‘The Dr. is out?’

July 25, 2013

Ashe County’s “provider gap” — the number of practicing health care providers in a community versus its population — is widening.

According to the most recent data from, Ashe County had a primary care physician to population ratio of 1,950 to one in 2011-12, a provider gap roughly 20 percent wider then the previous year.

Based on these figures, there were 14 primary care physicians serving the county’s population of 27,143 in 2011-12. Over the past two years, three physicians have ceased practice in Ashe, and have yet to be replaced, according to a local health care provider.

The county’s dentist to population ratio for 2011-12 was 4,612 to one.

Ashe Memorial Hospital, soon to be managed by Novant Health, is aware of the need for physicians in Ashe County, and the new management is making recruitment a priority, according to Ashe Memorial Hospital Interim Chief Operating Officer Joe Thore.

“Ashe Memorial Hospital is very proud to have an excellent medical staff that is committed to the well being of our community,” Thore said. “We are currently in the process of interviewing hospitalists and family practitioners to join our staff.”

“We look forward to our upcoming affiliation with Novant Health as our management company on Aug. 2,” he said. “This new relationship will be very beneficial to the hospital as we recruit new physicians.”

Ashe’s provider gap is wider for the low-income population. For residents at 200 percent of the federal poverty guideline who are on Medicaid or require sliding scale billing — about one fifth of Ashe residents — the physician to population ratio is 3,000 to one, according to the N.C. Department of Health and Human Services (DHHS) Office of Rural Health and Community Care (ORHCC).

This figure is of keen interest to the ORHCC, which is charged with assisting under-served communities by creating and supporting a network of rural health centers across the state.

According to the ORHCC’s Mark Snugg, communities where the physician to low-income patient ratio is 3,500 to one or more can be designated Health Professional Shortage Areas (HPSAs), and qualify for student loan repayment programs and other incentives used to recruit physicians to under-served communities.

According to federal guidelines, 78 counties in N.C. qualify as HPSAs because of shortages of primary medical care. Eighty-one counties qualify because of inadequate dental care, and 58 counties due to a lack of mental health providers.

“But, just because you’re not designated (HPSA) doesn’t mean everything’s hunky dory,” Snugg said. While Ashe is just below the threshold for a HPSA, the ORHCC also works with such communities to determine additional sources of funding, including federal and philanthropic grants.

Now in its 40th year, the ORHCC was created by the late Gov. Jim Holshouser to bring quality health care to rural areas of N.C..

With the support of state, federal and philanthropic sources, the ORHCC administers a $37 million budget, and helps communities develop strategies to improve access, quality and cost-effectiveness of health care, with a primary.

The ORHCC, works to recruit not only primary care physicians, but also dentists, nurse practitioners, physician assistants, psychiatrists and dental hygienists to rural and under-served communities.

During each of the past six years, the ORHCC has recruited an average of 149 health professionals to chronically under-served areas of the state. Recruitment efforts brought in a record 160 primary care physicians, psychiatrists and dentists over the past year, surpassing estimates for the department’s medical placement services initiative.

“We know that provider gaps still exist in parts of N.C. and we are actively exploring ways to expand recruiting efforts and use technology, like telemedicine, to meet those needs,” said DHHS Secretary Aldona Wos in a recent press release.