North Carolina does not have a statewide physician shortage. But action is needed to target state funds to specialties and communities with shortages

North Carolina has enough doctors to meet the needs of the state’s population but the doctors aren’t distributed well. Policy action is needed to encourage doctors to practice in the specialties and communities where they are most needed according to a brief published on August 27, 2015 by researchers at the Cecil G. Sheps Center for Health Services Research.

The brief, written by Erin P. Fraher, PhD and Julie C. Spero, MSPH ,shows that NC’s physician supply has increased steadily and now slightly exceeds the national average. However, 14 counties have experienced a persistent shortage of primary care physicians since 2004, and some areas have experienced a shortage for decades.

Tyrrell and Camden counties have no physicians, and almost one-quarter of NC counties do not have a general surgeon, meaning primary care doctors in those areas do not have surgical backup to deliver babies, emergency rooms cannot take trauma cases, and complicated screening procedures such as colonoscopies are less likely to be done locally. Psychiatrists are absent from many part of the state and half of NC counties qualify as mental health professional shortage areas.

“Expanding the state’s medical school enrollment alone is unlikely to improve the distribution of physicians in underserved communities or in needed specialties because only 3% of medical students go onto practice in rural primary care,” said Fraher.

The report highlights other, more cost-effective strategies that could be used to encourage physicians to practice in areas of high need. These include rotations in rural and underserved areas during medical school, expanding community-based residency programs, and supporting loan repayment programs for physicians who practice in needed specialties and in underserved areas of the state. The researchers suggest enacting legislation that increases the accountability and transparency of public funds spent on medical training to make sure funds are targeted toward areas and specialties facing the biggest shortages. They also suggest that support for programs which provide consulting and expertise to physicians in rural areas, such as those run by the NC Medical Society and AHEC, will encourage residents and physicians to stay in rural areas by providing the support they need to navigate the changing healthcare system.

Dr. Warren Newton, a family physician and Director of the North Carolina AHEC Program, noted that “these data demonstrate that there is great need in rural and underserved communities across North Carolina. Along with other policy changes, establishing community-based residencies in needed specialties can make a big difference for the future. This would provide needed care in underserved communities and stimulate economic development in the near term.”

Fraher and Spero note that the state’s health care needs will not just be met by physicians, but a broader team of health professionals. Between 1990 and 2013, the nurse practitioner (NP) and Physician Assistant (PA) workforce increased by 498% and 284% respectively, compared to a 42% cumulative growth rate for physicians. NPs and PAs, along with pharmacists, nurses, social workers, and others are taking on new roles in the health care system.