Healthcare Workforce Shortage Opportunities - WNC Health Policy Podcast Ep. 13
In this episode, UNCA student intern Emma Hoosier shares her perspective on the healthcare workforce shortage in Western North Carolina. Through her internship experience, she reflects on conversations with local providers and community members about the challenges facing the region — and the potential solutions emerging from local insights, state initiatives, and national policy discussions. She also shares her own path to becoming an intern with the NCCHW, offering a glimpse into how other students in WNC can get involved in public health efforts across the mountains. Stay tuned for updates on Emma’s written list of policy opportunities.
Listen via the audio bar above, or via Apple Podcasts or Spotify
About the WNC Health Policy Podcast: In each installment, we speak about different public health strategies for improving health and well-being in Western North Carolina (WNC). The WNC HPl is a collaboration between the NC Center for Health & Wellness at UNCA and MAHEC, with generous support from the Dogwood Health Trust.
Individual opinions, findings, conclusions, or recommendations expressed in this podcast are those of the author(s)/interviewee(s) and do not necessarily reflect the view of the WNC Health Policy Initiative or its host institutions of the University of North Carolina Asheville (UNCA), Mountain Area Health Education Center (MAHEC) or our funders.
Resources:
AHEC Opportunities for health professions students in rotation
“Why Diversifying the Health Professions Matters for Everyone” by Lauren Smith (Robert Wood Johnson Foundation)
Impacts of HR1 on NC: “Older and disabled Medicaid recipients, advocates ‘extraordinarily worried’ about potential Medicaid cuts” by Grace Vitaglione (NC Health News)
Transcript
AR: Andrew Rainey (WNC HPI)
EH: Emma Hoosier (UNC Asheville student and WNC HPI summer intern)
INTRO
[intro sound cue]
Emma Hoosier: The workforce shortage, it is like a web because there are so many contributing factors and they really all bounce off of each other.
Andew Rainey: You are listening to the Western North Carolina Health Policy Initiative Podcast, a collaboration between the North Carolina Center for Health and Wellness at UNCA, and MAHEC, with generous support from the Dogwood Health Trust.
I'm Andrew Rainey. In each installment, we speak about different public health strategies for improving health and well-being in Western North Carolina. Individual opinions, findings, conclusions or recommendations expressed in the podcast do not necessarily reflect the view of the Western North Carolina Health Policy Initiative or its host institutions of the University of North Carolina, Asheville Mountain Area Health Education Center, or our funders.
Recorded on the flickering Internet waves of mountainous Appalachia, in this installment, we're talking about our healthcare workforce shortage with the HPI UNCA student intern. (and one potential addition to our public healthcare workforce) Emma Hoosier.
According to the health resources and Services administration, all counties in western North Carolina are now officially designated as areas with a healthcare professional shortage. That means that not one county in our region has the workforce it needs to keep up with demand. In 2023, more than half of both children and adults in Western North Carolina were unable to access the healthcare they needed. For dental care, only three out of five adults had a dental visit in the past year. For mental health, 8 counties in Western North Carolina don't have a single general psychiatrist. And when it comes to women's health, 7 counties have no practicing OBGYN. Projections indicate that North Carolina could need 21,000 more nurses within the next decade just to meet baseline healthcare needs.
To hear about what's driving this healthcare workforce shortage, and some opportunities on what we can do, we'll speak with our student intern, Emma Hoosier, who took the opportunity of her internship to pull together a big picture of policy opportunities on how to rebuild a healthcare workforce that can serve all of our region. For interested students, we’ll also speak with Emma about the path she took to work with the HPI to illuminate how other students can learn about public health and support the work of the initiative.
AR: Thanks for joining me, Emma. Let's start off by getting to know how you stepped into this work as our intern could have you introduce yourself and what you're studying at UNCA.
