There’s a lot happening at the North Carolina General Assembly when it comes to health care improvements. Lawmakers are pushing forward bills like HB 434, which aims to fix the slow prior-authorization process, SB 316, which strengthens price transparency rules, and SB 315, focusing on emergency service improvements.
However, while these bills are crucial, there’s one more major issue that continues to be overlooked — fixing the primary care system.
NC’s Primary Care Problem: Hard to Get Appointments, Long Waiting Times
If you’ve tried booking a primary-care appointment in North Carolina recently, you probably faced the same issue many residents do — long waits and difficulty finding doctors who accept new patients. Even when you do find a clinic, it might take weeks or months before you can actually see a doctor.
This isn’t surprising, considering North Carolina ranks 33rd in the US for primary-care physician availability. According to the US Department of Health and Human Services, 92 out of 100 counties in NC are marked as Health Professional Shortage Areas (HPSAs). Simply put, there are more than 3,500 patients for every primary-care provider in these areas.
But it’s not just North Carolina facing this challenge. Across the United States, primary care is in trouble.
How the US Lags in Primary Care Compared to Other Countries
A 2024 study by the Commonwealth Fund looked at 10 developed nations, and the US performed poorly. Americans are the least likely to have a regular primary-care provider. Even simple services like home visits are rare — only 29% of US primary-care providers offer home visits, compared to at least 90% in half of the other countries studied.
The situation is similar when it comes to after-hours care and telehealth services. While industries like food delivery and online meetings have made life more convenient, the health care sector has yet to catch up.
Why Primary Care Is So Important
Primary care plays a critical role in keeping health care affordable and accessible. It acts as the first point of contact for patients. When people don’t have access to primary care, they often turn to expensive services like emergency rooms, ambulances, and specialist visits — even for non-urgent problems.
This not only drives up the cost for everyone but also stretches valuable health resources thin. The increased usage leads to higher insurance premiums, bigger copays, and more tax burdens for all of us.
What Can North Carolina Do to Fix Its Primary Care System?
Here are some simple yet effective ways North Carolina can tackle its primary care crisis:
1. Boosting Telehealth Services
Currently, North Carolina scores low when it comes to providing telehealth options. According to a study by the Cicero Institute, the state received a failing grade in telehealth availability.
By expanding telehealth services, patients can receive consultations without physically visiting clinics, especially for basic health issues. It will reduce unnecessary trips to emergency rooms and help people access timely care, improving the efficiency of the entire system.
2. Expanding Nurse Practitioner Authority
Advanced-practice nurses, such as nurse practitioners, are already providing essential primary care services. However, North Carolina requires them to be supervised by physicians, even if this oversight is minimal or remote. Many other states have removed this restriction without facing any issues.
Granting more autonomy to nurse practitioners can immediately ease the burden on the primary care system by increasing the number of qualified providers.
3. Joining the Interstate Medical Licensure Compact
North Carolina has yet to join the Interstate Medical Licensure Compact, which allows licensed providers from other participating states to practice freely across state lines. Senate Bill 324 proposed joining this compact but failed.
By removing barriers for out-of-state doctors to work in NC, we could attract more providers, helping fill the shortage gap faster.
4. Encouraging Medical Schools to Focus on Primary Care
One success story comes from the Brody School of Medicine at East Carolina University. Around 53% of their graduates become primary-care providers, thanks to their focus on serving the state’s health needs.
If other schools in the UNC System follow suit and prioritize primary care in their curriculum, it could gradually increase the number of doctors available in rural and underserved communities.
5. Promoting Direct Primary Care (DPC)
Direct Primary Care (DPC) is a subscription-based model where patients pay a monthly fee and receive unlimited access to basic health services without extra bills or copays.
DPC practices typically see fewer patients per day (around six) compared to traditional clinics that see 20-25 patients daily. This reduces paperwork, minimizes burnout, and allows doctors to spend more time with each patient.
The Primary Care Enhancement Act of 2025, a bipartisan bill, aims to expand the use of DPC by ensuring it’s not treated as insurance, allowing patients to pay for it through Health Savings Accounts (HSAs).
In 2020, NC passed a similar law at the state level, but matching federal laws could broaden its impact further.
Conclusion: Prioritizing Primary Care = Affordable, Accessible Health Care
Improving North Carolina’s health care system isn’t just about new laws and policies — it’s about making primary care accessible to every resident. Solutions like telehealth expansion, empowering nurse practitioners, joining the medical licensure compact, and encouraging DPC models can relieve the pressure.
If lawmakers focus their efforts on fixing primary care now, they can prevent larger health care issues down the road and ensure North Carolinians get the quality care they deserve.
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