For more than 50 years, Black River Family Practice in Burgaw has provided critical access to healthcare in a rural community. As a federally designated Health Professional Shortage Area (HPSA), Pender County has less than three primary care providers for every 10,000 residents, making activities that grow these ratios a priority.
Novant Health recently partnered with Black River, and in just a few short years, helped expand their facilities and the services they offer. It’s a significant step in growing healthcare access to the Pender County community, but the goal is to do even more. Black River has been working to become a Federally Qualified Health Center (FQHC), which would provide another significant boost to the services the clinic could offer residents nearby. However, more than a year after starting the process, the clinic’s application is at a standstill.
Building a sustainable future
Novant Health’s collaboration with Black River included a $2 million facilities expansion, completed in the summer of 2025. The number of exam rooms increased by 50%, pharmacy space was added, as well as a new learning and conference room.
These additions, along with Novant Health’s Rural Family Medicine Residency program that launched in 2025, created the area’s first rural family medicine interprofessional training site.
Research shows family medicine residents who spend 50% or more of their training time in rural settings were at least five times more likely to practice in a rural area than residents with no rural training.
That’s the goal of Novant Health’s program – help address the shortage of rural primary care physicians by creating a sustainable pipeline of physicians who train, and want to stay, in rural settings.
Seamless care, close to home
The inaugural track of residents at Black River is already bringing access to care closer to home for Pender County patients.
“I delivered a baby in the hospital at New Hanover, and now that they’re home, I’m taking care of mom and baby at Black River,” resident Dr. Hannah Hulshult said. “It’s really cool to have that continuity of care that we get here.”
Novant Health and Black River want to build on this connectivity in care by expanding prenatal services at the clinic. That would mean pregnant patients living in Burgaw wouldn’t have to travel to the next county for every prenatal appointment.
“Imagine having an expectant mother being seen here at Black River all throughout pregnancy and then delivering at Novant Health New Hanover Regional Medical Center and then coming back to Black River for follow-up appointments. Seamless care and close to home. So, it's a huge benefit,” said Dr. Joe Pino, senior vice president of Novant Health medical education.
One key to being able to provide that seamless care is becoming a FQHC.
Becoming an FQHC
Currently, Black River operates as a FQHC look-alike, a clinic where patients receive all the same care as an FQHC including:
- Offering a discounted or sliding fee schedule based on a patient’s ability to pay
- Offering comprehensive primary care services
- Maintaining a governing board that is made up of mostly patients
- Meeting other quality and reporting standards
Full FQHC designation from the federal Health Resources and Services Administration (HRSA) allows entities to access federal resources that support this work. In October 2024, Black River submitted its application to become an FQHC, but the usual months-long process has stalled, leaving the clinic unable to access federal support resources.
The Novant Health Center for Public Policy Solutions prioritizes simple policy solutions, like timely reviews of FQHC applications, to improve care access. Acting on an application can strengthen preventive care, better manage chronic diseases and help reduce hospitalizations in the community the clinic serves. Providing affordable, high-quality primary care also stimulates economic growth by creating jobs and making the area more attractive to potential employers.
The Center is now working to partner with lawmakers and federal agencies to ensure Black River’s application is reviewed and the clinic can open new pathways to care, protecting vulnerable groups and keeping care close to home for patients in Pender County.
