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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Farmworkers in South Carolina and across the U.S. face scorching heat with little protection at the federal and state level. However, the Farm Labor Organizing Committee is taking steps to enhance worker safety.

The group is ramping up heat protection guidelines for migrant workers in the South through an existing rule. Originally negotiated in 2006 with the North Carolina Growers Association, the rule aimed to address heat-related incidents. Now, it is being strengthened to improve conditions for more than 9,000 farmworkers.

Baldemar Velasquez, president of the committee, believes the efforts are key in safeguarding workers where legal measures do not.

"The problem with legislation, whether it's the federal or state, it takes forever," Velasquez asserted. "Enforcement is always an issue because we're not talking about big factories with a lot of workers. We're talking very remote labor camps, isolated, and so it's important that workers know how to take action on their own."

He noted under the new guidelines, workers who are a part of their union take heat safety into their own hands. The rules say if it is getting close to 85 degrees and workers have symptoms such as dizziness or nausea, they should take a break in the shade and drink water, no matter what the boss said. When it hits 95 degrees or more, breaks are supposed to happen every couple of hours.

According to the Centers for Disease Control and Prevention, 67 people died from heat-related deaths from 2016 through 2020 in South Carolina.

Mario Vargas, lead organizing development coordinator at the Campaign for Migrant Worker Justice, shared his 15 years of firsthand experience. He vividly depicted the challenges faced by workers, such as tall crops blocking the wind and constant pressure from employers.

Recognizing the urgent need for change, Vargas and his organization are teaming up with the committee to go beyond guidelines. They are prioritizing education.

"Because if you say, 'Oh, we got another 100 feet to go so we can finish the row,' you might not make it to the end of the row," Vargas pointed out. "You need to stop and find some shade and drink some water. We let them know their rights, that they have a right."

The group will be teaching farmworkers about the new guidelines, signs of heat stress, how to stay hydrated and when to seek medical help. Vargas added they will also have support channels to report issues or pushback to ensure their well-being is not compromised.

Last week, Walmart became the latest major retailer to retreat from providing direct health-care service by announcing closures of all its health clinics and virtual health-care operations.

However, Florida's health centers say they are ready to fill the gap.

Florida is home to most of the soon-to-be-shuttered health centers - 23 of the 51 centers are now winding down operations in the Sunshine State, where they offer various services, including medical, dental, and behavioral health care.

Benjamin Browning - vice president and COO of the Florida Association of Community Health Centers - said many have tried to figure out the complexities of delivering health-care services, which doesn't always work.

He said the current concern is ensuring displaced patients, often in rural underserved areas, can still access care.

"Fortunately," said Browning, "the community health centers are positioned throughout the state to be able to welcome those patients, to encourage those patients to come and visit and receive their primary-care services."

In a statement, Walmart cited the challenging health-care reimbursement landscape and rising operating costs as reasons for the closures.

Additionally, Walgreens is closing 160 VillageMD clinics, Amazon is cutting jobs at One Medical and Amazon Pharmacy, and CVS Health plans to shutter dozens of pharmacies in Target stores.

Browning said their model of providing care is embedded in their name - building community.

When a patient enters their facility, they might also be connected to additional services. He said the model is financially challenging, but they've been working to perfect it.

"There is a level of streamlining," said Browning. "There is a level of efficiency that is maximized to the extent possible, within the health centers to provide for those patients that can and cannot afford to pay the full bill."

Walmart expects the closures to occur within three months and will now focus its health business on its nearly 4,600 pharmacies and more than 3,000 vision centers across the United States.

Community Health Centers are in all of Florida's 67 counties, serving patients in more than 800 locations - including dozens of mobile units and school-based sites statewide.

Michigan farmers are responding to the new Avian Flu "Extraordinary Emergency" order from MDARD, Michigan's Department of Agriculture and Rural Development.

New safety guidelines must be in place by this Wednesday that affect all dairy and poultry operations in the state.

The guidelines include the designation of a biosecurity manager, establishing a perimeter that limits access to livestock, and implementing cleaning and disinfection procedures at those access points.

Chief Medical Executive for the state of Michigan, Dr. Natasha Bagdasarian, said the most severe cases of the Bird Flu seem to be in poultry.

"Poultry don't recover well from this virus," said Bagdasarian. "This is a highly pathogenic virus in poultry and the dairy cows do tend to recover, even though their milk production is slowed down."

M-DARD first detected Avian Flu in Michigan dairy cattle on March 29 of this year. The disease has since been detected in more dairy herds and commercial poultry flocks in 7 counties.

The emergency guidelines also include farms maintaining a record of vehicles and people who cross access points.

Regarding the health risks for humans, Bagdasarian said there is some positive news amidst the crisis.

"We had a number of workers who had been exposed, but very few have been symptomatic," said Bagdasarian. "And no one who has been symptomatic and tested for the virus, had tested positive. So, that's really good news. "

The Food and Drug Administation continues to advise against drinking raw milk and recommends that the dairy industry does not manufacture or sell raw milk or raw milk products.



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