North Carolina has the second largest rural population in the country, and for many of those residents, there are too many barriers preventing access to high-quality health care.
Addressing those coverage and access gaps requires specialized initiatives, new public policy efforts, and targeted resources from health systems.
In Pender County, around 30 miles from Novant Health’s major hospital in Wilmington, that work has meant local partnerships, new rural residency programs, significant clinic renovations and expansions, and an innovative paramedicine program.
Building Rural Residency Pipelines
In Burgaw, Pender County’s county seat and home of 3,800 residents, Novant Heath launched its Rural Family Medicine Residency program in 2025. Dr. Hannah Hulshult and Dr. Courtney Caruthers, the program’s first two residents, began work at the Black River Health Services clinic, helping bring high-quality care to rural Pender county.
Residents are able to gain additional training at Novant Health’s New Hanover Regional Medical Center. The program was created in partnership with the UNC School of Medicine, and over the next three years, will host a total of six rural physician residents.
It’s a model that Novant Health is focused on growing, with the potential to add more residency slots at Black River Health Services and establish training programs at Novant Health Pender Medical Center to grow rural-focused specialty and hospital-based residency offerings.
The program has two big advantages. Not only does it provide hiqh-quality care in rural areas during the residency period, but it also helps build a long-term workforce.
“When doctors train in rural areas, the odds of them staying in rural areas are five times as great,” said Joe Pino, senior vice president of Medical Education for Novant Health. “So that is going to be one of the major contributions of a program like this.”
When training physicians for practice in rural areas, investments in the community facilities and clinics where residents train are key. For Novant Health in Pender County, that means prioritizing its partnerships with Black River Health Services. Founded in 1975, the clinic has long been a full-service, non-profit family practice providing a full spectrum of affordable medical and pharmaceutical services for medically underserved and financially burdened children and adults across Pender County and the southeast region of North Carolina. Now, it is also the home of Novant Health’s rural residency program.
When Novant Health and Black River began their partnership, the health system invested significant resources to expand the facility, adding additional clinic and training spaces that will not only enable on-site resident learning, but also expand what care can be offered in the clinic. And with federal support, more care could be on the way.
The Novant Health Center for Public Policy Solutions is supporting the clinic’s efforts to receive a Federally Qualified Health Center (FQHC) designation. Earning this designation would allow the clinic to expand the care it provides, ensuring people living in Burgaw and nearby have access to services like maternal and pre-natal care, dentistry, expanded pharmacy options, and other care that would usually require travel outside the area or a trip to the emergency room.
Additionally, Novant Health’s Center for Public Policy Solutions is working with federal and state lawmakers to consider ways to further expand rural residency programs like the one that currently benefits Black River Health Services.
“We are not just filling gaps in care— we’re building long-term solutions,” said Lee Ann Amann, CEO of Black River Health Services. “This program strengthens our workforce, deepens our roots in the community, and creates a sustainable pipeline of primary care providers.”
Ensuring High-Quality Medical Facilities
Assembling a high-quality medical workforce is one key issue for rural communities. Another is ensuring local rural hospitals are able to remain open. Across the country, ongoing state and national financial and policy headwinds have led to rural facility closures, often when they are unable to repair aging infrastructure or recover after weather or other emergencies. Novant Health has prioritized ensuring these challenges do not close its rural facilities like Novant Health Pender Medical Center. The hospital joined the Novant Health system in the fall of 2023.
Then, in July 2024, Novant Health’s Pender Medical Center experienced severe water damage that required the hospital to be evacuated. Prior to joining Novant Health, this degree of damage could have closed the rural hospital. Instead, as a part of Novant Health, the system invested more than six million dollars in renovations, gutting the damaged areas of the hospital and rebuilding while also expanding and upgrading the facility.
Today, renovations are complete and patients are seeing the benefits. Nearly half of patients who previously had to transfer to other facilities for certain kinds of care are able to stay at Pender, closer to home and loved ones.
“We are operating on a very different level than we did,” said Ruth Glaser, president of Novant Health’s Pender Medical Center, “Without the support of Novant Health, we wouldn’t have been able to survive.”
Paramedicine Programs
Opportunities to grow rural access also extend beyond hospital and clinic walls. In coastal North Carolina, Novant Health’s community paramedic program meets people where they are by frequently caring for patients who fall outside of traditional care models like those who are home-bound, lack an accepting home health provider, or face housing insecurity. Community paramedics help patients avoid unnecessary emergency department visits and hospital admissions and fill a critical resource gap in the behavioral health care access.
For Novant Health, patients served by this program never receive a bill. The health system funds the program’s annual cost, ensuring access to care for more than 3,500 patients annually, regardless of financial or insurance status.
The program currently serves targeted rural areas of Brunswick, Pender, and Columbus Counties, and is poised to grow with additional federal and state policy support. The Novant Health Center for Public Policy Solutions continues to work with federal and state lawmakers to encourage that support.
