Here’s a simple illustration of the urban/rural population divide in North Carolina: The state’s two most-populous counties — Wake and Mecklenburg — are home to about as many people as the total number of residents in the 18 smallest counties. The spread between dense and sparse is growing.
Community leaders and policymakers have noted this gap in myriad ways: income, job opportunities, quality of education, and access to private and public services, among others. Finding health care nearby of any kind, let alone getting the most-sophisticated medical treatments, has gained more attention among rural lawmakers, as reported recently in a series of stories by Carolina Journal’s Dan Way.
Ratios of doctors and dentists to patients are shockingly low. Death rates are higher, and life expectancy and overall health quality often are stunningly lower than what you’ll see near the large population centers. In remote areas, it’s often quicker getting to a trauma center by helicopter than by ambulance.
The acute problem for a few million rural North Carolinians is access to basic medical, dental, and prenatal care. The chronic concern is persuading trained and qualified practitioners to work and live in areas that — aside, perhaps, from natural beauty and a low-key lifestyle — offer fewer amenities and lower incomes than cities, large towns, or suburbs.
The General Assembly may take a stab at part of the problem during the current legislative session with House Bill 999. The measure would offer a financial boost to nurse practitioners and physician assistants who practice in rural areas.
It would move $3 million in recurring General Fund spending to the Department of Health and Human Services’ Office of Rural Health. Of that, $800,000 would go to the N.C. State Loan Repayment Program — a fund run by DHHS forgiving as much as $30,000 in student loan debt to medical providers who make a two-year commitment to work in “underserved” areas.
The $800,000 in HB 999 would go to physician assistants and nurse practitioners, who can diagnose and treat many illnesses and injuries, prescribe most medicines, and — in the case of nurse practitioners — order and review tests.
They don’t have to complete as much training as medical doctors, though nurse practitioners must have years of nursing experience to be certified. They can handle most basic health care for most patients and do so for less than doctors typically charge.
The state’s repayment program is aligned with a 45-year-old federal program which either repays loans or gives scholarships to medical professionals who work in hard-to-staff areas. Even if the nurse practitioners and physicians assistants getting this relief move on after their two-year commitment, they’re easing a health-care crunch. They also may save everyone money, as rural North Carolinians whose “family doc” is only a few miles away may take care of minor health concerns before they become medical emergencies.
The bill orders the Office of Rural Health to formally study where more dentists are needed in rural areas of the state and report to a legislative oversight committee how loan repayment might entice more dentists to move to those places.
HB 999 isn’t the only answer. Lawmakers also should look at letting nurse practioners, physicians assistants, and other “advanced practice providers” — such as certified nurse midwives and dental technicians — operate independent practices without needing a doctor’s or dentist’s supervision. Or at least consider setting up pilot programs in low-income, remote parts of the state.
But it’s a start. In large areas of North Carolina, it couldn’t happen soon enough.
Rick Henderson is editor-in-chief of the Carolina Journal.