EH: So my name is Emma Hoosier. Currently I am at UNCA, the University of North Carolina at Asheville. This is my first college year, so I'm a freshman, but I am a community college transfer student so I am a junior by credit. And I am currently studying Health Sciences with a concentration in public health, but specifically I have interests that are tailored towards nutrition, physical activity and diseases and those sorts of areas. I haven't exactly pinpointed a specific interest for what I want to study in the future, but those are definitely some key ones that I'm keeping in mind.
AR: Right now, and that sounds like a fairly natural bridge to this internship.
EH: Yes, yes. I wanted to get involved and see more in the healthcare field, because prior to being a health science major, I was actually a communications major. And I just found out I was really unhappy with pursuing that. I didn't feel any sort of connection to it. And then I sort of reflected on myself and realized that I'm very interested in health and healthcare and nutrition and all these sorts of things, which led me to my major swap.
So my internship, I wanted to get more insight and awareness into the healthcare field. Because when people say healthcare and health science, they immediately think about hospitals and doctors and nurses, which is a very important part of healthcare and the healthcare system. But I wanted to see that there was more to it than just that, because I was told by many different people, you know, the healthcare system is more than a hospital, but they couldn't really give me an example when I would ask. So, the internship, I really wanted it to sort of open my eyes to see, well, what else is there in the system that's beyond the traditional environment that everybody comes to mind when they say healthcare. And I truly believe this internship has offered me that.
AR: How did you find this opportunity as a student?
EH: Yeah. So I was enrolled in UNCA's, their internship program that they offer and I was just going through the list of sites for internships. And the Health Policy initiative was the one that I was the most interested in, because it was tailored towards pretty much everything that I wanted, where it would explore policies - a little bit more of the behind-the-scenes, the things that I really wanted to see. So it was through the internship program offered by UNCA that really directed me towards the Wellness Center [NC Center for Health and Wellness] and the policy internship.
AR: We're so glad you took this route to work with us here. Could you describe how you came to the topic of the workforce shortage?
EH: Yeah. So actually I started going to HP I workforce meetings before my official internship start date. I have fantastic supervisors who basically encouraged me and said I was welcome to come. And as I was going to the meetings, pretty much the very first day I was there, they were talking about the workforce shortage - shortages of hospital workers and mental health workers and even administrative workers. And that was something that I honestly hadn't thought about. So when my official internship start date began, I was just very interested in the shortage and it was just something I just felt drawn towards.
And also the more I was working on the project, the more I realized that this shortage was actually happening and I didn't even realize it. Based on personal experience in my family's experience, when we would need medical help, I realize now that I have seen the shortage and I've seen it around me. I just didn't realize it.
AR: With this new awareness and interest in exploring the topic, what goals did you have for exploring the shortage through the HPI?
EH: So the main goal of the project, I would say, it was to promote policies and solutions that would just address the current shortage in Western North Carolina. To improve not only the work environment for healthcare workers, but also access to people. And again, reflecting on my own experience with the shortage and doing secondary research and going to all these meetings and getting all this information, and again just policies and solutions. So that was really the ultimate goal for the project, is to have almost a summary of some potential things that legislators and policymakers can look at. And maybe a spark will go and they'll say, “Hey, that might be something we can explore. It might not be exactly what we do, but that's a good direction and I think we should look at it further.” That's essentially the goal that. I want with this project.
AR: Could you talk some more about where the policy opportunity came from?
EH: Yeah. So again, the HPI meetings, they've been extremely helpful. I've also spoken with people who are in the healthcare field. The HPI helped me with that network and help me get access to people who are founders and CEOs of their own businesses that aim to help people get better insurance. I've spoken with academic officers and professors of nursing who have offered me their own insight. And another great resource that I have utilized is the Sheps Center with UNC Chapel Hill - they offer fantastic information. And I've also looked at MAHEC. They've offered their own articles looking into the shortage. So those have been very big contributing factors in the research and the information that I've done.
AR: With the policies you've seen, how much was locally based versus examples from other states or countries?
