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Expanding Access to Medical Care in Rural North Carolina


February 1, 2018
By Brian Balfour
Civitas Institute


  • Far too many rural North Carolinians lack adequate access to medical care
  • Physician shortages in rural counties is a primary cause
  • Eliminating restrictions on Advanced Practice Registered Nurses would go a long way toward alleviating the problem.

Most observers would readily agree that two major issues confronting health care in North Carolina are the rising cost of coverage and care and the limited access to care facing most of our rural populations.

But what if there was a simple way to address both of those problems, basic legislation that has already proved to be effective in more than a dozen states?

The Problem

Rural North Carolina counties face a significant doctor shortage. Access to care for our state’s rural population has become so acute that a new legislative study committee was formed to develop policies to address the issue. The Committee on Access to Healthcare in Rural North Carolina held its first meeting in January. Legislators heard testimony from health and economic experts about the problems facing healthcare in rural parts of the state.

As reported in North Carolina Health News, the experts informed legislators that “Rural areas have a shortage of almost every type of provider. In North Carolina, 20 counties do not have a pediatrician; 26 counties do not have an OB-GYN; and 32 are without a psychiatrist, according to the interactive North Carolina Health Professions Data System.”

Some of the alarming statistics discussed at the committee meeting included:

  • Nationally, only 11 percent of physicians choose to practice in rural areas
  • 70 of 80 rural counties in NC are currently designated “medical deserts” for their lack of primary care availability
  • 79 North Carolina counties are designated as “primary care health professional shortage areas”
  • A decade later, only 3 percent of North Carolina medical school grads from the class of 2008 are currently providing primary care in rural areas

Expanding Nursing Scope of Practice

Like many professional restrictions and licensing practices, limiting the scope of practice for nurses harms consumers, drives up prices and is designed to benefit specific incumbent professionals. Current North Carolina law restricts the scope of care that registered nurse practitioners, advanced practice registered nurses, and physician assistants can provide, while also requiring a certain level of supervision by a licensed physician.

With so few licensed physicians choosing to practice in rural areas, laws restricting the ability of highly-trained medical care providers to provide much-needed care are devastating to rural populations.

“Our nurses are our best source of practitioners in our rural areas,” Senator Ralph Hise (R-Mitchell) said in a 2016 Joint Health and Human Services Oversight Committee meeting examining a bill to loosen regulations on registered nurses. “You want the most likelihood of someone practicing in a rural area? It’s someone who attends a community college in a nursing program and even goes on to higher degrees that is most likely to serve in a rural area.”

Why maintain a decades-old restriction on nursing scope of care, when freeing them to perform many of the basic evaluation and treatment functions — currently limited to physicians — would drastically improve rural populations’ access to health care?

Those favoring the status quo may invariably bring up safety concerns, but those are misguided at best. Advanced Practice Registered Nurses (APRNs) are highly-trained professionals that require masters-level education. As North Carolina Nurses Association President Mary Graff argued, “Nursing is the most trusted profession in the country, but opponents to this bill imply that nurses can’t be trusted to practice to the full scope of their training and education. That simply doesn’t add up.”

Go here to read the entire article on the Civitas Institute’s website.