A global shortage of healthcare workers looms on the near horizon. The World Health Organization estimates a deficit of 11 million providers by the year 2030—an astonishingly close five years away. In Western North Carolina, HCA Healthcare North Carolina Division/Mission Health is tackling this challenge with a bold, practical solution: pay-to-learn workforce programs that remove traditional barriers to entering the medical field.

Mission Health now offers two fully paid, accelerated pathways into frontline care roles: a 12-week Medical Assistant (MA) program and a 6-week Certified Nursing Assistant (CNA) program. Both hire students as employees from day one, pay them during their training, and create a direct, supported pipeline into healthcare careers. Alongside these programs, Mission partners with MAHEC on Graduate Medical Education, supplies adjunct staff to area nursing schools, pays for teaching positions, and offers tuition reimbursement for ongoing education. Together, these initiatives help build—and retain—a local workforce at a time when the region needs it most.

Removing the Burdens

With a typical MA certification program lasting between 18 months and two years, time investment is a major burden for many considering a career in healthcare. The expense is also a concern. For recent MA program graduate Veronica Huerta, the pay-to-learn model made a career shift possible. 

“One of the obstacles for me was definitely monetary,” Huerta said. “I was concerned about how I was going to pay my bills or just make sure that everything was taken care of and also go back to school. Being paid changed everything for me. It gave me that chance to focus fully on the program without needing a second job or a supplementary income.”

Similarly, Mission Health was given accreditation by the State of North Carolina to facilitate a certified nursing assistant (CNA) training program at both Mission Hospital and Highlands-Cashiers Hospital. The program allows individuals to be hired as patient safety attendants and earn a salary while completing six weeks of rigorous, accredited CNA training at Mission Hospital or Highlands-Cashiers Hospital. All program expenses, including scrubs, testing fees, and training materials are fully covered.

Huerta, who previously spent five years in sales, was searching for a meaningful career change when she found the MA Apprentice listing on Indeed. She wasn’t specifically looking for clinical work—she simply wanted a path into healthcare. 

She completed the 12-week program this fall and now works as a medical assistant apprentice at Carolina Spine and Neurosurgery Center in Biltmore Park. She will take her certification exam soon to officially become an MA. 

Community Benefits of the Pay-to-Learn Model

Michael Newman, Division Assistant Vice President at HCA Healthcare, worked with his team to design the innovative program. “There was just such a shortage of applicants applying for our positions,” he said. “When we were Mission Health before [HCA Healthcare acquired the nonprofit health system in 2019], we used to hire people not certified, and so we knew we could do it. Our physicians are just incredible, so the team of us got together and everybody worked on it. We're all going to need health care one day, so this is our future right here.” 

As Katie Higgins, practice manager at Mission Hospital, describes it, the program isn’t charity—it’s strategy.

“Financially, we're gaining something from it… we're paying for the schooling, we’re paying for them to work… but it can only benefit us and our community, even if they choose not to stay with HCA. We're pushing for more healthcare employees in Western North Carolina.”

Now in its second year, the initiative has already expanded to HCA’s West Florida division. Mission is working to grow cohort sizes, increase rural placements, and continue refining the model based on student feedback.

Maintaining Quality and Rigor in a Shorter Program

A common question: how can such short programs produce fully qualified professionals? 

Stephanie Crawford, practice administrator at Mission Hospital, says the answer lies in immersive, real-time clinical learning.

“It's essentially a 40-hour-a-week class with hands-on and skills [training in] a learning environment with a lot of patients with a preceptor by each student’s side so that they’re able to teach while they work,” she said. 

Students spend two days each week in class and three days in the clinic, supported by preceptors, clinic managers, and program leadership. They will also train in Mission’s high-tech simulation lab and participate in study groups that Mission plans to expand for future cohorts.

Crawford has been told by physicians that the MAs from this program were some of the best trained MAs they’ve worked with.

“You're pushed out of your comfort zone from the first day,” said Huerta. “Immediately. You hit the ground running.”

While the program prepares students for immediate, sustainable employment, Mission also views the MA and CNA tracks as gateways to larger goals. Many graduates are already planning for nursing, advanced practice, or other clinical degrees—supported by Mission’s tuition reimbursement.

“This was just the start for many of them,” said Crawford of the recent graduates. “This was just a stepping stone.”

Huerta plans to become an advanced practitioner and possibly a nurse. 

“I have been very vocal about how much I love the program,” she said. “I’ve had such a wonderful experience from the interview process to the support of the preceptors to the clinic that I'm in right now. You're getting paid to learn, and you're getting all the support to learn everything that you can.”

The Pay-to-Learn programs are one piece of a growing ecosystem designed to strengthen Western North Carolina’s healthcare workforce—from entry-level positions to advanced degrees. And while the model is still young, its early outcomes signal promise.

To learn more about upcoming MA and CNA training positions, visit MissionHealth.org/careers.