For 36 years, the North Carolina Medical Society Foundation’s (NCMSF) Community Practitioner Program (CPP) has worked to improve access to quality health care for the state’s most vulnerable residents. By providing educational loan repayment grants to physicians, physician assistants, advanced practice nurses—and now behavioral health and maternal health clinicians—CPP enables practitioners to serve in rural and underserved communities where access to care is often limited.

Founded through the foresight of a small group of clinicians, CPP has become a cornerstone of rural health in North Carolina. Hundreds of clinicians have used the program to establish and sustain practices in remote communities, providing thousands of patient visits each year. Most CPP patients are uninsured, underinsured, or Medicaid beneficiaries; without CPP-supported clinicians, many would have no access to continuous primary care close to home.

Dr. Christian Lige exemplifies CPP’s impact. Burdened by significant educational debt, he wanted to practice in a rural area but could not have done so without CPP, saying that “Without the grant from CPP, I wouldn’t be here.” Today, Surf Pediatrics and Medicine in Kill Devil Hills serves more than 32,000 patients annually, has grown from one clinician to more than ten, and now offers pediatrics, family medicine, and full-access urgent care.

Loan Repayment and Practice Support

CPP participants commit to five years of service in a rural or underserved area in exchange for loan repayment assistance. The program reimburses half of a clinician’s outstanding educational loan balance, up to $100,000. Historically, the average award was $38,000; for the current cohort of 40 participants, the average is $51,000, reflecting rising education costs.

CPP’s support extends beyond loan repayment. Over 36 years, the program has provided funds for moving expenses, continuing education, training, and essential equipment. In total, 551 participants have been awarded approximately $18 million in grants, generating more than $800 million in free and reduced-cost care across 96 of North Carolina’s 100 counties. The current cohort alone benefits from an estimated $1.8 million in grant support.

One of CPP’s most valuable offerings is its consulting service. NCMSF practice improvement staff help clinicians navigate the increasingly complex business side of medicine, including electronic health record implementation, reimbursement challenges, value-based care arrangements, and evolving federal and state reforms. Annual CPP convenings further strengthen the network by fostering peer learning and shared problem-solving.

History and Evolution

CPP began in 1989 with a $4.5 million grant from the Kate B. Reynolds Charitable Trust. This investment allowed NCMSF to convene an advisory board of key stakeholders—including representatives from all North Carolina medical schools, North Carolina Area Health Education Centers (NC AHEC), the NC Office of Rural Health (NCORH), North Carolina Department of Health and Human Services (NCDHHS), and the North Carolina Medical Society—to design a program focused on educational loan repayment.

In 2006, CPP received an additional $10 million from the Blue Cross NC Foundation to establish a permanent endowment. Throughout its history, CPP’s mission has remained constant; CPP’s mission is to improve access to quality health care for uninsured and underinsured people, Medicaid recipients, and other vulnerable populations in rural and medically underserved communities.

CPP’s privately funded model complements state and federal programs by offering flexibility and responsiveness. While NCORH identifies community needs and navigates federal and state funding requirements, CPP can move swiftly to support clinicians and practices when public dollars are insufficient or delayed. As public funding streams have stagnated, CPP’s philanthropic stability has become increasingly vital.

Retention rates reflect CPP’s effectiveness: 63% of participants continue practicing in rural or economically distressed communities, and 79% remain in North Carolina.1 CPP, with the Cecil G. Sheps Center for Health Services Research, created the program’s first evaluation—using participant questionnaires and onsite visits—to support retention and identify strategies to increase participants’ success in practice. NCORH later adopted this strategy to measure successful retention. Close collaboration with NCORH and medical, physician associate (PA), and advanced practice nursing schools keeps recruitment costs low and ensures a steady pipeline of clinicians committed to rural service.

Growth and Impact

CPP’s reach has expanded significantly over time. In its first eight years, an average of 4 clinicians per year were added to the program, and in the ensuing 26 years, the program averaged 19 per year. Over the lifetime of the program, 551 clinicians have participated, including 341 physicians, 112 physician associates, and 98 advanced practice nurses. These clinicians represent 161 professional schools and 301 unique practice locations. Growth in PA participation mirrors the expansion of PA education in North Carolina, which now includes 14 programs. Emily Adams, President and CEO of the North Carolina Academy of Physician Assistants (NCAPA), notes, “The CPP program levels the playing field of career choices by providing loan repayment and authentic professional development.”

