By Melissa Patrick, Kentucky Health News · August 24, 2026

A shortage of physicians in Kentucky reflects a worsening national trend over the last decade, and Kentucky, like the rest of the nation, is turning to nurse practitioners to fill the void.

According to the Association of American Medical Colleges,  within the next 12 years, the shortfall of doctors nationwide could be anywhere from around 39,000 up to 124,000.

Advanced Practice Registered Nurses (APRN) are experiencing an unprecedented rate of growth, according to the American Association of Colleges of Nursing. They can do much of what a physician can – order testing, diagnose and write many prescriptions independently. But in several parts of Kentucky, especially in rural areas, APRNs already fill the community’s need for a doctor – and they have done so for many years.

Flight nurse to APRN

Donna Isfort in Estill County is perhaps a perfect example. Her name can be found in the news over the years, winning awards like “Nurse Practitioner of the Year” or being otherwise honored for her dedication to rural healthcare in the foothills of Eastern Kentucky.

Isfort knows firsthand about the lack of medical coverage around those parts. She’s been a nurse for 41 years, with her background in emergency medicine. She was a flight nurse for the University of Kentucky Medical Center on a medivac helicopter for 15 years.

“I learned so much, and I was able to fly throughout the commonwealth, meet people from all different areas – from the EMS … to small and big hospitals,” she said. “I got a good understanding of what rural healthcare is like.”

Isfort said the team frequently flew into rural areas because patients needed a higher level of care than what was available there.

“Even though I worked in Lexington, I still lived in Estill County – born and raised here,” she said. “We had one doctor in town, and he was elderly. We have a small critical access that has 20 inpatient beds. There was a huge need here.”

Along with her husband’s buy-in, a paramedic himself, Isfort went back to school for her advanced nursing degree. To become an APRN, she benefited from her “tons of prior experience,” like working in the ER for years at multiple hospitals.

“I wanted to be a nurse practitioner, and my plan was to come back home to work,” she said. Then a medivac helicopter crashed in 1999 in Breathitt County, killing all four on board, and that really made her want to be back home.

Benefits of APRNs

Isfort’s first job back in Irvine, Estill County’s county seat, was at Marcum and Wallace Memorial, the local critical access hospital that had never had a nurse practitioner. “I sold it to them, told them all the value; their physician was getting overloaded and that slowed them down.”

She also showed them how APRNs are “revenue generators, and all the things we can do.” Becoming a nurse practitioner requires hundreds, sometimes thousands of hours of supervised clinical practice, along with board certifications, depending on the specialty. They can order and interpret diagnostic tests, diagnose and create treatment plans.

Eventually, Dr. Charles Terry talked Isfort into working for him at Estill Medical Clinic, in which he had practiced since 1967.

“He was getting older, in his late 70s, and he wanted it to be a rural health clinic, which has to have a nurse practitioner employed,” Isfort said, adding that she “came over the hill to the clinic,” which was beside the hospital where she worked.

She eventually bought the clinic from Terry, sealing the deal with a handshake, because as she said, “That is your word around here, ‘Let’s shake on it.’”

Speaking of “around here,” Isfort said it makes her think of some of the obstacles to recruiting doctors. “I think you have to want to be here, number one,” which can be a hard sell – to both doctors and patients – if someone isn’t from the area.

Estill County’s poverty rate is twice the nation’s at just under 21%, according to the last Census, meaning one out of every five people live below the national poverty line. Like other counties in the area, fentanyl and methamphetamine have wreaked havoc, and there’s a lack of jobs due to the lack of industry.

“Most newer graduates want to go to the big cities,” Isfort said, where they get better pay and are closer to the action. And really, she said, programs that send people to rural areas as part of tuition reimbursement don’t really work.

“You have to be vested in the area. And a lot of people – they have stranger anxiety. Sometimes they can be very slow to accept outsiders.”

Eastern Kentucky blazed APRN trail

The federal program Isfort is referring to offers tuition help to new doctors if they agree to practice in a designated “Health Professional Shortage Area,” or HPSA.

Kentucky is a major HPSA, according to the Health Resources and Services Administration. It says that more than 100 of the state’s 120 counties have severe shortages in primary care, mental and dental health, especially in the rural areas.

