Rural care gap drives MAHEC push west
A group consisting of (from left) Dolly Pressley Byrd, Dr. Ernesto de la Torre, Casey Cooper, C.Y. Wang, Dr. William Hathaway, Carol Burton, Kelli Brown and Ashley Tickle cut the ribbon at MAHEC’s new Cullowhee facility.
Brenda Benik/MAHEC photo
Western North Carolina has struggled for decades with a simple problem that produces complex consequences — not enough primary care providers practice in rural areas. Specialists often practice in urban areas, routine care gets delayed until an urgent problem arrives and options for patients are limited. The Mountain Area Health Education Center was created to address that gap, and continues to do so with a new facility in Cullowhee.
“MAHEC is now 51 years old. We celebrated our 50th birthday right before the hurricane,” said Dr. William Hathaway, a physician and MAHEC’s chief executive officer. “Our mission is pretty straightforward, to inspire and equip the next generation of healthcare providers and to expand access to care for all. We still have care deserts and primary care access problem.”
Medical students carry heavy debt. Residencies cluster around major hospitals. MAHEC’s pitch runs the other way. Train in rural places. Practice where you train. Build teams that make the work sustainable.
“Primary care reimbursement tends to be lower than for specialty care,” Hathaway said. “If you go to medical school and you incur hundreds of thousands of dollars in debt, and you’re looking at making the primary care salary or two, three, four times that amount as a specialist, there’s a natural economic incentive for people to move into the specialties.”
In the mountains, geography multiplies the risk. A 33-trip can take an hour. A freak snowstorm can make that two. A late arrival becomes a missed appointment. A missed appointment becomes an emergency room visit weeks later.
MAHEC’s new health center in Cullowhee is the latest piece of a long effort to push services west while strengthening the training pipeline that feeds them. The health center is located in Western Carolina University’s Health and Human Sciences Building off Little Savannah Road, within reach of students, staff and nearby neighborhoods. The goal is faster access to care, fewer handoffs and less trips.
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“The idea and the philosophy behind this practice is to integrate maternal health, primary care as well as behavioral health and to make sure that everybody there can work together to provide holistic services to the community,” said Dr. Bryan Hodge, MAHEC’s chief academic officer.
Hodge argues that the best way to build a rural workforce is to create positive training experiences in supported settings. Too often, a rotation in an isolated clinic leaves trainees feeling stranded while overworked preceptors scramble. A well-resourced clinic with interdisciplinary teams shows how rural practice can be efficient and satisfying.
“What we really look for is places where we know we can resource things, many times through collaborative partnerships, like our one with Western Carolina,” Hodge said. “The idea is that clinicians and the teams that are providing services there are supported in a way that they feel good about the work they’re doing. They know that it’s impactful.”
Cullowhee’s service mix targets gaps that families feel the most. Primary care is the front door. Women’s health capacity remains thin in several mountain counties, where delivery suites have closed and prenatal care can mean a long time on the highway. Behavioral health demand has soared among children, college students and adults, fueled by isolation, economic stress and the opioid crisis. An integrated clinic can start counseling during a medical visit and follow up without a separate referral.
“We will be adding an OB-GYN physician in January, and we’re super excited about that,” Hathaway said. “We would love to be able to add services as the demand requires it.”
Hathaway is blunt about maternal care. Rural closures do not stop pregnancies, they only push care farther away.
“Just because there’s nowhere to deliver babies doesn’t mean that people stop making babies in those communities,” he said. “We have a problem across the board with maternal fetal health outcomes in our country.”
The Cullowhee clinic also connects to MAHEC’s academic mission. Students and residents who train in rural settings are more likely to return as practicing clinicians. If the experience is positive, graduates can perhaps envision themselves one day living and working in a small town like Cullowhee, without feeling isolated.
“We really do have robust residency training programs,” Hodge said. “We want to create learning environments that are interprofessional, that will inspire people to go to rural areas and continue serving, and to work together in a way that is going to make a big difference.”
Rural practice does not exempt anyone from hard math, so clinics must be financially viable to survive. Hathaway notes the strain when reimbursements lag and costs rise. He also points to a broader policy debate that could affect care across the mountains.
“It’s a balance between affordability and fiscal sustainability and mission,” Hathaway said. “No margin, no mission.”
Still, Hathaway worries about proposals that could reduce resources for patients who rely on public coverage.
“When we look at the kinds of cuts that the federal government’s talking — over 10 years a trillion dollars to Medicaid — I don’t understand it,” he said. “If we’re trying to serve the people who live in our country, then why are we not putting resources into primary care needs?”
For now, the Cullowhee health center adds access where it has been limited. Family physician Dr. Ernesto de la Torre anchors the medical side. A nurse midwife provides prenatal and gynecologic care now, with an OB/GYN joining soon. A licensed clinical mental health counselor handles a wide range of counseling needs and can coordinate with schools as demand requires.
The promise rests on simple measures. More timely blood pressure checks. Fewer missed prenatal appointments. Faster starts for therapy. Smoother referrals to specialists. If those numbers move in the right direction, Cullowhee will have done more than open a door. It will have made that door the one patients use first.
Hathaway frames success the same way. Train providers where they are needed. Support teams so they stay. Add services as demand grows. Keep the patient’s trip short.
“Our vision is a healthier Western North Carolina and beyond,” Hathaway said. “We want to improve the health of our community, and we want our care delivery and education models to be emulated across the country.”
For more information on MAHEC, visit mahec.net.
