Ashley Sanregret and Jessica Williamson have a lot in common.

Like all moms, they want the very best for their children. Both have a young set of twins and two older children. Both are married and work outside the home.

And both adore their respective medical provider, counting on them to keep their busy families healthy.

And like many families in small towns throughout West Michigan, their medical provider is not a doctor, but rather an advanced practice provider.

These types of providers create more access to medical care in rural communities, where physicians are often in short supply.

Nurse practitioners and physician assistants, both considered advanced practice providers, serve as primary care providers to thousands of patients.

The Sanregrets, who live in Lake Odessa, see Spectrum Health physician assistant Erica Nyman, PA-C.

The Williamsons, who live in Greenville, see Spectrum Health nurse practitioner Amber Goetz, NP-C.

And they wouldn’t have it any other way.

Nyman is a full-care physician assistant, but the Sanregrets consider her their doctor.

“Because she is our doctor,” Sanregret said. “She is our medical provider for our entire family.”

That family includes Ashley and her husband, Jon, high schoolers Garrett and Mackenzie, and 2-year-old identical twins Lily and Lila.

“She takes full care of all of us and we trust her,” Sanregret said. “I don’t blink an eye with the care we receive from her and it is really nice to have her here in a small, rural community.”

Williamson feels the same way about Goetz.

“I love Amber, she’s the best,” Williamson said. “I will not take my kids to anyone else but her. I like how she takes care of them and she’s always concerned about their problems. She addresses everything. That’s what I love about her. My whole family sees her.”

Her family includes her husband Jason, 2-month-old son Hunter, 16-month-old twins Jazalynn and Jayden and 14-year-old Caleb.

Home is where the heart is

Providing care in rural areas comes natural for Nyman and Goetz, as they grew up in the areas they now serve.

Nyman grew up in Lake Odessa. After getting her master’s degree as a physician assistant certified from Grand Valley State University in 2004, she reached out to her hometown doctor’s office to see if she could complete her clinical rotation.

“They didn’t know what a PA was 16 years ago when I asked to rotate here,” she said. “Once I came and they could see everything I could do they offered me a position. And I’ve been here ever since.”

Practicing medicine in her hometown is rewarding, she said.

“It was really great to come back here because I do know a lot of patients,” Nyman said. “Family practice is fun because you’re not doing the exact same thing every single day. You’re treating all sorts of different diseases and conditions. You get to do a little bit of everything—you can do sutures, take off moles and do some surgical procedures.”

Nyman works at Spectrum Health Pennock Family Medicine – Lake Odessa. She’s married and has four sons, including 7-year-old twins.

In addition to caring for her own twins, she’s been instrumental in caring for the Sanregret twins, as both Lily and Lila have had some health challenges in their young lives.

Lila had a scare with Kawasaki disease and Lily has reactive airway disease. Both girls have been treated at Spectrum Health Helen DeVos Children’s Hospital, care that Nyman helped coordinate.

Lila and Lily are both doing well. Ashley said she leaned on Nyman during their journey and has been so impressed with her continual care and assistance.

“It matters, in a time of crisis, when you can receive that kind of care when there are so many unknowns,” Sanregret said. “When you’re in a moment and you can’t protect your child but you have to trust your medical provider to give you answers that you need, it’s this relationship of trust and it’s exactly what we have with Erica. We really think of her as an extension of our family.”

Learning on the job

Goetz, a lifelong Greenville-area resident, started her medical career after graduating with a nursing degree from Ferris State University.

She worked 10 years at Spectrum Health United Hospital in Greenville in various departments, the majority in the emergency department.

But she wanted to make a bigger impact and see how her efforts made a long-term difference in patients’ lives.

“I moved on to primary care because in the hospital people came and left and you never really could see if the interventions made helped the person,” she said. “In primary care you can see the positive impact a health care provider can have on the lives of people.

“It is very rewarding,” she said. “I also wanted more of a challenge and I certainly found one. Having to understand all aspects of a person’s care is very rewarding but also very challenging.”

She received her nurse practitioner degree from Maryville University and has been providing primary care at Spectrum Health Belding Family Medicine for four years.

“I enjoy the job,” she said. “I love it.”

