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New federal grant money could give residents of rural Western North Carolina better access to medical care.

Western Carolina University recently received the first half of nearly $700,000 in federal grant money to train family nurse practitioners for WNC. The money, and the family nurse practitioner candidates it will support, could help fill an acute need in nearly all the region for primary medical care close to home, especially as WNC continues to be a popular option for retirees, Linda Comer said.

The need is large, not only for WNC but for all of North Carolina, said Comer, interim associate dean of WCU’s College of Health and Human Sciences, which oversees the Family Nurse Practitioner (FNP) program. Nearly all North Carolina counties without major metros are wholly or partially medically underserved, she said. In WNC, Buncombe and Henderson counties are the only two counties that are not.

That means residents of the other 16 WNC counties may drive as far as 70 miles for medical care, she said.

In 2011, Graham County had WNC’s smallest ratio of physicians of all types – three per 10,000 people, according to a study by the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill. Graham County’s ratio was the ninth lowest in North Carolina.

Surprisingly, Mitchell County, population 15,501 in 2010, had the state’s sixth highest ratio of primary care physicians per 10,000 people – 12.3 – ranking it just above Buncombe County, which had the seventh highest ratio at 11.9, according to the Sheps Center.

“This shortage is a trend that threatens to decrease the access to quality health care in our region,” Comer said. “Family nurse practitioners are increasingly needed to fill this gap. There is a need for primary care providers across the country, but the need in rural North Carolina is especially pressing.”

A FNP is a registered nurse with at least one year’s experience who goes back to school to take master’s-level program courses in advanced skills such as diagnosing, prescribing and case management. FNPs can prescribe medicine and, in North Carolina, they have a collaborative relationship with a physician. Unlike a physician’s assistant, a FNP works on his or her own.

In WNC, 90 percent of WCU’s School of Nursing FNP graduates have returned to their home communities since the program’s creation in 1999, Comer said. Their training includes diagnosing and treating maladies that particularly affect rural, often agricultural, populations, such as heat stroke and pesticide inhalation. Farm worker health and accident prevention play large roles in what FNPs address in their clinics every day. If cases are complicated, they consult with their collaborating doctors.

Each year, WCU graduates about 15 students in its FNP program. Reflecting the nursing field in general, 13 out of the 15 students in each graduating class are female, Comer said. Currently there are 42 students in the program, she said.

WCU was one of 65 higher education institutions to receive the grant money from the federal Health Resources and Services Administration, a division of the U.S. Department of Health and Human Services. The grant money will help second- and third-year graduate students who intend to stay in WNC with student loans, tuition, fees, books and reasonable living expenses.

The FNP program is not cheap at WCU. Graduate-level tuition for North Carolina residents is $4,098 and has been proposed to rise by 8 percent, to $4,402 for the 2013-2014 academic year. (If the UNC Board of Governors approves the hike at its February meeting, annual tuition will have risen nearly $1,000 in the three years since the class of 2014 entered the FNP program.) Books alone are expensive, at $850 per semester for FNP candidates, who spend that each of the program’s 11 semesters, Comer said.

The master’s degree program in family nurse practitioner is among the programs of study offered by WCU at its recently opened site at Biltmore Park. The site includes a high-fidelity patient simulation laboratory for nurse anesthesia students and a nursing skills lab featuring a simulated hospital and outpatient-care environment.

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Paul Clark is a contributing reporter for Carolina Public Press. Contact him at

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