What It’s Like Being The Only Doctor In A Rural Mountain County

This story originally aired in the December 19, 2024 episode of Inside Appalachia.

An urgent care center closed in November in Patrick County, Virginia, spotlighting growing challenges in staffing for rural healthcare providers.

Dr. Richard Cole was born and raised in Patrick County. He knew he wanted to be a doctor by age 5 and started practicing in the mid-1980s. In 1991, he founded Patrick County Family Practice. Three and a half decades later, at age 70, he’s still going. And he’s as busy as ever.

“My wife says it seems like over 100 hours a week. It’s hard to ever be totally off. The tasks and phone requests never stop,” Cole says.

Patrick County is a rural Appalachian county, home to a little more than 17,000 people. Cole is its only doctor. He’s seen ups and downs over the years. 

Things got a lot harder after 2017 when the county hospital closed after its owner, Pioneer Health Services, went bankrupt. The closure came after years of financial troubles. 

In response, Cole started Patrick Urgent Care in 2020. The urgent care offered longer hours, an X-ray machine and lab work. The COVID-19 pandemic hit just a few months after it opened, leading to a surge in patients.

“During COVID, the urgent care was thriving,” Cole says. “We were getting overrun. At one point, we had 90 patients coming in there the same day with two providers.”

Cole wasn’t just providing medical services. He managed the finances at both the urgent care and the family practice. He partnered with an accountable care organization and moved to make the practice a Rural Health Clinic to keep it in business. 

There was another problem facing rural health care providers that Cole couldn’t overcome: the challenge of keeping staff.

“In the end, we lost our nurses and we lost our providers who resigned, and we couldn’t replace them fast enough,” Cole says. “So we ran out of personnel, was the reason we closed.”

So in November, the urgent care announced it would close for good. The news came as a blow.

The closure comes as rural Appalachian communities are experiencing a shrinking number of healthcare options. 

Since 2005, more than two dozen rural hospitals have closed in the region. That doesn’t include smaller clinics and other providers. This year, Augusta Medical Group announced it would close three Virginia facilities after Congress passed the One Big Beautiful Bill Act, which changed how healthcare providers are reimbursed for Medicaid patients.

As healthcare providers pull back, rural communities are feeling the effects.

“For rural communities and in Patrick County, any kind of reduction of workforce and closure is difficult to swallow,” Rebecca Adcock says.

Adcock, executive director of the Patrick County Chamber of Commerce, has seen the loss of health care infrastructure just since she moved to the area in 2008.

“The hospital was open [then], we had some other medical facilities available, a couple more dentists than we do now,” Adcock says. “Patrick County Family Practice is the only medical facility doctor’s office in Patrick County.”

But the closure of the urgent care facility isn’t the end of the story. 

Cole may be Patrick County’s only doctor, and the family practice the only stationary doctor’s office. But there’s a free clinic for uninsured and underinsured patients, and a mobile facility that tries to meet people where they live. 

And there’s still talk the hospital could reopen after being closed for eight years now. After a previous company failed, Braden Health bought the hospital building in November 2024. It’s working on the empty facility and trying to win regulatory approval to reopen it. Braden Health CEO Larry Henson was on site recently, but he declined comment.

Meanwhile, Cole is making moves of his own. 

Currently, Patrick County Family Practice has about 38,000 patients — more than twice the population of Patrick County. They travel from nearby counties in Virginia and North Carolina, largely out of loyalty to Cole and his staff. About half are Medicare or Medicaid recipients, and it’s still unclear how pending changes from the One Big Beautiful Bill Act could affect them. 

Since the urgent care closed, the family practice is offering expanded hours. And it’s moving to hire additional nurses and other staff.

“It’s myself, I’m the only doctor in the county,” Cole says. “We have two physician assistants and five nurse practitioners. We have two nurse practitioners hired that are waiting to get all their credentials. So I have a new doctor coming in August of 2026, I have a doctor coming three years from now, one maybe in two years, one for sure in six years, one maybe in five years.”

Once more of those providers arrive, Cole plans to reopen the facility that housed the urgent care facility as another rural clinic that will be called Stuart Family Practice. As he sees it, the future is bright.

“I’ve never seen so much interest in young doctors wanting to come here and practice,” Cole says. “It opens up the door for me to finally retire.”

But even at age 70, that decision still seems a ways off.

“I’m hoping to gradually kind of slow down,” Cole says. “I’m fine right now indefinitely. I still enjoy the practice.”

So for now, just as he has for 40 years, Cole continues to serve the people of Patrick County and nearby communities.