Will UNCW’s Medical School Solve the Doctor Shortage?

The University of North Carolina Wilmington has initiated an ambitious project to establish a medical school intended to alleviate a severe shortage of physicians in rural and underserved areas of the state.

Existing state-based medical schools with similar stated aims have largely failed in that quest after years of teaching and hundreds of millions of dollars in state, federal and private spending.

Some health care experts caution it is unwise to continue creating four-year medical degree programs. Others insist a UNCW medical school, no matter how well intentioned, will have minimal impact on seeding physicians in doctor deserts. The skeptics say the physician deficiency won’t be cured without massive reform of regulatory frameworks.

UNCW cleared its first hurdle by gaining approval of the UNC System Board of Governors (BOG) on May 21 to “begin advance planning and study of the feasibility of helping remediate the ongoing physician workforce shortages in rural and southeastern regions of North Carolina.”

The BOG would have final approval of the medical school, UNCW spokeswoman Sydney Bouchelle told the Martin Center, but it will take time for the new program to earn the appropriate accreditation(s). A target date of fall 2029 or fall 2030 has been set for the first students.   

This effort to generate more North Carolinian medical students does not exist in a vacuum. Exhaustive data from UNC’s Cecil G. Sheps Center for Health Services Research 2025 annual report to the General Assembly reinforces the dilemma of North Carolina medical schools not significantly impacting the state’s physician shortage, most notably in rural and low-income areas, despite huge outlays of public money.

“In summary, out of the 628 medical school graduates from North Carolina’s five medical schools in 2019, 10% were in training or practice in primary care in NC in 2024 and less than 1% were in primary care in a rural county five years after graduation,” the report stated. 

“Both the percent of medical graduates practicing in primary care and in rural areas is lower than in previous years. A greater percentage of graduates from the state’s public medical schools are retained in NC five years after graduating, compared to the state’s private medical schools. Four graduates practiced in safety net settings and 3% of the class of 2019 worked in practices located in the most economically distressed neighborhoods in North Carolina.”

Against that dismal backdrop, the Cicero Institute projects 120,000 too few doctors nationally by 2030. North Carolina is expected to fall short by 7,725 doctors, with 1,885 of those in primary care. Yet, there are only 506 residency slots in primary care allotted annually to North Carolina, and nearly half of those residents will end up practicing out of state.

However, Shaheen E. Lakhan, a physician-scientist and former founding dean of a medical school, rejects the prevailing remedy to physician shortages.

“[T]he current rush to open new medical schools without commensurate investment in residency training is a misguided strategy that will fail to resolve the shortage,” Lakhan wrote in a 2025 editorial. “Unfortunately, establishing a new medical school is far easier (politically and financially) than expanding residency programs.” 

He advocates that states tie the number of medical school positions to a comparable number of Graduate Medical Education (GME) slots — the training that medical school graduates receive through residencies that is required before they can be licensed to practice. 

This shortage in residency positions, which are largely funded through Medicare, is a major obstacle to reform. Congress capped Medicare-supported residency slots in 1997, creating a bottleneck that many experts argue limits the physician pipeline. The Resident Physician Shortage Reduction Act of 2025, H.R. 4731 and S. 2439, would increase Medicare-supported residencies by 14,000 positions over seven years, prioritizing rural and underserved areas and recently established medical schools.

“The workforce is suffering from too many medical students not practicing after graduation,” said Congressman Greg Murphy, M.D., a member of the House Ways and Means Committee, referencing a critical shortage in rural areas. “Should Congress appropriate additional funding for new GME slots, I believe we need to consider where the country’s areas of need are, as well as which specialties are in short supply.”

“Is UNCW’s medical school going to change anything? That would be a tough one,” said Chris Shoffner, a North Carolina health care fiduciary.

“I think in the general sense, opening up a new medical school and giving more places for people to train is a good thing because we do have a shortage of physicians and we’re not producing enough physicians,” Shoffner said. “But it’s the way they’re being trained in medical schools that’s part of the problem.” 

According to Shoffner, the disparity in earning potential between specialist fields and primary-care practice is a bedrock impediment to addressing primary-care shortages. Medical schools predictably churn out more specialist track graduates and far fewer primary care students as a result.

“There’s certainly a need for all the great high-tech that you do, but we’ve done it at the expense of basic access and basic services, and that’s flipping a pyramid on its point,” Shoffner said. Instead, he argued that the base of the health care pyramid should be a primary care provider to diagnose illnesses, perform preventive care, treat and manage chronic conditions on the front end to reduce reliance on expensive hospital specialists later.

“In my lifetime, the Brody School of Medicine [at East Carolina University] hasn’t done anything to improve health in Eastern North Carolina” while spending significant public money, Shoffner said. The Martin Center examined that issue in 2019. Nothing will change until the payment structure is reformed to make a rural, independent physician practice economically viable. But Shoffner is pessimistic that the will exists to create such a sea change.

What North Carolina doesn’t need is more of the same lackluster results. If the architects of the proposed UNCW School of Medicine genuinely want to solve the state’s dearth of providers, they must design approaches and methods that shatter the misaligned mold.

Dan E. Way is a career journalist, investigative reporter and newspaper editor whose work has appeared in a wide variety of local, state and national publications.