#6 – From Policy to Practice: Healthcare Workforce Reform in Action

In this episode, host Josiah Irvin of Smith Anderson’s Health Care practice is joined by Wes Edwards, chief financial officer of MedFirst Primary and Urgent Care, and Smith Anderson attorney John Gibson for a discussion on the healthcare provider workforce and recent licensure reforms in North Carolina.

The conversation focuses on House Bill 67, newly enacted legislation aimed at addressing provider shortages across the state. The panel explores key components of the law, including North Carolina’s entry into the Interstate Medical Licensure Compact, new licensure pathways for internationally trained physicians, the pending licensure compact for physician assistants and expanded team-based practice models for PAs. 

Beyond the statutory framework, Wes offers an insider perspective on provider recruitment, retention and the day-to-day operational challenges facing primary care practices, while examining how these licensure reforms may reduce barriers to care, support value-based healthcare models and expand access for underserved communities.

Host – Josiah Irvin, Counsel, Smith Anderson
Co-host – John Gibson, Associate, Smith Anderson
Guest – Wes Edwards, Chief Financial Officer, MedFirst Primary and Urgent Care

Smith Anderson is a full-service business and litigation law firm serving regional, national and global companies. Our team of experienced health care lawyers are committed to guiding medical professionals, hospitals, health care facilities and industry organizations through the attendant changes and evolving regulatory environment. We advise on health care policy, legislative advocacy, executive strategy, mergers and acquisitions, privacy and data security, litigation and the complex business requirements of organized medicine. We have been integrally involved in launching innovative health care delivery initiatives such as clinically integrated networks, joint ventures between health systems and practitioners, Community Care of North Carolina and Accountable Care Organizations (ACOs) nationwide.

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Transcript

[Intro]

Welcome to Pulse on Carolina Health, a Smith and Anderson podcast focused on current healthcare trends and policy in North Carolina. In each episode, our host pairs up with industry executives and experts around the state to discuss where their finger is on the pulse of timely healthcare topics and to broadcast issues of importance that affect their business most. If you want to stay informed about the latest developments in healthcare law, policy, and industry trends, this is the show for you. 

[Speaker 2] (0:34 - 1:37)

Hello, and welcome to Pulse on Carolina Health. My name is Josiah Irvin, and I am pleased to be your host. I am an attorney in the healthcare practice group at Smith Anderson. 

I am pleased to welcome Wes Edwards of MedFirst Primary and Urgent Care. Wes is the chief financial officer of MedFirst, a North Carolina-based healthcare practice that provides complete family practice, primary care and urgent care services for patients of all ages, from the newborn to the elderly. MedFirst is a leader in providing high-quality, value-based care to rural and urban communities throughout the state. 

Joining me today as well is John Gibson, who is also a member of the Smith Anderson healthcare practice. Today, we are talking about recent professional licensure reforms in North Carolina and how these changes could impact providers on the ground, such as MedFirst. Wes and John, welcome to the podcast. 

Wes, can you talk a little about yourself? 

[Speaker 1] (1:38 - 3:26)

Yeah, I sure am, and thanks for having me on today. So like you said, I am Wes Edwards. I began my finance career as a uniformed military officer with a commission in the Air Force, and then after finishing active duty, I separated from the military and went to work for Procter and Gamble. 

So that P&G is where I kind of cut my teeth from a finance perspective. And then I left P&G in search of fame and fortune, I suppose, and working with smaller companies where I thought I could make a more immediate impact, and then began kind of in what I would call the middle market. Very shortly after transitioning from P&G into these middle market companies, found my way into healthcare to a publicly traded, Australian publicly traded pharmaceutical manufacturing company in what we call a CDMO business, which is a contract development and manufacturing organization. 

Did that for a few years, and then went on to do a role or stint as the chief financial officer of Avella Specialty Pharmacy, which is a private equity backed specialty pharmacy, a very interesting space within the healthcare ecosphere that sold to Optum, and then joined on with Paul Fennick, the CEO, and many great providers at MedFirst back in 2018, and I've been there as the chief financial officer ever since. So kind of a dyed in the wool, private equity CFO person, I suppose, just really trying to make an impact across all kinds of healthcare enterprises and currently trying to keep patients healthy and at home with MedFirst Primary Care.

[Speaker 2] (3:27 - 3:38)

You've had quite a journey throughout the middle market space. Can you tell me a little bit about MedFirst and what kind of business it is and where it comes from?

[Speaker 1] (3:38 - 5:41)

Yeah. So MedFirst was actually started by a chiropractor named Dr. Randy Shilsky, and Dr. Shilsky had a vision for a way to kind of bolster his chiropractic business through an affiliation with a primary and mostly urgent care group. So he started that group many moons ago in the Jacksonville, North Carolina area.

