GREENSBORO, N.C. - Local health departments that rely heavily on Advanced Practice Registered Nurses say the costly contract requirement that they be supervised by a physician are draining already scarce resources and affecting North Carolina's most vulnerable populations.

By law, APRNs must must work under doctor supervision, have a collaborative practice agreement, and meet once every six months with their supervising physician.

Health Director at Guilford County Public Health Department Dr. Iulia Vann said her large APRN staff spans the fields of maternal health, primary care, family planning, and HIV and Sexually Transmitted Disease prevention and care.

"And all of these team members, they have to have a supervising physician," said Vann, "based on the requirements from the Board of Nursing in order for them to stay licensed and certified."

The SAVE Act, introduced in North Carolina this year, would remove supervision requirements statewide. But physician groups like the American Medical Association maintain patients are better served by an integrated care team led by a physician.

Vann noted her department shells out tens of thousands of dollars for supervision contracts.

"Our role in the community, and our services for the community are really nurse-driven," said Vann. "And we do not have the resources to include some of these collaborations all the time."

At the Craven County Public Health Department, Health Director Scott Harrelson said physician oversight costs his department around $91,000 a year. He explained that they rely mostly on primary-care physicians to help keep contract costs low.

"They can go from pediatrics and adult primary care, so you could see some maybe potential savings of just doing one contract for the whole shebang," said Harrelson, "especially if you're a smaller health department that doesn't have a whole lot of volume coming through on your primary care."

One 2018 study of rural health clinics in the Southeast found loosening supervision requirements for nurse practitioners improves the numbers of providers, healthcare access and quality of care in rural regions.

October is Breast Cancer Awareness Month and health professionals are urging women to get screened at earlier ages than previously suggested.

After skin cancer, breast cancer is the most diagnosed form of cancer for women in the U.S.

Dr. Anne Gayman, a family medicine physician at Kaiser Permanente in Seattle, said there has been an increase in breast cancer rates in women in the 40- to 50-year age range. She noted previous recommendations called for women to speak with their health care provider after age 40 about when to start screening.

"These new recommendations from the United States Preventative Services Task Force state that all women should begin screening now at age 40, and repeat screening every other year through age 74," Gayman explained.

About one in eight women will develop breast cancer in their lifetime, according to the American Cancer Society, which also said breast cancer rates in Washington state are higher than the national average and screening rates are lower. The state has the ninth-highest cancer rate in the country, and the 10th-lowest screening rate.

Gayman said it is unclear what is driving up the numbers for younger women.

"We don't know, but we know that younger women can get often quite aggressive forms of cancer," Gayman pointed out. "These new recommendations help us to get more young women having regular screenings, which can help to intervene earlier."

Gayman emphasized there are new treatments to target breast cancer and more research is being done because some forms are still hard to treat and acknowledged some big improvements in breast cancer survival rates.

"A lot of that is thought to be due to the increased rates of screening, because the earlier we catch breast cancer the more treatable it is, right?" Gayman added. "If we can catch it before it's moved outside of the breast, your prognosis is much better."

A community health center in East Tennessee is offering essential medical services on wheels, to families cleaning up after Hurricane Helene.

Cherokee Health Systems in Knoxville has sent out its mobile clinic, equipped with exam rooms, a lab and telemedicine capabilities.

Dr. Parinda Khatri, CEO of Cherokee Health Systems, said it has been stationed at places like community parks, gas stations and church parking lots, to provide comprehensive first aid and health care, along with mental health support.

"This week, we are focused on the community center, and we're offering medical care, behavioral health via telemedicine," Khatri outlined. "Because people are experiencing quite a bit of trauma. So, we are giving hepatitis A vaccinations, because of the risk with the contaminated water, and also tetanus shots."

Gov. Bill Lee recently announced a $100 million Helene Emergency Assistance Loans Program to help Tennesseans in counties affected by the hurricane. HEAL funds will be used to repair water and wastewater systems and remove dangerous debris.

Khatri emphasized her pharmacy's involvement is crucial due to people's ongoing needs for medications. The mobile medical clinic is also addressing basic care needs, distributing items like baby formula, diapers and blankets. She added the mobile clinic prioritizes providing care regardless of cost and has not turned anyone away due to financial reasons.

"We have been giving out water, a tremendous amount of water," Khatri observed. "We've been giving out personal hygiene kits, emergency medical kits, wound care supplies, because people have come in with injuries. We are giving all of those resources that, you know, the medical supplies that they need."

She noted the community has never experienced such widespread destruction and it is unclear how long the recovery will take. The psychological effects of the disaster are significant, as people recount being rescued from their homes and losing contact with loved ones. The trauma of rebuilding and the financial, emotional and physical strains will likely have lasting impacts.


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Following Hurricane Helene, Hurricane Milton left a trail of destruction across the Sunshine State and the combination has pushed some Community Health Centers to their limits.

While some were spared from structural damage, other clinics were not so fortunate. The Florida Association of Community Health Centers represents 54 health centers across the state that see patients regardless of their ability to pay.

Jonathan Chapman, CEO of the association, said more than 30 service locations have been significantly damaged by the storms, which has prompted deep concerns about the health center network.

"I talked to a health center just a few minutes ago," Chapman recounted. "They just went on one of their sites this morning, only to find out that all the windows were smashed in from the storm; the rain, the wind caused damage."

He noted closing the six centers in the immediate Tampa area would mean at least $1.6 million a day in lost revenue. While national disaster agencies are offering assistance with mobile units and temporary locations, Chapman emphasized the available funding falls short of covering operational costs, especially as many centers had already depleted their reserves from Hurricane Helene.

Chapman added he has been frustrated with the federal response, particularly the lack of immediate financial relief for operational costs. However, he pointed out the clinics are doing their best to remain fully operational where possible, using whatever resources they can get.

"We're looking at smaller grants, maybe $10,000 or $15,000, from here and there," Chapman explained. "If we're looking at $1.5 million to $2 million a day, as good as that sounds, that's barely scratching the surface."

Chapman added in some cases, federal funding, including FEMA aid, will not be accessible for months. In Congress, House Speaker Mike Johnson faces pressure to reconvene lawmakers to pass more FEMA funding for recovery, but Johnson insists funding is not the issue, pointing to the $20 billion Congress previously allocated to FEMA.