EH: I wish I could say it stayed mostly local, but with my secondary research I did have to look beyond the state because the healthcare workforce shortage, unfortunately is something that is nationwide. So, reviews of literatures, journals, I have looked at news coverage for the shortage. And looking at policies and solutions, a lot of them were very broad, very nationwide, not tailored specific to the Western part of the state, but just as applicable.
AR: I know a lot can play into one policy or another of being effective in a region, including what's already on the ground. From your interviews did you hear any strengths in Western North Carolina that ought to be considered in however a policy plays out?
EH: Yes, the biggest strength and reoccurring theme, I guess that I've noticed when I've spoken with people is partnerships. For example, I've been to several HPI work group meetings where they've discussed people like [NC] AHEC and Dogwood [Health] Trust - they have been repeated partnerships that have been supporting with the shortage. The Sheps Center with Chapel Hill and the Wellness Center, they've also been supports. And so partnerships I would say has been the biggest strength in supporting the workforce for a plethora of reasons.
AR: Could you speak to some of the factors that are causing the shortage of health care workers in our region?
EH: There are many challenges that contribute to the workforce, but ultimately you can't really address them without you know proper funds. And also there's been legislative action taken at federal and state levels that just make it a lot harder to address a challenge that has already been so exacerbated by so many different factors.
AR: I'm thinking HR1, which passed last July with the support of most of North Carolina's legislators. Its passage is expected to both drop some 600,000 North Carolinians from Medicaid and add an increased workload to our healthcare system with the new Medicaid work requirements, requiring a larger workforce to offer care to uninsured folks and to navigate a more complex system. We'll look at that in an upcoming HPI podcast. We've also heard how dropping the Healthy Opportunities Pilot funding in the state budget will add stress onto the system.
EH: Also, I've seen limited legislative action. Again with the HPI meetings and even the Wellness Center meetings, and also just in the news, where information about the shortage is being brought up and the needs of healthcare workers, all these things are being mentioned, but then not much really happens after that.
So a lot of this was eye opening for me because I didn't realize that, you know, it was this bad and that there was so many things contributing to it. But some factors that I found that really influenced the shortage, where money and financials and that can relate to improper pay. And Medicaid expansion, which is something that has been very under attack recently. Things like education - a lot of people in the healthcare workforce, they don't want to work again because of lack of pay. Why would someone want to be a teacher and get paid less than someone who actually works in the field? That has been a significant problem in the field. And other issues like training on site that's very limited. And people have called for basically stronger core curriculums tailored around science and medicine, and integrating a lot more clinical settings.
Another problem I've seen is diversity in the healthcare workforce. There's a limited number of minority groups who are being represented in the healthcare field. There's not enough minority groups who are healthcare professionals, and they're not being seen as much, and therefore, patients don't feel like they're being seen either.
You also have issues with childcare. There's not a lot of access for healthcare workers. They work long hours, they work night shifts, and a lot of times they don't have anyone to look after their children. And again, childcare is so expensive now anyway, they can't even afford it.
There's issues like burnout, which has been exacerbated by COVID-19, the pandemic. During the pandemic, you saw a huge outflux of healthcare workers because they basically saw death every single day and they were worked to the bone and they were tired. So burnout is leftover from COVID and it was even bad prior to COVID. And people don't want to even be healthcare workers anymore because they've seen what COVID and has done to them on the front lines. So you have a lot of healthcare workers who were leaving and not enough people are wanting to take their spot just because they saw what they've been through.
Another problem has been healthcare workers that can't afford housing, because they don't get paid as they should. Especially in rural areas with mountainous terrains and just the type of geography, some healthcare workers basically can't afford to live by where they work. They have to travel so far just to go and do their job.
All of these things have just culminated into the workforce shortage and in turn, it just affects so many people and it's projected to continue to get even worse.
BREAK
[Musical humming with cricket sounds in the background]
AR: Hey there, this is Andrew. You're listening to the Western, North Carolina HPI podcast, a show exploring health issues and policy impacting Western North Carolina. We’re a production of the North Carolina Center for Health and Wellness at UNCA, and MAHEC with funding from the Dogwood Health.