 It grew to several locations. He sold that business in 2016 to Severica Capital Partners, the private equity sponsor who owned the business up until August when it became part of CCNC, August of 2025. It is a very standard primary care business. 

Think of us as your primary care physician or provider group. We treat over 200,000 patient encounters every year. We have 27 locations across North and South Carolina, mostly in North Carolina.

Just really trying to get the best version of patients that we're able to through following their chronic conditions and keeping them healthy and at home, like I mentioned earlier. We are participating in a lot of value-based programs, which puts the impetus on a provider. And we've got wonderful providers that really are the pulse of our business, and they are the ones that interact with our patients to fulfill our mission kind of on the ground, but they do a wonderful job serving patients, serving our staff.

And so we're pleased to be in partnership with them. But in general, just a very center-of-the-plate primary care group that is, again, whose mission is to kind of find the best version of patients and to work with them and to keep them healthy.

[Speaker 2] (5:41 - 6:06)

Yeah, it's great work you guys are doing throughout the state, and you have locations in rural areas down the East and throughout the state in North and South Carolina as well. Can you talk a little bit about your provider, what kind of recruiting and how you are able to get providers into some of these locations that are more rural or hard to fill?

[Speaker 1] (6:07 - 7:59)

Yeah, absolutely. I suppose if we were just in the major metros in Raleigh and Charlotte and Asheville, recruiting would be fairly easy. We are in Keenansville and Richlands and some locations that are off the beaten path.

And so it is, recruiting can be challenging, but North Carolina has a lot to offer and our rural locations have a lot to offer. We are part of a great and supportive group that empower our providers to practice medicine autonomously. So that is a wonderful reason to join our group.

But first and foremost, providers care about patients, and so we extend them the opportunity to care for patients in the secondary markets. Most of them have some kind of affinity with these markets. Maybe they grew up in Eastern North Carolina or Western North Carolina, if it's our Morganton Clinic.

So they've got an affiliation. A lot relocate here to North Carolina because they've heard how wonderful the area is and it's growing. And of course, they hear predominantly about Raleigh and Charlotte, but when they begin the conversation with us, I think they find that there's a lot more opportunity outside of the major metros where MedFirst has many of its locations.

So it's a grind, but we've got a wonderful group of recruiting resources that help. And we're obviously always trying to get the word out with MedFirst about the many, many, many opportunities that we have. And if you're listening and you're a provider, www.thinkmedfirst.com, you'll find opportunities to partner with patients there.

[Speaker 2] (7:59 - 8:11)

That's right. Go work for MedFirst. And that leads nicely to our kind of substantive topic today. 

John, do you want to kind of give a background on the law and what was introduced? 

[Speaker 3] (8:12 - 9:16)

Sure. So North Carolina recently enacted a statute that has a lot of different factors to it, but really how we wanted to talk about it today was more focused to what's most applicable in MedFirst. But the overall goal of the law is to basically streamline, expedite providers to some of these areas we were just talking about throughout the state, both through licensure compacts for physicians as well as physician assistants, as well as supervisory flexibilities for physician assistants going forward, and getting internationally licensed physicians to some of these rural areas. 

So I think part of what we'd like to chat about today is some of the high level of what's included in the law and sort of hear from you, Wes, on how you see that working in a more kind of practical way of feet on the ground with the providers. So I think we can maybe just touch on some of the main pieces of the law and then kind of ask for Wes to comment, if that makes sense for everybody. 

[Speaker 2] (9:19 - 12:06)

Fair. That's right. Yeah. 

So Josh Stein, Governor Stein, signed this bill in July of 2025, House Bill 67, called it an Act to Enact, that's not very nicely phrased, an Act to Enact Healthcare Workforce Reforms in the state of North Carolina. And there's four main elements that kind of support healthcare professional licensure. I'll touch on two of them related to physicians. 

The largest one is North Carolina is finally joining the Interstate Medical Licensure Compact. This is an agreement amongst 40 states, and now North Carolina will be number 41, to share licensure amongst these states. And so it provides an expedited pathway for physicians in other states to become licensed in North Carolina, and by the same token, North Carolina licensed physicians become licensed in those other states. 

And basically you'll need to be fully licensed in the other state to come in, and then it'll be pretty streamlined. It'll be a streamlined process for becoming licensed in North Carolina, which obviously we think that would help North Carolina recruitment, but also maybe could have the other effect of leaving. And in terms of, you know, participating jurisdictions, interestingly, Virginia and North Carolina, South Carolina do not participate, so we can't, you know, work with them as much, but Tennessee and Georgia do, and then 38 other states. 

This is supposed to be effective January 1st of next year, or I think this is late release, January of 2026, and the medical board will be releasing more guidance. They haven't yet seen about this law. I'll quickly touch on the other physician element, which is the internationally trained physician licensure pathway. 

