Like a lot of patients at Jackie Baer’s health clinic on Johns Island, S.C., Bill* had limited financial means and a chronic health condition. Baer, a family nurse practitioner, had managed to lower Bill’s blood sugar, but she arranged for him to see an endocrinologist to put the finishing touch on his diabetes management.
Imagine her shock when she saw Bill in her clinic weeks later and his blood sugar level had spiked. “I was shocked — that was the opposite of what I was expecting after sending him to a specialist,” says Baer, who earned her doctor of nursing practice degree from the University of South Carolina’s College of Nursing.
The mystery was quickly solved when Bill confided that he couldn’t afford the expensive medicine the endocrinologist had prescribed. And because he had no smartphone or computer, Bill hadn’t done any virtual follow-ups. Baer called the endocrinologist to explain the situation, suggested a cheaper prescription and asked him to forget email and Skype, to simply call Bill for follow-ups to keep him on track.
“So, problem solved, but it took some effort. It’s like that with a lot of my patients — they need advocacy,” she says. It’s why she works long hours and often stays open in the evenings to accommodate the work schedules of her patients — many of them hourly paid service industry employees who can’t afford to miss work during the day.
Baer’s patients definitely need her — and South Carolina desperately needs more dedicated nurse practitioners like Baer, especially in rural and underserved communities where primary health care providers aren’t nearly as plentiful as in larger cities and affluent suburbs. It’s estimated that the Palmetto State needs more than 800 additional primary care providers in the next 10 years just to keep pace with the needs of its growing and aging population.
We have quite an opportunity in South Carolina to improve health care just by making sure we have more providers in underserved areas.
Alicia Ribar, College of Nursing associate dean for academic affairs
That’s why the College of Nursing is working on a solution that could provide a model for all of South Carolina and perhaps even the rest of the country, where the coming shortage of primary care providers also looms large.
Funded with a grant from the federal Health Resources and Services Administration, the college has partnered with the Eau Claire Cooperative, the state’s largest federally qualifed health center, to train a new wave of family nurse practitioners for underserved communities. The grant also aims to increase the diversity of the family nurse practitioner student population and workforce in the state.
“We have quite an opportunity in South Carolina to improve health care just by making sure we have more providers in underserved areas,” says Alicia Ribar, the nursing college’s associate dean for academic affairs. “Nearly all of the 46 counties in South Carolina are considered underserved for primary care.”
Given their training and the scope of their practice, family nurse practitioners are a vital component in the state’s primary care provider network, especially in rural areas where new doctors are less likely to practice. New rules initiated in 2018 governing nurse practitioners in South Carolina made it far easier for family nurse pracitioners to establish collaborative partnerships with physicians. Now a family nurse practitioner can partner with a physician anywhere in the state; previously both parties had to be within 45 miles of one another, a requirement that was often a deal breaker for nurse practitioners in remote communities. Through its grant, the College of Nursing is recruiting graduate students from rural communities and offering scholarships for the master’s degree that leads to becoming a family nurse practitioner.
“We’re actively looking for people from rural areas, including RNs who are working in federally funded health clinics, and those with diverse backgrounds to receive this scholarship funding,” says Sheryl Mitchell, ’99 B.S., ’05 B.S.N., ’08 D.N.P., director of the college’s family nurse practitioner academic program. “We know that students who live in rural areas are more likely to go back to those communities to work if they have the financial support they need to further their education.”
This is overwhelming poverty here. I mean, if I talk about it too much it makes me cry, the poverty that exists that people don’t know about.
Dale Barwick, FNP, College of Nursing graduate
There have been other attempts to place family nurse practitioners in rural and underserved areas, but it can be a struggle if practitioners are not from that community or didn’t grow up in a similar community. “We’ve seen people put in a year or two and then leave in those situations,” Mitchell explains. “We really want to establish a long-term presence with our FNPs in these areas.”
That’s what Dale Barwick, a College of Nursing graduate and family nurse practitioner, has done in Summerton, S.C., where she opened a solo practice. The small, impoverished town had gone seven years without a primary care provider before Barwick arrived. Most of her patients are on Medicaid or Medicare, and many of them walk or ride bikes or motorized wheelchairs to her practice.
“This is overwhelming poverty here. I mean, if I talk about it too much it makes me cry, the poverty that exists that people don’t know about,” Barwick says. “I just try to focus on the fact that I’m here helping them, so at least I know I’m making a difference.”
Before Barwick opened her clinic there, she says many Summerton residents were using emergency rooms in nearby towns for routine health care needs.
“Either they caught a ride to the emergency room or they called 911 to get over to the emergency room in Manning because their meds had run out and their blood sugar was 500 or their blood pressure was 230 over 120. So I’ve cut down on a lot of that because now they’re coming here to get their blood pressure checked and get their labs done and all of the things that are supposed to be done to take care of those chronic illnesses.”
Understanding the nuances of providing care in settings like Summerton is one of the goals of the College of Nursing grant.
“By teaming with the Eau Clair Cooperative, we have more control over our students’ residency experience,” Ribar says. “We can fashion their experience much more thoughtfully through the cooperative and give them some exposure and learning opportunities that will help them succeed down the road.”
The College of Nursing’s objective is to place 60 new family nurse practitioners in rural and underserved areas over the next four years. Danny Black is president and CEO of the SouthernCarolina Alliance, an organization that recruits industry and works to improve quality of life in several Lowcountry counties in South Carolina. He says the lack of primary health care providers there makes his job difficult, but he’s encouraged by the College of Nursing’s push to place more nurse practitioners.
“We don’t have the down-home physicians anymore to take care of the local folks,” Black says. “That’s a concern for them and it’s a concern for me as I try to get companies to locate here and bring high-paying jobs. They look around and say, ‘What are my medical options?’ If we can’t provide that, industry won’t want to come here. And it’s tough for residents in the rural counties to get the medical care that the Columbias and Greenvilles and Charlestons enjoy.”
Serving a patient population that’s in a rural or underserved area typically translates into some degree of financial sacrifice and often means longer working hours. Tamieka Alston-Gibson can relate to both. Having earned both bachelor’s and graduate degrees in nursing from the University of South Carolina, she now has a solo family nurse practitioner practice near Spartanburg called Visions Medical Health Care.
“We definitely cater to the underserved and take care of uninsured patients,” says Alston-Gibson, who grew up in the small South Carolina town of Estill. “My goal is to provide equality in health care because I truly believe that health care is a human right. I try to make my community my priority and help everyone that’s willing to take my help. You have to have a heart for it.”
* Patient's name changed to preserve anonymity