RALEIGH, N.C. – A hospital in Rockingham County is recruiting nurse practitioners to fill in health-care gaps created by a rural doctor shortage.

When a hospital in Eden, a region with a population of around 15,000, had trouble finding a replacement for a recently retired orthopedic surgeon, Tom Bush got a call at the University of North Carolina School of Medicine.

Bush, an associate professor in UNC's Department of Orthopedic Surgery, directs one of the few orthopedic nurse-practitioner fellowship programs in the country, and is an advocate for nurse practitioners providing much-needed health care in rural parts of the state.

"With the aging population and a shortage of primary-care providers, there needs to be an effort to help provide musculoskeletal care, particularly in rural communities," Bush said, "and that's what we've done with the Orthopedic Advanced Practice Provider fellowship at UNC."

Nurse practitioners are increasingly providing primary-care services. According to the Sheps Center for Health Services Research, between 1990 and 2013, the nurse-practitioner workforce jumped by almost 500%, compared with 42% growth in the physician workforce.

A bill introduced earlier this year, known as the SAVE Act, would increase the ability of advanced-practice registered nurses - such as nurse practitioners - to practice with autonomy.

A few days a week, Terra Beek, a family nurse practitioner who specializes in orthopedics, travels to see patients at the hospital in Eden. Beek said she enjoys practicing in a close-knit community.

"But you also learn how to be very resourceful as a provider, and as a new provider, that's been a learning process," she said. "But also, these are the kind of patients that don't have great access to health care, and so they might have had something ongoing - for months and months and months - and not able to get care that they need."

From her experience, Beek said, she believes patients just want a qualified and knowledgeable professional with whom to discuss their health issues.

"Sometimes you get the odd comment, 'Well, are you the doctor?' And it's not so much of a derogatory kind of thing, but as maybe, you know they're not aware that there are so many different kinds of providers these days," she said. "They want someone who is going to help them, and so they just care that someone's qualified."

It's not just rural areas innovating ways to maintain access to health care. With the medical demands of an aging population, the country could face a shortage of more than 100,000 doctors by 2030, according to projections by the Association of American Medical Colleges.


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Health disparities in Texas are not only making some people sick, but affecting the state's economy.

A new study shows Texas is losing $7 billion a year because it does not adequately address quality-of-life issues and the health care needs of its lower-income residents.

The research was sponsored by the Episcopal Health Foundation, Methodist Healthcare Ministries of South Texas, and St. David's Foundation.

Brian Sasser, chief communications officer for the Episcopal Health Foundation, said health care includes more than doctors' visits and medication.

"Everything from increasing access to affordable health insurance to investing in under-resourced neighborhoods to give them more options, whether that's exercise options or food options," Sasser outlined. "Look at policy changes that expand health insurance coverage for new moms."

The report breaks down the economic costs of preventable health differences for every Texas county. It found Bexar, Dallas, Harris, Tarrant and Travis counties are losing the most money annually because of health disparities.

The amount of the economic impact depends on the racial and ethnic makeup of the county and the size of its working-age population. Sasser added the report shows Black and Hispanic children are more likely to grow up in neighborhoods with high poverty levels, and higher rates of diabetes and obesity.

"What can we do to work to make sure that the rate of diabetes isn't dramatically different between white households and Black households?" Sasser asked. "That we can make sure the food insecurity isn't dramatically different between someone who makes over $100,000 and someone who makes less than $30,000?"

The Texas Legislature has passed laws to address some of the disparities, including House Bill 12. It extends Medicaid health coverage for 12 months for new mothers, and pays for maternal health services for community health workers and doulas.

There is light at the end of the tunnel for Tennesseans struggling with opioid addiction, as a bill has been passed to increase access to treatment for opioid use disorder at Community Health Centers.

More than 3,800 lives were lost to overdose in the state in 2021, according to the Tennessee Department of Health.

Emily Waitt, policy and advocacy manager for the Tennessee Primary Care Association, said the original bill limited the number of patients nurse practitioners and physician assistants could treat with buprenorphine. The update removes the limitations, allowing more Tennesseans to access medication assisted treatment in their communities.

"It allows NPs and PAs to prescribe to 100 patients at a time, versus 50," Waitt explained. "Basically doubling the number of patients that they can prescribe to."

Community Health Centers serve more than 423,000 patients across Tennessee, regardless of their insurance status or ability to pay. About 7.7% of Tennesseans do not have health insurance.

Libby Thurman, CEO of the Tennessee Primary Care Association, said bringing the treatment to rural health centers expands access to a crucial service for patients who otherwise could not afford it. She noted it is important because people in remote areas often face challenges finding specialists and treatment facilities.

"We really wanted to work on this issue, because we know our Community Health Centers are where patients go for care," Thurman emphasized. "We really believe in an integrated model. So we want to treat the whole person, including if they are struggling with an addiction issue or a substance abuse disorder issue."

Health Centers offer behavioral health care, including counseling, along with treatment. The clinics also focus on creating a supportive network to help patients with family resources, job assistance and community connections.

While Black Maternal Health Week is wrapping up, health disparities for pregnant Black women continues to be an issue.

From April 11-17 this year, the high death rate of Black mothers is in the spotlight. Black women are three times more likely to die from pregnancy-related causes than their white counterparts.

Dr. Patricia Egwuatu, a family practice physician at Kaiser Permanente in Seattle, said racism is at the root of the disparities, which create barriers to health care access. She pointed out lack of access can lead to problems during pregnancy that are preventable or treatable.

"They may exist prior to pregnancy and then it gets worse during pregnancy if it's not managed as part of that maternity care," Egwuatu emphasized. "There are more pregnant women that have chronic conditions such as hypertension, diabetes and heart disease that are amplified during pregnancy."

The White House released a proclamation recognizing Black Maternal Health Week. The Biden administration began recognizing the week in 2021.

Egwuatu noted there are some warning signs any pregnant woman should be aware of and check in with their physician if they develop.

"You might get some changes in your vision that is not your normal. So, like, fuzziness, you can't see as well, or an excruciating headache," Egwuatu outlined. "You could also develop new swelling in your lower extremities that's making it difficult to get around or even new shortness of breath."

Egwuatu stressed physicians also need to recognize the role of racism in medicine. She argued continuous medical education is important for learning how to confront biases, and it is important for doctors to understand how they can provide people with resources.

"Asking the questions about personal barriers," Egwuatu suggested. "Does a patient have issues with getting to work, child care, transportation? What's their education, what's their cultural background and language? And do they even have a cell phone so we can connect with them?"