How Many Healthcare Professionals Work in Communities in North Carolina Impacted by Hurricane Helene?

By Catherine Moore, Connor Sullivan, Evan Galloway, Abhi Joshi

Jan 31, 2025

In September 2024, Hurricane Helene devastated many counties in North Carolina (NC), especially those in the western part of the state. The Federal Emergency Management Agency (FEMA) designated Hurricane Helene disaster areas in 28 North Carolina (NC) counties, making them eligible to apply for individual and public assistance for both emergency work (to be completed within six months) and permanent work (to be completed within 18 months) (these counties are indicated by shading in Figure 1). In this blog, we examine the health care workers located in areas impacted by Helene. We also provide an overview of regulatory waivers implemented by the state and licensure boards in response to the hurricane.

Figure 1. Federal Emergency Management Agency North Carolina Disaster Declaration

What was the 2023 health workforce supply in the 28 NC counties prior to Hurricane Helene?

• Among the 21 NC healthcare professions within the NC Health Professions Data System (HPDS), 36,849 (15.5%) of the state’s clinicians were employed in Hurricane Helene FEMA designated disaster areas (Table 1).

• Registered nurses (RNs) comprised almost half of the actively practicing healthcare professionals in designated disaster areas (n=17,660, 47.9%) (Table 1).

• The physician workforce represented 10.5% (n=3,872) of healthcare professionals in designated disaster areas (Table 1).

• The top five professions with the greatest percentage of their workforce in designated disaster areas included: physical therapy assistants (n=755, 25.2%), occupational therapy assistants (n=480, 22.8%), the chiropractor workforce (n=452, 20.4%), certified nurse midwives (73, 18.7%), and dental hygienists (n=1,187, 17.9%) (Table 1).

Table 1. Healthcare Professions in North Carolina Hurricane Helene Disaster Areas, 2023

What was the 2023 health workforce supply in the 28 NC counties compared to population?

Most counties in designated disaster areas were underserved compared to state averages in 2023. The devastation of Hurricane Helene may cause additional shortages of healthcare professionals if clinicians are unable to return to active practice in previous practice locations.

• More than half of health professions in the HPDS (12 professions, 57.1%) had fewer health professionals per 10,000 (10k) population in practice in effected areas compared to the state rate of professionals per 10k population (Table 2, Figure 2).

• In three counties (Macon, Graham, and Caldwell), 20 of the 21 health professions had clinician to 10k population rates less than the state rate (Figure 2).

• Buncombe county was the only county in effected areas in which all health professions represented by the HPDS had a clinician to 10k population rate greater than the state rate (Figure 3).

• Registered nurses and physicians represent the two largest healthcare workforces in NC and therefore it is not surprising that these two workforces had the largest percentage of healthcare professionals in designated disaster areas. Given that some of the smaller healthcare workforces had a larger percentage of their professions in the disaster areas per 10k population compared with state rates (Table 2), we will monitor the potential decline in number of these smaller professionals post-Helene for impact to these workforces and the services they provide to the region.

Table 2. North Carolina Active Healthcare Professional Rates per Population, 2023

Figure 2. Number of Professions in County with Rate Lower than the State Rate per 10,000 Population, 2023

Figure 3. Number of Professions per County with Rate Greater than the State Rate per 10,000 Population, 2023

The potential for increased clinician shortages in post-Helene disaster areas will be met with a heightened need for care in effected communities. The types of care needed after a hurricane vary depending on the amount of time elapsed since the event, especially regarding impacts related to storm-associated flooding. Immediate care required may have included responding to traumas, drowning and hypothermia. The onset of infections during subsequent time after the event may require a different mix of health care professionals. Care in the longer-term will include responding to healthcare needs of the population related to routine physical health, mental health, oral health care, and management of chronic diseases. Thus, monitoring changes in the supply of all healthcare professionals in areas impacted by Hurricane Helene is essential.

How might state and regulatory board policies address issues in workforce supply?

Anticipating the impact of Tropical Storm Helene to the state, North Carolina Governor Roy Cooper declared a statewide state of emergency through Executive Order (EO) 315 on September 25, 2024. On October 5, 2024, EO 318 was issued to respond to recovery needs and relief efforts related to the impact of Hurricane Helene. Section 1(A) of EO 318 granted health care licensure boards the authority to create regulatory waivers, within certain criteria, to increase the supply of healthcare workers available to provide services during the declared state of emergency (SOE). NC Session Law (SL) 2024-51 created The Disaster Recovery Act of 2024 which was modified by SL 2024-53, The Disaster Recovery Act of 2024-Part II. Section 4B.3.(a) of SL 2024-53 also included additional waivers to NC healthcare clinician regulations. Section4E.1.(a)–(f) of the law authorized state agencies to exercise regulatory flexibility for employment-related certifications.

A review of NC occupational licensing board websites suggests six of the eleven boards in the HPDS implemented regulatory waivers in response to the Hurricane Helene SOE (Table 3). Regulatory waivers vary by profession and include one or more provisions to allow healthcare professionals to reenter practice or to practice with modifications to normal regulatory restrictions during the declared SOE. Some of these provisions include:

• waivers related to specific sections of collaborative practice agreements and/or quality improvement meetings and related documentation for advanced practice clinicians who require physician supervision to practice

• emergency limited licenses for out-of-state professionals to practice in NC during the SOE

• emergency reinstatement for retired/inactive licensees to reenter the workforce and provide care during the SOE

• authorization for relocation of pharmacies as needed to provide continued operations

• authorization for a one-time emergency refill for prescriptions

In addition to regulatory waivers for practice, the NC Medical Board website includes a resource that identifies medical practices in western NC in operation after the hurricane and the NC Board of Pharmacy website includes a resource with open pharmacies in effected areas (Table 3). These examples are not all-inclusive of regulatory waivers enacted during the emergency. Regulatory waivers vary in content and length of time before expiration depending on the profession and regulatory board.

Table 3. Hurricane Helene-Related Regulatory Waivers for Professions included In the NC Health Professions Data System