In this installment, we're speaking with our HPI student intern, Emma Hoosier, about her experience as an intern and her project to compile various solutions to our healthcare workforce shortage in Western North Carolina. We'll return to the conversation in just a moment.
[Musical humming with cricket sounds continues]
AR: That was Asheville based Appalachian ballad singer Saro Lynch-Thomason humming the old shape-note-style ballad “Evening Shade.” You can learn more about her work and regional music traditions at sarosings.com. And now back to the show.
POLICY OPPORTUNITIES
AR: Before the break, we heard how, as a student intern with the HPI, you've been working to compile strategies that could be used to address the healthcare workforce shortage in Western North Carolina. We heard how issues like funding, falling support for Medicaid, low incentives to enter the field, low wages for healthcare instructors, clinicians who don't have similar backgrounds as their patients, insufficient clinical training sites, housing cost, no childcare, and provider burnout all contribute to this growing problem.
These all sort of intersect into a web of challenges that I imagine require a similar web of solutions. Taking all this into consideration, what kinds of policy opportunities or recommendations have you identified?
EH: Yeah, so I do want to add to your point, as well, where you did say it is like a web. And that is so true because there are so many contributing factors, and they really all bounce off with each other. So it's really hard to pinpoint it from just one. Policywise you can break it down into categories. So with financials, the call for Medicaid expansion and broadening Medicaid reimbursement and the eligibility, that would help a lot of the administrative burdens.
AR: So easing the workplace challenges there by using Medicaid funds.
EH: And a lot of residents rely on Medicaid Services, so that would really help them not only patients, but workers too.
AR: What else is in this funding category?
EH: With students and money for med school, you can offer loan forgiveness, repayment options, and even just offering better pay and benefits. That would attract a lot of people to pursue medicine and go to the healthcare field and work and even stay. That would help them a lot.
AR: OK. So incentives for students to pursue clinical training like pay and removing debt?
EH: With education. I think I mentioned this before, but educators, they don't feel desire to work because they're not getting paid enough. So paying an educator higher, that would help them stay and teach. Even doing things like expanding clinical training sites. I know, for example, MAHEC did a build a couple of homes basically on site, so that their medical students can live there and basically work there. Because the home is there, the place where they're being taught is there. It's all right there. So they don't have to travel farther away to go and train and go learn.
AR: So removing the concern for housing by providing it on a regional scale, it does bring up the image of company towns if it's within a for-profit hospital. But presumably regulations and creativity could make that work.
EH: Another way you could help with the education you can help get better pre-health advising systems at the UNC school systems. Stronger biomedical science for their core curriculum. And again, just improving the pay and the policy surrounding the instructors. That would just really help a lot because it would bring more in because there is a lack of teaching instructors, too.
AR: Right, there needs to be infrastructure and teachers to be there, and if they're highly skilled and not getting paid well, as you mentioned, the cost of living is high with housing, they're not going to become a teacher. And even motivated students are struggling to find faculty or placement while in training.
EH: And with diversity, this was actually one of the most interesting potential solution that I found, was actually reintroducing military trained professionals into the workforce because they have that experience. And also I think it would help again with people feeling seen and feeling noticed, especially with patients, having someone treat you who was a veteran too. They have the knowledge and they have basically your experience, so they understand.
AR: Thinking of MAHEC out here, I'm reminded of both the AHEC scholars program. And Mahek medical mentoring program, which is an internship for high school seniors who have an interest in the practice of medicine and could open the door to folks who may not have had much exposure to the medical field as a career option beforehand. I could imagine these as some models that could fit that mold.
EH: Yes, yes
AR: That leads us to another category of policies. Lauren Smith wrote for the Robert Wood Johnson Foundation in 2024 that underrepresented physicians are more likely to practice in underserved areas like Western North Carolina, and certain health outcomes like infant mortality rates can improve when physicians and patients have the same background. As we've seen in the Health Policy initiative in episodes like maternal, infant and child health or the Healthy Opportunities Pilot, providers from Western North Carolina understand the issues here best. Are there other policies you've seen that could expand the number of providers coming from our communities out here?
