Rural Health Initiative

Training Providers to Practice in Rural WNC

For more information and/or questions about the Rural Health Initiative, please contact the following:

Yancey, Mitchell and McDowell Counties -

All other counties -

With the passage of the North Carolina state budget in September 2015, MAHEC was given funding to develop new residency programs in General Surgery and Psychiatry, expand its existing Family Medicine residency programs and medical student training, increase the amount of time learners spend training in rural communities, and research what works in producing rural physicians. 

Why this focus and why now?

The need for more healthcare providers in WNC is great: 

  • Every one of the 16 counties in WNC is a population or geographic primary care Health Professional Shortage Area (HPSA).  
  •  In WNC, there is an estimated shortage of 140 primary care providers and at least 20 general surgeons. 
  • The number of people in the region with behavioral health problems continues to grow.  An estimated 16% of adults have a behavioral health diagnosis, and the region has a suicide rate significantly higher than national benchmarks. 

Access to effective healthcare, a healthy workforce, and lower overall healthcare costs are key factors to promote growth in our region.

This is not only a WNC problem, but a state wide and a national problem:

  • The American Medical Association says the number of psychiatrists in the US has grown by only 12% since 1995, much less than physicians in general at 46%.  Psychiatrists, like the rest of the physician workforce, are not evenly distributed across the country. 
  • Only 10% of graduating surgery residents are practicing as general surgeons - the only type of surgeon needed in rural areas. 
  • Numerous calls for an increase in family physicians and other primary care physicians have been voiced state wide and nationally.

So why not just train more surgeons, psychiatrists and family doctors?  The average cost of training a resident is $150,000 per year and the primary source of funding for resident training is Medicare.  Since 1997, the number of positions funded by Medicare has been capped at 1996 levels, even though the population has increased and aged.  Hospitals have found other sources of funding to train residents in hospital-based subspecialties, since residents in hospitals can be a relatively inexpensive source of labor.  So despite the Medicare cap on new residencies, the number of subspecialty residents has increased by 61% between 1996 and 2011, whereas primary care has only increased by 8.4%.   

In 1993 a General Statute required 60% of students in North Carolina’s two public medical schools and 50% in the two private medical schools to enter into primary care.  But reports by the Sheps Center at UNC Chapel Hill show the state’s need for primary care physicians is not being met.  Last year, of the 427 graduates of the four medical schools:

  • 29% are in practice or training in primary care
  • 14% are in North Carolina
  • 2.5% (11 doctors) are in one of the 54 rural counties in North Carolina
  • 4% (16) are general surgeons in rural NC
  • <1% (1) are psychiatrists in rural areas. 

The $8million North Carolina budget appropriation, championed by Senator Tom Apodaca, is a good investment of state resources to address the health workforce needs of the region and the state.  MAHEC’s track record is strong. For more than 40 years we have trained physicians, pharmacists, and dentists for WNC.  Currently there are more than 300 physicians practicing in WNC and every county has been a beneficiary of MAHEC’s training programs.  More than 60% of the graduates of the family medicine residency program have remained in WNC.

Over the next two years MAHEC will be developing the infrastructure for the new training programs in surgery and psychiatry, moving through the steps of accreditation, and developing the curriculum for the new programs.  Over the next three years, expect the following:


  • Development of a surgical simulation lab on the Biltmore Campus
  • New clinical space for training psychiatry residents on the Biltmore Campus
  • New training space for family medicine and psychiatry residents at expanded outpatient sites
  • Recruitment of Psychiatry and Surgery Residency directors and completion of the accreditation process
  • An increase in the Asheville Family Medicine Program to 12 residents per class in 2016 and perhaps more in 2017
  • In July 2017 we expect the first four residents in psychiatry and the first four residents in surgery to begin their residencies.  By 2022, MAHEC will have more than 40 new residents.
  • The Asheville Campus of the UNC School of Medicine will expand by four students per class, all in the rural hubs
  • New support for the medical school will accelerate the inter-professional training and practice in primary care that includes integrated behavioral health, clinical pharmacy and public health. 

Rural Training Hubs: 

  • Development of two rural hubs utilizing community providers and partners to lead the programs and train students and residents in rural areas
  • All three residency programs will have significant portions of the training in rural areas outside of Buncombe County. 
  • This opportunity will enable MAHEC to expand training sites to even more rural counties and hospitals in the region with hopes that more health professionals will choose to practice in our most needy communities. 

Population Health:

  • New opportunities to conduct population health interventions and research effective clinical-community connections that will benefit the entire state. 


  • New opportunities to conduct research about rural, longitudinal, and interdisciplinary medical education that will benefit the entire state.

This initiative has the potential to make a substantial health and economic impact in the region.  Since we expect at least 50% of doctors who train in these new residencies to practice within a 100 mile radius at the completion of their training, WNC communities will see a benefit for years to come.  MAHEC’s long standing relationship with the University of North Carolina, particularly the School of Medicine, and the WNC hospitals will further carry the excellence of these institutions into our communities.