Small Town Roots and the Future of Nurse Practitioners
I recently had the privilege of seeing John Mellencamp perform live at Wolf Trap National Park for the Performing Arts in Virginia. It was a warm summer night, and I kicked back on a blanket on the lawn of the outdoor theater. As I looked up at the stars, Mellencamp began singing “Small Town.” The lyrics carried me into a moment of reminiscing about my own small-town beginnings.
I left Cortland, NY (population under 20,000) at 17 without any clear direction, certainly not planning to become a nurse or midwife. I drifted through Upstate New York and New England until, almost by coincidence—or perhaps fate—I encountered contemporary midwifery. That introduction changed everything, and I’ve been on this path ever since.
The Origins of Nurse-Midwifery and Advanced Practice
As Mellencamp continued singing, my mind wandered to the origins of nurse-midwifery and advanced nursing practice. Nurse practitioner (NP) history dates back to the 1960s, while midwifery reaches much further. Both trace part of their foundation to the Frontier Nursing Service (FNS), established in the 1920s by Mary Breckenridge in Hyden, Kentucky.
Working in the poor, rural communities of Appalachia, FNS nurses cared for patients where no doctors were willing to go. Breckenridge, trained as a nurse in the U.S., a midwife in England, and in public health in New York City, meticulously recorded outcomes. Her statistics showed improved health and reduced mortality rates, capturing national attention.
Today’s Rural Health Landscape
Fast-forward to today: NPs and certified nurse-midwives (CNMs) consistently demonstrate patient outcomes and satisfaction equal to or better than those of physicians. Meanwhile, doctors—especially specialists—continue to gravitate toward cities, leaving rural areas underserved.
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Rural areas have fewer than half the number of physicians per capita as urban areas.
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In the most rural settings, the ratio drops to about one-sixth the number of physicians compared to cities.
The National Conference of State Legislators (NCSL) warns that this shortage will only grow, predicting a need for thousands more primary care providers now and tens of thousands more in the coming years.
This is a gap NPs are uniquely positioned to fill.
NPs Are in Demand
I spoke with David Wolfe, owner of NP Now, a recruiting firm that places nurse practitioners nationwide. He told me that 80% of NP placement requests come from rural areas.
“Client demand [for NPs] is growing as doctors are harder to find, and many of the current ones are retiring in the next 5–10 years,” Wolfe said. While NPs with rural roots are helping meet the need, the predicted shortages mean local providers alone won’t be enough.
Why Now Is the Time
If you’ve been considering the transition from RN to NP, now is a great time.
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You are needed. Rural health care providers are in short supply.
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You are wanted. Communities are eager to welcome NPs into primary care roles.
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You are respected. The role now carries unprecedented autonomy and recognition.
Practical concerns also favor rural practice:
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Loan repayment: The National Health Services Corps designates many rural areas for loan repayment.
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Pay vs. cost of living: Salaries for NPs in rural areas are comparable to those in urban areas, but the cost of living is usually much lower.
Beyond the Numbers
Financial incentives are important, but there’s more to small-town life:
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A slower pace
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Shorter commutes
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Stronger community connections
For me, the pull of small-town life never fully went away, even if I haven’t returned to it—at least not yet. Who knows? Maybe one day I will.
And maybe you can go and “have yourself a ball in a small town.”
