Deb Miller, CNM, PNP, ANP Family Practice Medical Staff Franciscan Skemp Calcedonia Clinic, Calcedonia, MN

What is your background?

In 1978, I received my BSN at Louisiana State University in New Orleans, and in 1981 a CNM from the Medical University of South Carolina. In 1982 I moved to Minneapolis where I received my Masters of Science at the University of Minnesota.

In 1983, I developed the Nurse-Midwifery partnership in Minneapolis, Partners in Birth. At this time I also took business courses because I couldn’t find a single text that had information for CNM’s and NP’s to start their own practice. The practice was challenging as I fought for third-party reimbursement and hospital privileges. At this time my stumbling blocks frequently were my own colleagues-nurses and physicians who too often had the notion that the practice of health care was competitive, not collaborative. I was sustained through this difficult period by the love of my patients. Unfortunately, the practice suffered financial and economic hardship due primarily to the restraints of direct 3rd party reimbursement and in 1986 closed its doors. Nonetheless, the experience provided a foundation for the direction my practice would take over the years ahead.

In 1986 a family move brought me to the Houston/Caledonia, MN, area, a rural farming community with residents who hold a strong work ethic and spend quality time raising their families. I heard about a CNM opening at the then Caledonia Clinic (now Franciscan Skemp Healthcare) after a church service while chatting with a fellow member of the congregation.

At first I was hesitant to pursue this opportunity because of my concerns over challenges I had previously faced with an overly competitive, non-collaborative environmnent. Therefore, I was careful and determined to only accept a position in which I knew there would be mutual respect.

Based on my experiences, I advise when interviewing to remember that it is not a one-way street. You must ask questions of your potential colleagues as well. Rather than simply focusing on the basics of salary and benefits, other important questions to ask are: How are we going to work together? What are the expectations? How do you view my role?

Satisfied with the response to these questions, I accepted a .75 position at the Franciscan Skemp Clinic in Caledonia a truly collaborative practice with three family physicians: Dr. J. Alan Fleischmann, Dr. John Cochran and Dr. Ingrid Watkins. I see about 10-15 patients a day, compromised of the following: 5% prenatal, 20% pediatrics, 25% routine physicals, and 50 % acute and chronic.

Shortly after accepting the rural CNM position, I decided to continue my education and in 1988 graduated as a PNP from the College of St. Catherine in St. Paul, MN. I then continued on to receive my ANP from Winona State University in 1995. I felt this provided a well-rounded preparation for providing health care to families in a rural family practice.