This is a new limited license that physicians can obtain. It's for internationally trained physicians who have a full-time job offer from a hospital or medical practice, such as MedFirst, in a county with less than 500 people per square mile, which is, interestingly, pretty much every county in the state outside the nine most densely populated. So pretty much the entire suburban and rural North Carolina, this would be available. 

And basically you would, you know, practice for a few years under this limited license, and then you could kind of go about your way. So it's an opportunity to encourage internationally trained physicians to join and join North Carolina. That will also start January of 2026. 

John, do you want to tell us about the other specific cases? 

[Speaker 3] (12:07 - 14:48)

Yeah. So there's a comparable physician assistance license, compact license as well, that basically facilitates the same way as the physician one does, where if you're in a compact state licensed, it streamlines getting licensed in North Carolina and vice versa. One thing to note on that, though, is if you're, say, you're a student, you're trying to get licensed to be a PA in North Carolina, that process is still the same. 

This is just a new process for out-of-state people in other compact states to kind of streamline that process. The compact as it stands today for PAs is smaller than physicians, so it's not as widespread yet, and it's not active in North Carolina until a sufficient amount of states that are in the compact are active, sort of generally phrased in the law. So we're going to be monitoring that for when it's actually up and running, and PAs out there can also monitor medical board, other type organizations that would update that kind of thing as well. 

But in general, it operates the same way as the physician compact does. And then one other sort of important PA piece under the law is the team-based practice updates to the law. You know, long story short, the purpose is to streamline practice for very experienced PAs that, you know, to simplify the supervision requirements that they would normally have to comply with. 

However, in order to fall under this team-based category, you have to have quite a bit of experience, thousands of hours of clinical practical experience, and a thousand hours of clinical practical experience within your medical specialty. And you also have to be working in pretty limited, we'll call them team-based settings. They either need to be medical practices that are owned by a majority of licensed physicians who also participate in the design, the provision of care, or you need to be with a hospital, clinic, nursing home, other facility where physicians have consistent meaningful role in designing the care delivery process. 

So if you think about that in more practical terms, if you're sort of a lone PA working at a multi-specialty hospital or something like that, and you're not regularly working with folks in your own specialty area, this team-based approach would not be available to you. You'd still need to have a supervising physician, etc. But that's a new flexibility as well. 

And I should also note that if you're a PA and you're in a perioperative setting, you still need your traditional supervising physician. 

[Speaker 2] (14:49 - 15:08)

So good flexibilities. I know being, you know, over, you know, starting in 2026 and then moving onwards, Wes, I know we, at first, you know, we hire a variety of types of providers. Have you guys, you know, begin to think about, you know, these opportunities in any way? 

[Speaker 1] (15:10 - 18:04)

Yeah, thank you for the question. Yes, but it's early, right? So we are, or at least I won't say we, I am really excited about, you know, flexibility to attract and retain providers, be they physicians, physician's assistants, or nurse practitioners to North Carolina with more flexibility. 

So it's very common for us to recruit out-of-state folks that don't have a license to practice in North Carolina and there to be an extended time period where they can't work, at least in our setting. I think maybe in some hospital systems, they're able to work before they, you know, with different supervision. But in our setup, you've got to, you have to obtain your medical license in North Carolina. 

That's an extensive process. And then you have to go through credentialing with payers, which is also an extensive process. So sometimes it can take months and months and months where we might extend an offer to a provider and then either accept it, understanding they've got to wait, or not be able to accept it because it's a little too uncertain for them. 

So this, you know, may not solve all those problems, but anything to, you know, tighten that timeframe where you can accept an offer and then begin meaningfully work at a practice, I think is great. Some of the flexibilities around the team-based care, you know, we have to dig into a little bit. You know, I'm a big fan of physician supervision. 

It's important for the physician. It's important for the physician assistant that is being supervised to have that avenue to get help when they have more complicated cases. So we certainly love that and practice that vigorously in our locations. 

But any flexibility to do that simply expands the ability for physician's assistants to provide services. And it's important now because we, while I read something or heard something that we graduated more primary care providers in 2025 than we ever have before. These are people that have graduated medical school and intend to go on in a residency program in primary care more than ever before.

But yet the shortage is greater than ever before. So we just don't have enough primary care physicians entering the workforce. And so what that means to me is that when you can expand the ability of a physician assistant, a physician assistant to be able to practice, that is a good thing for giving care to people that don't have access to a physician. 

[Speaker 2] (18:05 - 18:59)

Yes, yes. There's such a, you see this a lot in the news, you know, provider shortages, you know, primary care for a variety of reasons. And, you know, improving primary care access is so fundamental to, you know, all these value-based care initiatives and keeping patients in the home, like you said. 

