North Carolina’s healthcare access challenge is, in part, a workforce challenge – but simply training more providers is not enough. We also need clinicians who understand and are committed to the communities they serve.
That distinction matters as colleges and universities consider their role in addressing one of the country’s most persistent workforce challenges. Demand for physician assistants (PAs) continues to grow rapidly: North Carolina is projected to add approximately 2,150 PA jobs between 2024 and 2034, a 24% increase, with roughly 700 openings each year. Nationally, PA employment is projected to grow about 20% over that same period.
With an existing 76-student PA program at its main campus in Alamance County, Elon University is opening a new PA track in Charlotte – historically the largest city in the United States without graduate PA education – which plans to welcome its first class in January 2027, pending accreditation-provisional review by the Accreditation Review Commission on Education for the Physician Assistant. Going forward, the university is preparing to educate cohorts of 76 PA students in both locations – substantially increasing its capacity to prepare clinicians for North Carolina and beyond.
But increasing the number of graduates alone will not solve every access challenge. Higher education has an opportunity to think more broadly about what it means to build a healthcare workforce for a particular place.
I have seen that firsthand in Charlotte. The region is growing rapidly, with major health systems expanding alongside its population. Yet access to care remains uneven.
A 2026 Mecklenburg County Public Health report found that 45% of adult Medicaid members studied had not had a primary care visit in the prior year. The county’s recommendations include increasing the supply and capacity of primary care teams while building stronger connections between those teams and community-based organizations.
Those two recommendations belong together – and that philosophy has helped shape our PA program in Charlotte.
That connection matters in practice. A clinician may diagnose hypertension or diabetes in an exam room, but a patient’s ability to manage that condition can depend on factors well beyond it: housing stability, transportation, food access, insurance, behavioral health resources or simply knowing where to turn for help. Preparing tomorrow’s providers therefore requires us to teach not only clinical medicine, but how communities actually operate.
In Charlotte, community engagement is intentionally built into the educational experience. Students will work with nonprofit and community organizations like Camino, Care Ring, Crittenton of North Carolina, NAMI Charlotte, RAIN Carolina and Veterans Bridge Home that address the health, social and community needs of Charlotte. In these experiences, our students participate in faculty-guided projects that might involve data collection, policy development, quality improvement or other community-identified initiatives.
We want future PAs to understand what resources exist outside a hospital or clinic, how those organizations serve residents and how clinicians can connect patients to them. Just as importantly, we hope students develop relationships with these organizations that continue long after a course ends. In my view, the strongest clinicians should be prepared to become advocates, collaborators and leaders within the communities where they practice. That is the kind of clinician – and the kind of neighbor – we are preparing them to become.
Where students train matters, too.
PA education is inherently tied to clinical experience. Our Charlotte students will ultimately spend a full year completing clinical rotations, drawing on a network of more than 800 placement opportunities that include major regional health systems and other clinical partners, with our hope being that students choose to continue their career in the region post-graduation. When students train in a community, they learn its healthcare system, build professional relationships, invest personally and begin imagining a future there.
For colleges and universities, the lesson extends beyond PA education. Workforce development is most powerful when institutions ask not only, “How many graduates does this region need?” but also, “What does this community need those graduates to understand?”
If we get both questions right, a new academic program can become much more than another pipeline of degree-holders. It can become part of a community’s health infrastructure.
Veronica Marciano, DMSc, PA-C, is the founding chair and program director of Physician Assistant Studies at Elon University’s Charlotte campus.
