North Carolina’s rural communities are around “40 percent of the state’s population.”[1] These communities face a lack of access to health care with struggling facilities and hospitals, and are considered medical deserts.[2] For example, Stephanie Atkinson describes there being “only one orthopedic doctor” in Clinton, North Carolina,[3] a rural area focused on agriculture.[4] Atkinson’s experience is not unique. Rural areas often lack access to or have shortages of doctors, including pediatricians, gynecologists, and psychiatrists.[5] Further, nationally, “only 11 percent of physicians choose to practice in rural areas.”[6] Many hospitals and clinics in rural areas in North Carolina have also closed. For example, in Martin County, Martin General Hospital shut down, leaving many residents with a “30-mile drive to the nearest hospital.”[7] Residents should not have to choose between spending money on gas and adequate medical care.
To address the lack of access in rural North Carolina, a potential solution is House Bill 67. Governor Josh Stein signed this bill on July 1, 2025.[8] The designated purpose of this bill is “to strengthen access to health care.”[9] The bill does this in three forms: (1) launching a license for internationally trained physicians, (2) enhancing the portability of physician’s assistant’s (PAs) licenses, and (3) relaxing physician supervision requirements for experienced PA teams.[10]
The license for International Medical Graduates will enable the government to tap a wider variety of physicians and ensure that rural communities receive experienced physicians. International Medical Graduates “make up nearly one in four physicians nationwide.”[11] Previously, North Carolina law required all physicians to complete their residency in the United States regardless of other training in another nation, making it time consuming and expensive to obtain licensure.[12] This bill would allow experienced physicians trained abroad to gain licensure without repeating their training.[13] This does not limit the competency of the physicians, who must still meet other requirements like holding a foreign license and passing background checks.[14] The bill also requires that:
“the applicant has been offered employment as a physician in a full-time capacity at (i) a hospital that is located in North Carolina and licensed by the State of North Carolina or (ii) a medical practice located in a rural county with a population of less than 500 people per square mile, in North Carolina, where a physician fully licensed by the State under this Chapter is physically practicing on-site at the rural medical practice.”[15]
The bill creates a prerequisite for international physicians to either begin their work in a licensed hospital in North Carolina or a rural practice. Since there are a limited number of employment opportunities at hospitals in North Carolina, at least some International Medical Graduates will need to work in rural medical practices to obtain licensure without redoing their education, and this will better redistribute medical expertise.
House Bill 67 seeks to limit restrictions on PAs by enhancing the mobility of licenses, consolidating the licensure process to increase access to medical services, and easing physician relationship requirements.[16] For example, this bill allows North Carolina to join the PA Licensure Compact, a new organization that allows PAs to have portable licenses that can be used in any other compact state where they plan to practice in.[17] The PA just needs to gain licensure in one compact state and then can use that licensure to receive their compact privileges to practice in other compact jurisdictions.[18] This will better incentivize remote work because PAs can offer telemedicine in compact states where they are authorized to practice in without having to go through bureaucratic applications, making it easier for rural communities to get access to care.[19] The bill also allows PAs to work in a team setting without a specific physician relationship after they have worked a requisite number of hours under physician supervision.[20] This provides more flexibility to the team to give medical care to more patients.
House Bill 67 is the first step in alleviating pervasive medical deserts in North Carolina. With more doctors and PAs practicing in rural areas or utilizing telehealth, medical expertise will be more evenly distributed throughout the state. However, more still needs to be done to enable these communities to have enough access to hospitals, clinics, and physicians’ offices, and to prevent these facilities from closing. Although the House Bill is providing solutions for a lack of physicians and medical expertise, it does not address the entire problem, if medical practices in rural areas continue to shut down and create medical deserts.
[1]Jaymie Baxley, Disparate issues shape rural health in North Carolina, N.C. Health News (May 19, 2023), https://www.northcarolinahealthnews.org/2023/05/19/disparate-issues-shape-rural-health-in-nc/.
[2] Jaimie Cavanaugh & John Sweeney, Rural communities in NC have little access to health care, overregulation is to blame, Carolina J. (May 23, 2025), https://www.carolinajournal.com/opinion/rural-communities-in-nc-have-little-access-to-healthcare-overregulation-is-to-blame/.
[3] Interview with Stephanie Atkinson, S. Oral Hist. Program, at 09:59 (June 25, 2018), https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/27930/rec/3.
[4] Id. at 04:12.
[5] Brian Balfour, Expanding Access to Medical Care in Rural North Carolina, N.C. Nurses Assoc. (Feb. 1, 2018), https://www.ncnurses.org/about-ncna/latest-news-archive/expanding-access-to-medical-care/.
[6] Id.
[7] Chris Young, Rural residents face 30-mile drive to nearest hospital after Martin General closure, News ABC 12 (July 8th, 2025), https://wcti12.com/news/local/rural-residents-face-30-mile-drive-to-nearest-hospital-after-martin-general-closure.
[8] House Bill 67/ SL 2025-37, N.C. Gen. Assembly, https://www.ncleg.gov/BillLookup/2025/H67 (last visited, Sept. 28, 2025).
[9] H.B. 67, 2025 Gen. Assemb., Reg. Sess. (N.C. 2025).
[10] Bill Summary for H 67 (2025-2026), UNC Sch. of Gov’t (May 22, 2025), https://lrs.sog.unc.edu/billsum/h-67-2025-2026-0.
[11] Adam Meier, HB67: A smarter path to a healthier NC, Carolina J. (Aug. 27, 2025), https://www.carolinajournal.com/opinion/hb67-a-smarter-path-to-a-healthier-nc/.
[12] Id.
[13] Id.
[14] Bill Summary for H 67 (2025-2026), supra note 10.
[15] H.B. 67.
[16] Id.
[17] PA Licensure Compact, American Academy of Physician Associates, https://www.aapa.org/advocacy-central/pa-licensure-compact/(last visited Sept. 29, 2025).
[18] Id.
[19] Id.
[20] H.B. 67.
