When physicians off Route 66 saw their struggling community hospital hand control to an out-of-state, for-profit management company, they feared it was getting ready to close. With one third of the staff gone, a few gathered at a backyard meeting to figure out what to do. Knowing their patients had limited options, they worried primary care would be among their greatest needs. So the group decided to open their own primary care clinic. 

They chose to form a physician-led, nonprofit clinic, similar in legal structure to a federally qualified health clinic (FQHC) but they decided theirs would decline to receive grant funding. That choice would make their clinic eligible for multiple types of federal aid including drug pricing discounts and higher Medicare/Medicaid reimbursement as a rural health center treating a population of underserved patients. 

It may be the first FQHC led by physicians themselves, says Tim Putnam, a faculty member of the Medical University of South Carolina, a former hospital CEO, and a past president of the National Rural Health Association. He says FQHCs are usually started by community groups. They differ from rural hospitals in that they offer primary care, crucial preventative and early intervention to avoid later need for ER services. 

Since most clinics struggle to offer specialty care, and rural hospitals are increasingly being purchased by private entities that prioritize lucrative specialty care, the physicians at both realized they could work together for the benefit of all, especially the patients. 

According to July, 2023 data from the Sheps Health Services Research at University of North Carolina, 195 rural hospitals in the U.S. have closed so far in a trend that has lasted nearly 20 years. Hundreds more have cut services, such as closing birthing centers and wings for specialty inpatient care such as mental health, cardiac care, pediatrics, or orthopedics. 

Physicians taking the lead in their own center, directed by what they consider their patients' greatest medical needs, has had an empowering effect. They report the clinic has drawn in physicians who had lucrative offers elsewhere but wanted more rewarding work. At the clinic they get to care for populations they see as suffering medical injustice from a lack of sufficient services. Specialty physicians working elsewhere have willingly set up telemedicine consults to help out the clinic where they can. The collaboration, say the physicians, is key to their success.