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A Rural Calling: For Brie Folkner, the Return to Spruce Pine Was an Arduous One [1]
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Date: 2025-02-20
Folkner oversees a small, independent family medical practice in this town of just over 2,000 residents in the Blue Ridge Mountains of Western North Carolina. When, on the morning of Friday, September 27, 2024, Hurricane Helene hit with a fury, she was at an American Academy of Family Physicians conference in Phoenix.
Having driven from the airport in Charlotte as near as possible to Spruce Pine, Folkner joined four others in trekking the final six miles or so up Peppers Creek Road, past “landslide after landslide … so much mud,” through “creeks that had become rivers and had just destroyed the road. Water up to here. It was crazy.” Downed trees. “So many trees.”
It was a journey of nearly six hours – a journey of a sort she could never have imagined when, pre-medical school, envisioning her life and career ahead.
“I never thought for a second that she would end up in Spruce Pine, North Carolina,” Benjamin Gilmer, rural fellowship director for the Mountain Area Health Education Center (MAHEC), said of Folkner.
Folkner was a Florida girl. She’d attended the University of Florida for both undergraduate and medical school. She came to North Carolina in 2009 for MAHEC’s family medicine residency program. It’s quite difficult to recruit health care providers to rural communities. Gilmer was certain she’d return to Florida.
He was wrong. Folkner stayed. In 2012, she moved to Spruce Pine. There, she met her husband, Eric Nutter, and opened her own practice.
“She discovered a community and felt a real compassion to serve,” Gilmer said. She’s served, and been embraced. “Her cultural competency is, really, completely post-residency competency. She didn’t have any of that before she landed there,” he said. “To set up your own practice in a rural community like that is challenging.”
The consequences of a hurricane on a community – among the hardest hit in the region – has underscored the critical role Brie Folkner plays here.
Difficult, but Rewarding
Folkner recalls, in the days immediately after the storm, the Red Cross director assigned to the area saying, “We’ve never been in anything this bad before.” Communication networks can be hit and miss in this remote region in the best of times. Now shut down – folks shut off from the outside world – that remoteness was vast.
Once reconnected with her family, Folkner, and her tightknit team, got to work.
Emily Tipton is a native of nearby Burnsville, a family nurse practitioner, and a MAHEC rural fellow gaining experience in Folkner’s practice.
Tipton was working in an eye surgery center in Asheville when she contacted Folkner saying she was interested in going into rural primary care. “And I was like, ‘Are you sure?’” Folkner recalled. “‘Do you really want to do this?’”
She soon learned of Tipton, “She’s passionate about it. She’s great at it.”
Now those skills were being put to true test. The local health care providers, with assistance from outside volunteers, began working out of fire stations and schools, opening ad hoc field hospitals, stabilizing patients with very little to work with.
“Someone went into respiratory distress,” Tipton said, “I was, like, ‘Oh, I have an inhaler in my car. I’ll use that.’”
She partnered with a Marine Corps operation, helicoptering into ever-more remote areas, advancing on foot, home to home, offering medical care and reassurance that folks weren’t forgotten.
Back in Spruce Pine, Folkner and the rest of her team were seeing all comers, “anyone who needed to be seen, ‘Just come.’”
Mornings, Folkner would see patients at the high school, then back to her clinic, then return to the high school in the afternoons when needed.
Such was the routine for more than a month.
Emma Nipp is a MedServ fellow, working as a medical assistant in Folkner’s practice. In July she will enter medical school. She’s a city girl, from Charlotte, who, like her mentors here, has been called to rural medicine.
“It was all so very emotional,” Nipp said of those weeks post-Helene. “It still is.” As a medical assistant, her job entails gathering information when a patient arrives. “I’m often the first person they would tell, ‘I lost my house; I’m homeless now.’”
“It’s been very hard, emotionally, having people I care about dealing with that,” she said. “It’s definitely reinforced my interest in rural care.”
Cultural Competency
Eric Nutter tells of when his future wife first arrived in Spruce Pine – how some of the older men would ask, “Have you guys seen that new young doctor?”
“They’d never seen anything like her,” Nutter said. “She rode her bicycle to work.”
In no time, though, she was among the fold. The not-so-secret secret, Folkner and Tipton agree, is to just treat everyone with respect, and to respect cultural traditions.
“I also just think you go into primary care because you love people, right?” Folkner said. “I just like people.”
Sue Wasserman, a local photographer and Folkner patient, is a proponent of pursuing non-medical solutions to health care. She’s found that doctors tend to be dismissive of alternative approaches. Not Folkner.
For example, “I don’t feel nuts when I talk to her about working with my acupuncturist on an issue,” Wasserman said.
Folkner is helping Wasserman lower her cholesterol. She suggested red yeast rice, but that didn’t help. They’re now trying Cheerios.
Folkner has proven that cultural competency can be learned. For Tipton, it’s innate. And in the aftermath of this storm, her dedication to her community has redoubled.
“Seeing the tragedies that everybody went through, and everything that they lost, has definitely made me more compelled to try to help them, in any single way possible,” she said.
Emily Tipton, from Burnsville, North Carolina, is a MAHEC rural fellow gaining experience in Folkner’s practice. (Photo by Taylor Sisk)
Tipton’s MAHEC rural fellowship helps facilitate that. The fellowship program is focused on developing both core competencies and particular areas of interest the fellows identify for themselves. Her project, still in its early stages, is helping improve emergency-management preparedness for her community.
Speaking Up
Running a rural, independent family practice presents, each day, new challenges. It requires doing a little bit of everything.
“When I was in med school,” Folkner said, “I remember a psychiatrist I did a rotation with said, ‘If you want to do primary care, you better learn psych.’ And I was like, ‘What?’ He was right.”
As her community incrementally recovers, that skill has been of the essence.
Challenges, yes, but Folkner will assure you the rewards of a rural practice are many – finding community primary among them.
And: “I don’t have a boss,” she said. “Nobody can tell me what to say or not to say” – which is important because, she believes, what ails our nation’s health care system can only be fixed if providers take the lead.
“I believe that the only way to truly improve health care is for more physicians to be in independent practice so that you do have a voice.”
Benjamin Gilmer calls Folkner’s experience at Spruce Pines the “ultimate example” of a rural provider seeing a need, meeting it, and venturing beyond. “It really requires a lot of courage.”
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