If you live in North Carolina, you know just how rural some parts of the state are. Take a drive to the mountains or the coast, and you’ll pass by miles of farmland with small towns dotted in between. While these locations are beautiful, they can present a challenge for the people who live there when they seek medical care.
Of the state’s 100 counties, 20 have few primary care physicians and three counties have none, according to the North Carolina Health Professions Data System. People may have to travel many miles to reach the nearest primary care physician and possibly across the state to find a specialist.
“If you don’t have a car, or a neighbor with a car, there is no public transportation in those areas to get you to your appointment,” says Mary Beth McGranaghan, PhD, PA-C, who served as a physician assistant in communities throughout North Carolina for 21 years. Dr. McGranaghan is an associate professor for the Physician Assistant Studies program at UNC Chapel Hill and sees patients through an organization that provides in-home treatment.
For people in rural areas, travel to and from a doctor’s appointment often means taking time off work and making child care arrangements. Some patients struggle financially as well.
“I’ve had patients come in and say, ‘Here are all the medicines you want me to take,’” Dr. McGranaghan says. “‘Pick three because that’s all I can afford.’”
These hardships related to cost and access affect North Carolinians across the state, but they often present themselves differently in rural and urban settings.
Creating More Locations for Care in Rural North Carolina
UNC is working to improve access to care by partnering with affiliate hospitals and hospital systems across the state. The UNC Health Care System includes more than 10 hospitals and hospital systems and nearly 3,000 providers. While many specialists are concentrated in more urban areas, like the Triangle, hundreds of providers are based in rural counties, providing primary and specialty care in those communities.
These providers can use the resources and expertise located in the Triangle to benefit their patients. For example, the UNC Cancer Network connects cancer doctors across the state to researchers based at the UNC Lineberger Comprehensive Cancer Center in Chapel Hill. At UNC Lineberger, one of only 70 National Cancer Institute-designated comprehensive cancer centers in 36 states, patients have access to clinical trials and cutting-edge treatments not available locally. In some cases, patients can seek treatment closer to home at
Training Doctors for Rural Areas
Another part of serving rural areas is training doctors with a passion for these populations. The School of Medicine is working to attract students from North Carolina who will be more likely to practice in the state once they graduate.
The Fully Integrated Readiness for Service Training (FIRST) program is a three-year medical school curriculum to fast-track students into the UNC Family Medicine Residency Program, which they will follow with three years of service in the state.
Training local health providers is also a main focus of the Physician Assistant Studies program, which culminates in a master’s degree, Dr. McGranaghan says. A physician assistant works in collaboration with a licensed physician and can diagnose and treat illnesses and prescribe medications.
“By attracting people from rural counties to become health care providers, we have a higher chance of getting them to go back to practice in their areas,” Dr. McGranaghan says.
Using Technology to Close the Distance
In addition to adding providers in rural areas, UNC Health Care is using technology to reach patients in their homes. UNC Urgent Care 24/7 is a virtual care service launched in April to provide easier access to physicians by phone, tablet or computer for nonemergency medical issues such as allergies, fever, nausea and sore throat.
The service costs $49 or less per visit, depending on insurance. Patients with true emergencies, including chest pain, should still go to a hospital emergency department, or dial 911.