Health woes persist in Eastern N.C.

Growth of ECU's medical school is on hold, but high rates of chronic disease in rural counties are not.

Staff WriterApril 30, 2010 

  • In Northeastern counties, cardiovascular disease accounts for a state-high 19.3 percent of deaths among people younger than 65.

    Many of those same counties have diabetes rates among adults that exceed 11 percent, compared to the state average of about 9 percent.

    HIV/AIDS is disproportionately high, with upward of 20 cases for every 100,000 people.

    Source: N.C. Division of Public Health

The troubled economy and health problems that have long rivaled those in Third World countries are straining the capacity of Eastern North Carolina's only medical school to provide care.

Dr. Paul Cunningham, dean of the Brody School of Medicine at East Carolina University, said Thursday that rates of heart disease, stroke, diabetes, obesity, infant deaths and HIV/AIDS in many of the state's rural counties are among the nation's worst - on a par with the rates in nations where U.S. doctors often volunteer for mission work.

"I wonder why some of our doctors want to serve in Nicaragua, where there is a dire need, but they can drive through it [Eastern North Carolina] today" and see similar levels of need, Cunningham said. He made his comments while releasing an analysis of the health needs of Eastern North Carolina and the medical school's efforts to meet them.

Cunningham said recruiting and attracting doctors to the rural counties east of I-95 remains difficult. Nearly 19 counties in the region showed a drop in the ratio of doctors to residents between 2003 and 2008.

ECU's medical school was established in the 1970s to train home-grown doctors who would remain and practice in the state's rural communities. All its students are from North Carolina, and nearly 60 percent of its graduates remain in the state - a rate that far exceeds the state's other medical schools at UNC-Chapel Hill, Duke University and Wake Forest University.

"They are already getting national attention for their emphasis on rural health," said Gordon DeFriese, a professor emeritus at UNC-Chapel Hill and research fellow at the Cecil G. Sheps Center for Health Services Research. "And they are a model on how to do regional health care."

As the new health care law begins to take effect and 38 million more Americans are covered by insurance, the need for more doctors, nurses, physician assistants and other care providers will increase - particularly in family medicine, pediatrics, and obstetrics and gynecology.

Cunningham said the school would like to add programs for training certain specialists, including OB-GYNs and neurologists. He said those specialists could help treat many of the health problems in the region.

But current economic conditions are hurting that effort, Cunningham said.

Slump stymies growth

Several years ago, the state legislature gave ECU and UNC-CH the go-ahead to expand their medical school enrollments. Then the recession hit, and neither school has had the money to hire professors, add teaching space and make other adjustments necessary for major expansions. Still, Cunningham said, ECU has increased its enrollment from 72 students to 78.

"We can't go beyond 80," he said, noting that expansion plans called for ECU to have 120 medical students. "We're not going to expand under the current economic circumstances."

Instead, he said, other urgent needs are being pressed. Top among them is a request to the state legislature for a $3 million funding increase to offset losses in revenue from patients' care.

Seventy percent of the school's budget comes from fees patients pay when they visit ECU's network of doctors and clinics.

Because so many of the patients are poor, revenue is falling short.

"We have to work harder to generate those funds than if we lived in a more well-heeled part of the state," Cunningham said.

He said economic recovery has not yet spread to most of Eastern North Carolina, and that translates into worsening health conditions. People are waiting longer to see their doctors, often not showing up until their conditions are serious and much more expensive to treat.

"It's keeping us incredibly busy," he said.

sarah.avery@newsobserver.com or 919-829-4882

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