Monitoring the Workforce Outcomes of North Carolina Medical School Graduates: Retention In State and in High Need Geographic Areas and Specialties

By Evan Galloway, Erin Fraher, Nathan Tarr, Catherine Moore, Hugh H. Tilson Jr.

Aug 14, 2026

The full text of the report will be available soon

Executive Summary

In 1993, the General Assembly required the University of North Carolina’s Board of Governors to submit an annual report to the legislature on the number of North Carolina (NC) medical school graduates going into primary care. Since 1994, the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill (“Sheps Center”) and the NC Area Health Education Centers program (AHEC) have collaborated to produce this report which tracks the number of students practicing primary care in rural NC five years after graduation from an NC medical school. As a result of the legislative mandate, NC is a national model for tracking medical student outcomes.

As in prior years, this report summarizes the Sheps Center’s analysis of the workforce outcomes for physicians who graduate from the state’s five medical schools, including whether they practice in North Carolina, in rural areas, in high-need specialties, and in NC safety net settings¹ five years after graduation. Appendix B details data collected by the NC AHEC on each medical school’s efforts to increase the number of graduates practicing primary care in rural NC. Appendix C reports on AHEC’s on-going efforts to establish a “Pathway to Primary Care” in NC.

Historically, this report examined NC medical school outcomes five years after graduation, per the legislative mandate. However, this period is not ideal because the time required to complete residency after medical school graduation ranges from three to more than six years for different physician specialties. At five-years post-graduation from medical school, physicians in psychiatry, obstetrics & gynecology (ob-gyn), surgery, and medicine/pediatrics are just completing residency, or may be in fellowship/specialty training, and may not have settled in a permanent practice location. Thus, although not required by the legislature, this report also includes ten-year outcomes for the 2015 cohort. The Campbell School of Osteopathic Medicine graduated its first class in 2017, so they are included in the outcomes measured at 5 years but not 10 years.

Analyses of the five-year outcomes of NC class of 2020 graduates and ten-year outcomes of NC class of 2015 graduates show:

• Of the 614 NC medical school graduates from the class of 2020, 201 (33%) were retained in NC, 69 (11%) were in practice or training in primary care in NC, and 10 (2%) were in primary care in a rural NC county in 2025, five years after graduation.
• Of the 463 NC medical school graduates from the class of 2015, 179 (39%) were retained in NC, 58 (13%) were practicing primary care in NC and 8 graduates (2%) were in rural primary care in NC in 2025, ten years after graduation.
• UNC-CH and ECU retained the largest proportion of 2020 graduates in practice or training in NC in any specialty after five years (41% and 36%, respectively), followed by Wake Forest (31%), Duke (28%), and Campbell University (27%).
• ECU and UNC-CH had the largest proportions of 2020 graduates practicing in primary care in NC five years after graduating (16% and 15%, respectively). From this cohort, UNC-CH contributed 25 graduates to the state’s primary care workforce, followed by Campbell with 15 and ECU with 12.
• Across both the 2020 and 2015 cohorts, 10 graduates were practicing or training in safety net settings (5 from each cohort) that deliver care to uninsured, Medicaid, and other vulnerable populations five and ten years, respectively, after graduation.
• Among graduates practicing primary care in NC, 32% of the class of 2020 (22/69) and 16% of the class of 2015 (9/58) worked in a practice location in the most economically distressed areas of NC five and ten years, respectively, after graduation.
• Four 2015 graduates were in practice in general surgery in NC ten years after graduating, but none had a primary practice in a rural county. Ten graduates from the same year were practicing psychiatry in NC ten years later, with none practicing primarily in a rural county.

It is important to consider this report’s finding that relatively few NC medical students end up in primary care specialties and rural areas in the context of broader workforce trends in the US. National data show a declining proportion of medical school graduates and residents entering primary care careers.² Also important for contextualizing the findings is the fact that a physician’s training pathway is long; medical school is just one component of a physician’s training that shapes their career trajectory.

Where a physician completes residency training is a better predictor of where they will end up in practice than medical school location.^3,4 Physicians who complete residency training in rural areas and community-based settings are more likely to choose rural, primary care careers.⁵ The number of graduates of North Carolina residency programs increased from 1,145 in 2017 to 1,264 in 2019. On average, just 37% of these graduates were retained in active practice in NC five years after graduation and 3% were in rural communities.⁶ However, nearly 65% of “double” NC educated/trained physicians were retained in-state after five years, underscoring the return on investment of building in-state pathways from medical school to residency training.

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