Melissa Carter (right), 44, of Salem, treats a two-year-old pediatric patient inside her mobile clinic. The Salem-based nurse practitioner launched To You Pediatrics in December to bring emergent care to families in the Northern Massachusetts and Southern New Hampshire area to avoid costly and inconvenient emergency room visits. Courtesy photo/Rebekah Kay Photography
SALEM, N.H. — When a sick child steps into Melissa Carter's mobile clinic they are met not by the sterile smell of a doctor's office but by books and toys, popsicles and walls decorated with rainbows.
Carter, a Salem-based nurse practitioner, launched To You Pediatrics in December, offering mobile pediatric urgent care to families across northern Massachusetts and southern New Hampshire. Operating out of a customized medical van, she brings care directly to patients' homes, a model she hopes will improve access to care while keeping children out of crowded emergency rooms.
"I really loved the idea of a mobile pediatric clinic where it was a safe and fun space for kids," Carter said. "I thought, instead of going into their space to swab them or do a minor laceration repair, it'd be nice to have a comfortable, neutral space for them to be in."
The van functions as a fully equipped clinic, with medical equipment, an examination table, a privacy curtain, open seating for parents, biohazard waste disposal and a refrigerator stocked with medications, like steroids and antibiotics.
Melissa Carter of Salem, NH., recently opened To You Pediatrics, a mobile doctor's office bringing medical services to the homes of children in the area via a medical van. (TIM JEAN/Staff photo)
Carter, 44, has spent more than a decade working in pediatric medicine. She earned an undergraduate degree in nutrition and worked as a registered dietician at Boston Children's Hospital before returning to school in 2009 for a direct-entry nurse practitioner program. She graduated with a master's degree in nursing in 2012 and returned to Boston Children's Hospital as a nurse practitioner, later overseeing a team of 12 clinicians.
Carter left her full-time leadership role at Boston Children's Hospital in September and remains on a per diem basis while launching To You Pediatrics that officially began taking patients in December.
The idea for a mobile pediatric clinic began taking shape during the COVID-19 pandemic, when Carter and many of her colleagues struggled to balance demanding clinical roles with caring for their own sick children at home.
"My fellow nurse practitioner parent friends and I were losing so much work around COVID," she said. "It was so challenging to balance working with finding appointments for our kids when sick."
She recalled thinking, "Wouldn't it be great if there was someone that came to us?"
While researching mobile medicine models, Carter found a small but growing community in the Boston area largely focused on public health outreach, homelessness and communicable disease response.
"I couldn't find anything pediatric-specific, and I felt like this suburban middle ground wasn't really being served," she said.
She partnered with a North Dakota-based company that builds mobile medical units, often for rural communities and Native American reservations with limited access to care. After months of virtual planning, Carter traveled to North Dakota with her father to train on the van's systems before driving it back to Salem.
To You Pediatrics officially opened on Dec. 8. Carter said demand has steadily increased since then. In her first few weeks, she saw one to two patients a day. More recently, she has averaged three to four daily visits and, during a surge in respiratory illnesses, she treated as many as six children in a single day.
Weekends have been the busiest, as families seek alternatives to urgent care centers and emergency rooms, particularly parents with multiple children who find it difficult to leave the house with everyone in tow when one child gets sick, Carter said.
One of her most recent visits came during this past weekend's snowstorm, when a family called late at night with concerns about their 5-month-old. Carter drove out to evaluate the infant, offering reassurance and helping the family avoid a trip to the emergency room.
"I really missed seeing patients," she said. "That's been the best part, seeing the kids again. They're the best patients. They still want to play, they still want a sticker, they still want to interact even if they're not feeling 100%."
Carter treats many of the same conditions families might seek care for at urgent care centers, including flu- and COVID-like illnesses, ear infections and minor injuries. She offers point-of-care testing for respiratory illnesses and strep throat, nebulizer treatments, steroids administration, splinting for minor orthopedic injuries and surgical glue applications for small cuts.
She does not offer stitches, vaccinations or routine pediatric visits and emphasized that she does not want to replace primary care providers.
"I really want to partner with pediatricians and general pediatricians," Carter said. "I don't want to take too much business away from them. There's something to be said about (families) having a pediatrician they have a good relationship with.
"But for sick visits when you can't get in, instead of going to a more adult-based urgent care, that's what I'm there for."
The service is cash-based, with most visits priced at $150, which Carter said is comparable to an urgent care copay. She also accepts HSA and FSA cards, but does not bill insurance, noting that reimbursement for at-home pediatric urgent care does not yet exist.
Carter serves families within a 30-minute drive of Salem, including communities like Haverhill, Methuen, North Andover and parts of southern New Hampshire. She hopes to eventually hire additional nurse practitioners and expand the model to include more than one van.
Carter and her husband both grew up in Salem, where they are raising their two young sons. Staying rooted in the community was a major motivation behind launching the service.
"This is kind of what doctors used to do back in the day," she said. "If it can be convenient and provide care at home to families in this area, it might make it a little easier for them. That's the goal."