By Rose Hoban
When it comes to health care, one of the biggest problems faced by rural residents often is finding a doctor, dentists or other practitioner near home.
A bill unveiled in the waning days of the annual legislative work session seeks to find ways to incentivize more medical providers to settle – and stay – in rural North Carolina.
“If individuals practice, or learn or are educated in rural areas, they tend to stay in rural areas,” Rep. Greg Murphy (R-Greenville) told his fellow lawmakers this week as he moved a bill that will study what it takes to get and keep health care providers in rural burgs.
Lawmakers spent last winter on two different committees which were dedicated to examining health care workforce issues throughout North Carolina. One of those committees sought ideas on the best ways to improve health care access in rural parts of the state, the other, headed by Murphy, looked at how to help induce physicians to practice in rural areas.
One way to do that is to create more training opportunities in rural areas themselves. To that end, the bill orders the Department of Health and Human Services to identify which rural hospitals could become teaching facilities and figure out what they’d need to become successful.
“Take Ahoskie, for example, it is a very rural hospital, has a 120 bed system,” said Murphy. “It’s putting family practitioners, family practice residents to rotate out in those areas, it’s possible to put internal medicine residents there … just a rotational thing.”
But making the conversion to instruction is no easy task, said Southeastern Health CEO Joann Anderson. Her Lumberton-based hospital partnered with Campbell University to start a medical residency program which will graduate its first students this month. Four of the primary care residents signed up to stay in Lumberton, another two will move to rural Western North Carolina. The program has also recruited education slots for family doctors and emergency medicine.
“This year, we had six slots for emergency medicine, we had more than 600 applicants,” she told lawmakers this March when the rural health care access committee visited Columbus County.
But to do this is expensive. Anderson described the dollars spent on startup costs, enhanced salaries to attract faculty and students, and equipment.
“It was a little over $11 million for this year,” Anderson said. “The cost of that was the salaries for each of the residents, faculty costs, the location, the space that we had to provide for them, all the equipment they had to have. For example, we had to buy three ultrasound machines for them to use. Each costs thousands of dollars.”
The bill also instructs DHHS to rejigger its North Carolina State Loan Repayment Program to help people practicing in rural areas shed their debt, with an eye toward recruiting new providers to small towns and getting them to stay there.
Dentist credentialing gets nod
And, at the last minute, lawmakers inserted a provision to make it easier for dentists from the neighboring states of Virginia, Tennessee, Georgia and South Carolina to become licensed in North Carolina.
In the past, dentists from other states have had to jump through multiple hoops to obtain a license to practice here. Until now, North Carolina has only accepted dentists who have passed a credentialing exam that’s accepted in only seven other places: Alabama, Louisiana, Puerto Rico, the US Virgin Islands, West Virginia, Arkansas and Utah. Dentists from states other than those have had to submit to a recredentialing process that can take months and cost thousands of dollars.
In some quarters, this has been seen as a block to getting more dentists into North Carolina, which has historically had fewer dentists per capita than most other states. Three counties in the state have no dentist and the state consistently ranks 47th among the 50 states in terms of dentist-to-population ratio.
“That certainly may have an impact on addressing the dental workforce capacity in counties adjoining the neighbor states, particularly in our more rural counties,” wrote Lewis Lampiris, who trains students in community dentistry at UNC-Chapel Hill’s dental school.
Lampiris noted another important change, namely loosening restrictions on dentists who receive these licenses “by credential.” Currently, dentists licensed by credential have to choose only North Carolina as a location for practice; this has limited the ability for dentists in towns along North Carolina borders to open up a satellite office across state lines.
The bill removes that restriction.
The Senate passed the bill with little debate. But Sen. Erica Smith (D-Jackson) said the bill falls short in one important way.
“The elephant in the room and in this bill is the lack of opportunity to study Medicaid expansion,” Smith said.
“How do you improve rural health care?” she asked. “You expand [Medicaid].”
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