“You serve as a doctor, basically,” Goetz said. “You learn a lot every day. And I’m still learning as I go. It’s overwhelming at times, because in primary care with all the specialties out there, people expect you to know everything—and I don’t.”

But she says that’s OK.

“I’m the first one to tell a patient, ‘I don’t know what that is and I’m going to go look it up,’” she said. “I had trouble with that at first, but I find that patients respect and love that about me. I feel like I can be myself with my patients and I think they like that, too, like I’m real.”

It’s the relationships with patients that makes the job rewarding, she said.

“It makes the care so much better when you’re able to know everything about the family—even if it’s what kind of dog they have, or if their mother was sick and died 10 years ago,” she said. “It’s good to have that knowledge to take care of someone appropriately because it might matter, those little things might matter. Even if it doesn’t directly involve them.  I love taking care of whole families.”

In rural Belding, Goetz also treats opioid addiction. She is licensed to provide medication-assisted therapy.

“It’s a nice tool to have in your pocket if a patient needs that service,” she said. “I’ve used it to help people get their kids back or get back to work. It’s a beautiful thing really.”

Goetz said many of her patients have limited finances and can’t get to Grand Rapids for care to see a specialist. Some simply don’t want to travel, she said.

“It’s really challenging to provide care sometimes because people can’t go to Grand Rapids to see specialists, so you have to do the best you can to provide the services they need,” she said.

Local, local, local

In Zeeland, Spectrum Health physician assistant Matt Middleton, PA-C, deals with the same challenge.

“Patients don’t want to go to Grand Rapids to get their health care,” he said. “A lot of them probably haven’t set foot in Grand Rapids. They like their care local.”

Middleton, unlike Goetz and Nyman, isn’t from the area in which he provides care. He grew up near Bay City.

He said he always knew he wanted to treat patients in a rural setting—and he agrees that it’s the relationships with patients that make the job fulfilling.

“It’s pretty rewarding,” he said. “The trust starts to build up and they see you as a partner in their health, not just somebody telling them what to do. The relationships over time mean better medical care.”

Mike Groeneveld is a Zeeland patient who appreciates that relationship with Middleton.

The 70-year-old Vietnam veteran first saw Middleton for his annual, mandated veteran’s physical.

“He gave me a better, more thorough physical than I had in 25 years,” Groeneveld said.

Later, Groeneveld suffered an angina attack.

“He immediately diagnosed that and got me hooked up with Spectrum Health Butterworth Hospital,” he said. “Got me there quick, fast, and in a hurry.”

Middleton earned his physician assistant studies degree from Findlay University in Ohio. He’s worked at Spectrum Health Zeeland Family Medicine for more than four years.

During the pandemic, he said many patients have needed help caring for their mental health.

“We do a lot of psychiatry in primary care,” he said. “Specifically, anxiety has been through the roof. Concerns about the pandemic, about financial concerns, about sending their kids off to school, just the unknown, the election, politics. All of it goes into it.”

Middleton said he values collaborating with doctors in his office, but for most care, his patients are fine seeing him.

“I don’t think any of my patients would rather see a doctor than me,” he said. “I think 95% would probably be fine seeing me for all of their issues. Doctors have more training, are more educated and can handle some complex stuff we can’t handle—that’s why they’re here. If we need to go to them. But I would say at least my patients, they want to see me, because I know them, I know their history.”

Groeneveld said Middleton’s bedside manner sets him apart.

“He has the ability to talk to you, not around you, over you or under you,” he said.

Providers such as Nyman, Goetz and Middleton are filling the gap in more rural areas where providing access to patients is critical, said Jodi Meinke, director of Advanced Practice Provider Services at Spectrum Health.

“They work in communities where they know the people—and that’s their desire,” Meinke said. “That’s what makes the role of an advance practice provider so unique; there is great flexibility in finding the perfect professional fit. They love practicing medicine, but caring for their community is what matters most.”

Advanced practice providers are starting to gain more recognition—and that’s a good thing, Middleton said.

“We’re a benefit to the health care system,” he said. “And I think a lot of companies, organizations and physicians themselves see our value. We know our value. I think (advanced practice providers) are going to be around for a long time.”