EH: Yeah. So you also could improve the practitioner cultural knowledge and expanding cultural competence education. And also just addressing educational differences between different groups of people, because different minority groups, you know, they don't have the same educational opportunities and exposure as maybe others. So that's very important to address to help promote diversity just in the healthcare field.
AR: I guess the next overarching category opens the door to more providers who are parents, and that's childcare.
EH: Yes. With childcare you could expand on site vouchers and even expand sites that are there. You could also help by revising parental leave policies, that way they're more family friendly, especially for working parents. You could do things like offer them offer workers an option to choose their preferred shift - if some wanna work nights, and some don't, give them that opt. And providing predictable schedules so that way families can plan around their own lives and their work at the same time. And just establishing more childcare centers that have operating hours that are tailored towards healthcare worker hours, maybe staying open longer or opening sooner. Just centering it around the worker of the parent would help a lot.
AR: For any listeners interested in learning more about childcare, you can also hear more about the childcare crisis in Western North Carolina on Episode 9 of the HPI podcast and hear from folks in that field.
You mentioned COVID-19 has left its mark on healthcare providers with burnout. What kinds of policies could support providers dealing with burnout or prevent it altogether?
EH: With burnout, that has been caused by so many things, not just COVID, but just with administrative tasks and all these other difficulties. You could do things like utilizing more technology to do the mundane tasks that really drive workers out, so that way they can focus more on what their job is meant to be. Because you have a lot of nurses and physicians, for example, in hospitals, who have had to do administrative tasks just because there's not enough administrative workers to do them. But using AI like for note taking and even robotic support from lending tasks, that would help healthcare workers actually do their job and not feel like they have to juggle between two different things at once.
You could also do things like paid leave time policies, increase their vacation time, and you could also implement mindfulness programs into whatever environment a healthcare worker is working in just to help their mental state and help their burnout. You also can do things like task sharing amongst different healthcare professionals. Again, just to help them balance out that load of not having someone who's a doctor also, do the office task - have the office worker do the office task, so that way the doctor can focus on the patients.
And with housing and transportations and those sorts of things, this is similar to the MAHEC buildings that I had mentioned earlier, but providing like low income homes for workers, and even homes just based on their income. So that way it's affordable and it's accessible for them.
You also can do things like starting a mobile clinic. That way you can actually bring the worker to the patient or vice versa. That way workers don't have to try to navigate getting from home to their job, their job is basically on the wheels and they can get to the person that they need to. And telehealth - you can try using a lot more telehealth. And I know that was a big platform that was used during COVID, especially with social distancing and all those sorts of things. But telehealth is - it would be helpful. Because unless you have a active emergency and you need to go to the ER to see a doctor, really, if you can use telehealth to just have a general wellness visit with a doctor, that would save your doctor time to treat a patient who has a severe condition. Like that would save up a lot of time for the doctor, would just make it a lot easier for them.
And I know I listed quite a bit there and that that's really just the snapshot of so many other things that you can do to address the shortage. You have to look at everything because they all basically are dominoes of each other.
AR: In a number of our conversations on the HPI podcast, we've heard how bringing community health workers into the picture has supported many folks navigating our complex healthcare systems through shared lived experience, language, knowledge of resources, that sort of thing. Did you hear anything about community health workers in any of your interviews? As a way to support the regional workforce.
EH: Yeah, I have. Especially when you're discussing community access, and representation, and taking a load off healthcare workers. They can help be that bridge between a community and a healthcare provider, and that's very important when you're talking about access and the representation of a specific community. And going back to the taking a load off of doctors and nurses and physicians, community health workers, with what I have found, they can help basically do the administrative or the smaller tasks that way that people like nurses and physicians and doctors can focus on the things they were trained to do and the very big part of their job, and not have to worry about all of the things behind the scene. Because one that's not what their job is, and two with community health workers, there wouldn't be as much of an employee shortage so that they could do it.
