/renovate a class A recreational vehicle that we could use to transport a clinic environment directly to patients in outlying areas as part of our home visit service as well as to do some community outreach and onsite migrant health care.
There used to be a Governor’s Wellmobile that serviced Somerset one day a week but it was discontinued several years ago due to state budget cuts. A similar Wellmobile could be easily resurrected as an extension of the clinic and would be self-sustaining by healthcare visit reimbursement.
I’m fortunate to have a little over an acre of ground around the clinic and can easily envision in five years expanding the building to offer more services as well as create collaborative arrangements for specialty care services.
Within the next five to ten years I would also like to explore the possibility of expanding to include a community wellness center which would also include after-school programs for area students.
There is a direct correlation between educational achievement level and health care outcomes and in order to make a sustainable difference in the health care of the area we need to integrate services in both areas.
My son is in nursing school and hopes to become a nurse practitioner. My daughter-in-law is pre-med and will be graduating from medical school and residency in approximately 8-10 years. My 10year plan includes hopefully transitioning the practice to them as full-time providers and remaining on part-time as I work toward retirement.
I’m sure they taught you a lot in school about how to medicine. Did they teach how to run a business? What is your advice for other sole practitioners who might want to strike out on their own?
I received absolutely no training in school about the business side of medicine. The majority of my knowledge came from “on the job” training that I learned as I moved from the ranks of hospital department manager, private practice manager, healthcare system director to COO/CEO of health care service organizations.
Along the way I always made certain that I learned as much as possible about every job that I supervised and I believe that provided me with the background to develop the clinic from the ground up.
My advice for other sole practitioners is that they need to understand the magnitude of work involved in striking out on your own as well as the risk/reward ratio of private practice.
Typically I work 70-80 hours per week and it can be grueling at times. Most people entering the health care field now are looking for lucrative positions where they are supported as employees and have set schedules. While the work to pay ratio is significantly less in private practice, the rewards from being able to make independent decisions about the services and fees that you offer as well as to follow your passions are not always available in corporate America. I hope to be able to encourage other people interested in entering into private practice, especially primary care, by sharing my success story with them.
Anything else you want to add?
Plan for everything, including the unexpected. When writing my business plan I didn’t include planning for a hurricane. The clinic fared well from the storm with minor damage to the surrounding trees. The community, on the other hand, is still well steeped in the recovery effort.
I hope that everyone on the Delmarva Peninsula remembers Crisfield and works with us to rebuild and restore what was at the turn of the 20th century the second largest city in Maryland.
The life of a waterman, farmer and small business owner is a difficulty one but their products are essential to the lifestyle that we all enjoy about the Delmarva Peninsula. I want to thank MCE for giving me the opportunity to follow my dream and develop the clinic. Without the loan program I would have not been able to achieve the success that I have in the short time that we have been open.