And so it's great to see the state and working to address this. And, you know, hopefully we kind of reduce some of those licensure obstacles. I take your point, you know, credentialing, this isn't really addressing credentialing. 

So it's still, you know, have to think about how you minimize that time to a certain extent. What other kind of issues do you see, you know, in terms of this provider enrollment and support space over the next couple of years are kind of top of mind for MedFirst? 

[Speaker 1] (19:01 - 19:03)

Can you repeat the question? 

[Speaker 2] (19:05 - 19:20)

Yeah, of course. What other issues do you see as kind of top of mind for your providers, as particularly on the kind of the recruiting and workforce development avenues over the next few years? 

[Speaker 1] (19:22 - 23:25)

Yeah, it's, it is a, it's a grind. It is a grind because we are on a mission to provide more and better primary care, which means more interactions with patients. We've got this growing business where our patient enrollment is growing. 

And so keeping up with that from a provider count perspective is challenging. So we have to take advantage of all of the flexibility and opportunity that, you know, has been afforded. We haven't dabbled yet into the kind of the internationally medically licensed folks in a way that maybe some other bigger organizations have. 

That's just, you know, kind of not a matter of preference, just simply a matter of resources. But that may be something that we need to look at as well. But yeah, I mean, we are, it's kind of an all above the approach, all of the above approach, Josiah, in that we have to look at everything in order to staff the current vacancies that we have, as well as keep up with the new vacancies that we are creating as we expand, you know, offices. 

We grow from a practice in Tarboro that has two providers to a practice in Tarboro that needs four providers, which is a great problem to have, but it's a problem nonetheless. So just from a recruiting end perspective, I would say that is important. It kind of dovetails into the other much better half of recruiting, which is retention. 

So it is the ability to retain the folks you have. You know, I'm a big fan of people being allowed to grow and to bloom from a professional development standpoint. So I love when a provider comes into our office, works with us for several years, and has a wonderful opportunity to practice in a different organization or a different pathway. 

We celebrate those opportunities, while at the same time, we love to, we love providers to stay with that first. So we simply want to be the best place that they could work. And that way, if you can imagine what we talked about is the recruiting market is tight, which means that providers have many, many opportunities for every, you know, filled role that there is, there are others that remain unfilled, which means that we need to be very competitive. 

So we must pay well, we must treat our providers well, they simply have to really enjoy working and caring for patients with us, and we are not perfect. But, you know, we get feedback from our patients about our providers in the form of a net promoter score. So typically, a net promoter score is good for healthcare when it is above 55. 

In our business, our typical net promoter scores are above 75. And so what that means is we have far more people willing to provide good references for us than folks that don't enjoy their experience with MedFirst, which is great. And the reason that that's important to retention is because that means that providers are happy. 

Happy providers treat patients well. And so we need to continue on that journey to treat our providers and our provider support staff well so that they stay so that the retention problem or the recruiting problem is still there, but it is minimized because we've got great retention. So we are not full grown in that area. 

We do not have all the answers. But every day we have a dedicated team that's working, trying to make this place the best possible work environment for our employees so that they're willing to stay with us in the journey to to provide access. 

[Speaker 2] (23:25 - 24:01)

That's such a great point about connecting kind of workforce retention and development with, you know, a workforce satisfaction and job quality of life. And, you know, provider burnout is such a scourge on our industry. And, you know, you know what MedFirst is doing and other providers to kind of address the needs of their other folks, you know, kind of pays in so many different ways. 

I know we're kind of run up on time here. John, did you have any questions or topics you want to bring up before we close out? 

[Speaker 3] (24:03 - 24:22)

You know, I don't think anything really additional. This has been super, you know, really appreciate you coming on, Wes. It's been really informative to kind of hear the insider track. 

We see these things from a, you know, broad legal perspective. And it's it's nice to talk with you guys about the actual provider side of things. Absolutely. 

[Speaker 1] (24:23 - 24:39)

You know, I certainly appreciate the opportunity to talk about our business. We're very proud of our business. We're proud of our providers. 

We're proud of our provider staff and our wonderful patients. And so any opportunity that I get to represent them is a good day for me. 

[Speaker 2] (24:40 - 24:42)

Very nice. Thank you both for joining today. One process comment. We are recording this on December 10th, 2025. 

The Medical Board is expected to issue guidance on these topics. That has not yet. It may do so by the time this podcast has been aired. 

So just always be mindful of regulatory updates. Thank you again for joining us today on the Pulse podcast and have a good afternoon. Thank you. 

[Outro] (25:26 - 25:43)

Thank you. The views expressed in this podcast are those of the individuals only. This podcast is not intended as legal advice and does not create an attorney client relationship between you and Smith Anderson. 

If legal advice is sought, please contact qualified legal counsel.