AR: How can folks review the topics you brought up and learn more about our workforce shortage?
EH: Yeah. So for people who want to learn on their own, doing your own research and finding that information and looking at journals and articles, those are extremely helpful tools. And I would also encourage people to look at the HPI website and the NC Health and Wellness Center website where people can learn about policies and initiatives. And also look at MAHEC - they have a bunch of information about this as well.
Future directions for this project - what I would like to see personally - is to put this towards possibly an undergrad research project. That's where I'm at with it right now.
AR: We've talked mostly from a government or organizational policy perspective. But I'm curious if that's made you think of ways other kinds of listeners may get involved as well, whether that's a student thinking about an internship with the HPI or another community member.
EH: Yeah, yeah. So student internship for, sure. That is a fantastic way, especially for college students, to get involved in just the local healthcare community. And you don't have to go to college to get involved and help with the workforce shortage. You can become a community health worker, and you can help connect community members to resources.
You also can make donations to a wellness center, that is also a good way to help. Volunteer at any of your local health centers and mobile clinics and hospitals, and really just anywhere where the healthcare workforce is needed. And you also can complete mundane smaller tasks and those little things, they really make a big difference in supporting the healthcare workforce community and just pushing them to have more support and just helping them to do their job.
You also can do things like donate supplies, donate any food to a veteran hospital or attend any local events and fundraisers. So for involvement, I would say it doesn't have to be huge. It can be something that might seem small, like doing some volunteer work or donating supplies, or even going to a local event. But even those small things they quickly add up and they really do make a huge difference.
AR: Now that you've completed the internship, do you have a sense of what you'd like to do next?
Yeah, staying with HP I right now is a future goal, because I have enjoyed it so much and I do think there's a lot left that I can learn from this opportunity. But at the same time, I like exploring things as well. So I'll probably be looking as well as a bunch of other things.
AR: Well, thank you Emma, for exploring the western North Carolina Health Policy initiative as an intern, and working to compile different policy and advocacy strategies, you've come across that supports our healthcare workforce as well as sharing some of those findings with us here.
You yourself are an example of a new addition to the healthcare workforce, using your public health investigation to point our field in the right direction. So thank you very much for being a part of the solution.
EH: Yeah, and thank you for inviting me and just allowing me to have this opportunity to say all this, because it really has been amazing to say.
OUTRO
AR: You've been listening to the Western North Carolina Health Policy Initiative podcast, the collaboration between North Carolina Center for Health and Wellness at UNCA, and MAHEC with generous support from the Dogwood Health Trust.
To listen again or learn more about public health issues in Western North Carolina, check out the website at wnchealthpolicy.org, or listen to more of our shows on Apple Podcast or Spotify. If there's a Western North Carolina health issue that you'd like to hear more about, speak about or have comments about anything you've heard on an HP I podcast, feel free to send us an e-mail at info@wnchealthpolicy.org, or write a comment on wherever you listen to podcasts. That also includes students who may be interested in exploring an internship with us.
Another big thanks to Asheville-based Appalachian ballad singer Saro Lynch-Thomason, for humming the old shape-note-style ballad “Lady Margaret” in the mid-show break. You can learn more about her work and regional music traditions at sarosings.com. Other music in this podcast includes old ballad “Little Margaret,” performed on banjo by Kath and Phil Tyler, found on the Free Music Archive, is licensed under an Attribution Non Commercial Share Alike 3.0 United States license. Additional music on the podcast included the tracks “Some Nights End,” “Lover’s Hollow,” and “Night Watch” by the Blue Dot Sessions. These tracks are found on the Free Music Archive under license Attribution International CBY 4.0.
Be sure to check out the website for more HPI podcast episodes and other resources at wnchealthpolicy.org. Thanks for listening.