CPP has also played a critical role in disaster response. During the COVID-19 pandemic, NCMSF and CPP distributed $25 million to 638 practices for pandemic-related expenses. As Dr. Challie Minton of Surry Rural Health Center shared, “Without this assistance, the practice would not have survived.”

In 2024, CPP provided disaster relief after Tropical Storm Helene devastated parts of Western North Carolina. Hendersonville Pediatrics used CPP support to sustain operations during months of cleanup and reconstruction. Practice administrator John Yeatman said CPP’s assistance allowed them to “hold onto what mattered most: our commitment to the children and families of the community.”

CPP 2.0: Expanding the Mission

In May 2023, a $2.25 million donation from the Blue Cross NC Foundation launched CPP 2.0, expanding the program’s scope through four priorities:

  1. Improving access to care by extending loan repayment to behavioral health, maternal health, and women’s health clinicians, including psychologists, social workers (Master of Social Work), and psychiatric nurses.

  2. Strengthening clinician retention by supporting participants in NCORH incentive programs and offering scholarships to NCMSF’s Kanof Institute for Physician Leadership, as executive education has been linked to higher retention.2

  3. Increasing diversity by partnering with historically Black colleges and universities (HBCUs) and undergraduate programs serving minority students to expand the number of African American/Black, American Indian, Latinx/Hispanic, and LGBTQ+ clinicians entering CPP.

  4. Building workforce pathways through expanded precepting opportunities. From 2023–2025, CPP partnered with the Town of Manteo to establish a precepting hub across three Federally Qualified Health Center (FQHC) sites—Engelhard, Manteo, and Ocracoke—where medical and PA students live and train in the community. This hub was one of four statewide recipients of a three-year AHEC interdisciplinary teaching grant.

Looking Forward: Sustainability and Community Health

CPP’s future priorities extend beyond workforce placement to the long-term sustainability of rural practices and the health of the communities they serve. Its philanthropic model enables nimble, targeted investments that strengthen practice capacity and community impact.

CPP’s Carteret Mothers Project in Morehead City illustrates this approach. Since 2023, it has provided 330 nutritional food bags to food-insecure pregnant women and families, addressing immediate social needs while supporting maternal health.3

CPP is also exploring a multispecialty clinically integrated network (CIN) to help independent community-based practices share resources, align care, and prepare for more accountable models of care. This reflects a broader understanding of rural health sustainability: recruitment is essential, but lasting success requires operational resilience, community partnership, and attention to social determinants of health.

The NCMSF CPP Value-Based Care Accelerator Program further advances this strategy.4 Using NC Medicaid Advanced Medical Home Tier 3 as a baseline, the accelerator provides tailored assessments, technical assistance, workflow redesign, peer learning, and population health technology. The goal is sustained capacity-building—not one-time training—to improve reporting, care coordination, social needs screening, and readiness for multi-payer value-based contracting.

Conclusion

Rural North Carolina faces a complex landscape of policy shifts, funding challenges, workforce shortages, and technological demands. Value-based payment models offer opportunities to reward prevention and person-centered care, yet they also pose risks for small, under-resourced practices.

CPP’s philanthropic identity is central to its success. By combining flexible funding with cross-sector collaboration—NCORH, FQHCs, local health departments, hospitals, behavioral health organizations, and community-based service providers—CPP strengthens the underlying capacity of rural practices to meet both clinical and social needs.

For 36 years, CPP has been a lifeline for rural communities. Its evolution reflects a deep commitment to clinician support, practice sustainability, and community health, ensuring that North Carolina’s rural residents continue to receive the care they deserve.

Declaration of Interests

The authors have no relevant conflicts of interest. Perplexity AI was used to edit this article.

Financial Support

The authors received no funding for the preparation of this article.

Correspondence

Address correspondence to Franklin Walker, 222 N. Person Street, Raleigh, NC 27601(fwalker@ncmedsoc.org).