The United States averages 68 primary-care physicians for every 100,000 residents in rural areas, compared with 84 per 100,000 urban residents, according to the American Academy of Family Physicians. (Adobe Stock)



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.