Estill County’s population was just under 14,000 at last count, and it relies on an incredibly small group of physicians. Listings say there are five to eight practicing doctors in the county, between the hospital and Mercy Health’s Primary Care Clinic.

So the APRN workforce is definitely supplementing the need – but the National Institutes of Health says this is nothing new. APRNs have been filling healthcare gaps in the Eastern Kentucky region for more than a century, “establishing a legacy that pioneered rural public health nursing for the entire United States.”

It all started in the 1920s, in “The Horseback Era,” with Mary Breckinridge riding through Hyden; then came The Frontier Graduate School of Midwifery in Hyden that Breckinridge started in the ’30s; up to the big nurse practitioner boom of the ’70s, establishing Eastern Kentucky as a primary training location.

The biggest increase of APRNs happened during the Covid-19 pandemic and since, according to the American Association of Nurse Practitioners, has nearly doubled in size nationally to over 385,000 providers.

“Listen, no one is going to ride in on a white horse and save our community – it has to come from within,” Isfort said.

She said she’s never received pushback about being a nurse practitioner as opposed to a doctor. “I’ve not heard any voices of concern. Of course, people know me here and know I’m willing to help,” she said.  And one of her promises to patients is, “If I don’t know the answer, we’ll find it. I have connections, and I have people we’ll call if I need help.”

Isfort says APRNs have a pretty intense set of guidelines and rules they must adhere to. “We’ve fought for so long just to get rid of the collaboration agreement. For years, I was paying thousands to have one with a physician who really didn’t do anything for me.”

Loosening the hold

The fight over the required collaborative agreement between APRNs and physicians has been ongoing even though organizations have stepped forward with APRNs over the years, arguing that the collaborations are unreasonably costly and actually work against the goal of expanding healthcare coverage.

APRNs have been able to prescribe Schedule 2 drugs, the highest level of legal painkillers, under the supervision of a physician, called a collaborative agreement, since 2006. It is a requirement that they have worked for years to eliminate.

Under a law that passed in 2023, Kentucky  APRNs who want to prescribe controlled substances independently must work under an agreement with a physician for four years before they can petition the Kentucky Board of Nursing for an exemption from the agreement. They must also have a current Drug Enforcement Administration registration and be registered with the Kentucky All Schedule Prescription Electronic Reporting system, or KASPER.

But if a physician retires, relocates or dies during the collaborative agreement,  the APRN would no longer have prescriptive authority – it is instantly frozen. Advocacy groups say these legal mandates force clinics to cancel appointments and turn patients away, and that it compromises patient safety over paperwork.

Expanding access to healthcare is a huge issue in Eastern Kentucky, which is affected by drastically higher rates of chronic diseases, including heart disease, COPD and cancer.

“And I don’t want to be political, but there’s a pay disparity between nurse practitioners and physicians,” Isfort said. “I can see a patient and bill for it,  but I will get less reimbursement than the physician does, while I’m doing a lot of the same things.”

For example, a doctor must sign for things like a pair of diabetic shoes, she said. “But he’s not examining their feet; I am. And we have to jump through all kinds of hoops – all kinds – just to get a pair of diabetic shoes.”

The Kentucky Coalition of Nurse Practitioners & Nurse Midwives has stated that these requirements, when restrictive, can actually harm patient care.

If the system wants more medical professionals in these underserved areas, the system could use a good overhaul, Isfort says. Some things are very frustrating, “but you have to learn to play the game, how to get authorization when your patient needs it.”

Isfort also serves on the board of directors for the Kentucky Nurse Practitioners Association, and recently returned from its conference in Louisville.

“Nurse practitioners have their heart in the game. The ones I know and share with, we have a passion for what we’re doing,” she said. “And no, we’re not physicians. If I wanted to be a doctor, I would’ve gone to medical school.”

Bobbie Curd is a freelance journalist based in Danville, Kentucky. Her stories appear in a variety of area publications, and her experience includes reporting and editing duties at both daily and weekly newspapers. This story is part of a package about health care issues in Eastern Kentucky produced with a grant from the Foundation for a Healthy Kentucky.