GALLUP, NM — About a year ago, Valory Wangler, a family medicine doctor, invited some former colleagues to her backyard.
During the early months of the covid-19 outbreak, Wangler and her colleagues worked at a former railroad center hospital of about 21,000 residents just a few miles from the Navajo Nation. The pandemic has plagued Rehoboth McKinley Christian Hospital. Federal emergency funding is dwindling and nearly a third of employees — including Wangler, chief medical officer — have left after the agency’s board hired an out-of-state for-profit managed services firm to take over operations in August 2020.
The group of former hospital staff in Wangler’s backyard that afternoon in June 2022, including two obstetricians and gynecologists and a chaplain, knew the situation was dire and wondered what they could do.
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Wangler said they realized “the most important thing we can do for the community is good access to primary care.”
The healthcare cliff faced by Wangler and her former colleagues is a challenge that has challenged dozens of rural communities over the past two decades.
By the end of 2022, the hospital had closed its labor and delivery departments, and lost most of its primary care physicians. Gallup’s McKinley County is recording the largest primary care provider deficit in rural New Mexico—and local doctors know it can lead to an increase in untreated conditions and patients seeking emergency services instead of preventive care.
As of July 11, 195 rural hospitals have closed inpatient units or closed altogether in the United States since 2005. Hundreds of other hospitals, like the one in Gallup, have cut service. Meanwhile, between 2006 and 2018, the total number of Federally Qualified Medical Centers and Rural Health Centers—outpatient clinics that receive federal funding to operate in health-deprived areas—increased about 50%, according to a 2021 study by the University of North Carolina-Chapel Hill. By 2019, 20% of rural residents receive care in such community health centers.
In response to the challenges facing their hospital, Wangler and colleagues gathered in her yard decided to open a doctor-led nonprofit clinic that was on track to become FQHC Look-Alike, an organization that met the FQHC eligibility requirements but received no funding. That status would qualify the clinic for a variety of federal aid including drug discounts. Since opening last August, Gallup Community Health has treated about 3,000 patients in a plastered office space just a block from historic US 66th Street. Many of the GCH doctors had come to Gallup from elsewhere and may have left town for more lucrative jobs. Instead, they decided to stay and try to fill the primary care gap.
“I have not seen [an FQHC] like this,” said Tim Putnam, lecturer at the University of South Carolina School of Medicine, former hospital CEO and former president of the National Rural Health Association. While it is rare, if not the first time, for doctors to lead their own FQHCs, he said, it is not uncommon to see FQHCs initiated by community groups, and at Gallup, “doctors are so committed to the community” that they are like a community group.
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Unlike rural hospitals, which are increasingly bought up by private equity firms and prioritize lucrative specialties to boost profits, these medical centers must provide primary care regardless of patient ability to pay and are overseen by a panel composed primarily of patients. But while clinics provide critical primary care services, the researchers note that they struggle to fill gaps in specialty and emergency care caused by hospital closures.
Marcie Richmond, one of the clinic’s family medicine doctors, came to Gallup for the same reason that appealed to many of her colleagues: “working with populations that may not get as much care.” She envisions more Gallup area service providers one day coming from the local Navajo and Zuni communities, but until then, she hopes to continue to provide “much-needed care to those who are victims of chronic injustice.”
The clinic’s interior reflects that concern: Indigenous children’s books like “Where Do You Get Moccasins?” and “We Sang You Home” fill the lobby, prints by artist Zuni Mallery Quetawki are displayed in the exam room, watercolors of nearby Red Rock Park and photographs of Canyon de Chelly hang in the hallways.
On a Thursday morning in April, Renie Lente and her sister, Elsie, waited for their date.
Elsie has cerebral palsy and lives in a nursing home; Lente is her caretaker. Lente had called the night before after she noticed Elsie’s foot had a fungal infection and the clinic was able to arrange for her the next morning with a doctor treating her entire family. The community clinic, Lente said, is a “huge change” from Rehoboth McKinley, where primary care providers have to deal with backlogs that send patients to the emergency department. After family medicine doctor Neil Jackson treated Elsie, creating space in the small clinic for both the sisters and nursing home staff, Lente noted that she appreciated how Jackson “treats you like family.”
“One of the things the staff commits to from the start is to do what’s right for the patient and calculate the finances afterwards,” says Wangler, the clinic’s chief executive officer.
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The clinic is open in large part thanks to community donations: Hospital systems across the state have donated equipment, Gallup residents have raised $30,000, and more than half of the doctors have volunteered their time or asked not to be paid until the clinic is up and running.
The group intends to provide some reproductive health care, but not prenatal care. Their clinic is not a hospital, so patients will have to give birth elsewhere. But by the time the clinic opened, Rehoboth McKinley had closed the labor and delivery department after every OB-GYN had left the hospital, forcing pregnant patients to transfer their care to the local Indian Health Service facility—a large hospital where many Native Americans can seek care but not all of them enjoy—or more than an hour’s drive away.
Doctors quickly began to consider what was needed to provide prenatal care. They want to at least help patients not have to choose between spending hours and money on gas to get to appointments and giving up prenatal care altogether. By November, the community had raised $24,000 to pay for prenatal malpractice insurance. And in the meantime, the clinic’s obstetricians and family physicians have developed a plan to deliver prenatal care while maintaining relationships with more distant hospitals where their patients can deliver.
Clinic leaders intend to stay open by applying to become a Federally Qualified Medical Center Look-alike. That would qualify for higher Medicare and Medicaid payments.
Clinic staff hope that providing quality outpatient care can reduce the number of hospitalizations and the need to travel for intensive care. One of the tools that helps GCH doctors provide that care is the University of New Mexico Health System PALS, a hotline service that connects doctors anywhere in the state with professionals who can answer questions about care outside of their practice area.
“There is a shortage of doctors everywhere and people really understand that it is very difficult for people to come from the countryside,” said Wangler, adding that experts are ready to cooperate and provide guidance.
Doctors like Jackson say Gallup’s tight-knit community makes them want to stay and try to fill primary care gaps. “All the people I’m working with here are really rooted in the community and will be here for better or worse.”
This article is supported by the Women’s Health Journalism Scholarship and thematic Journalism, with support from the Commonwealth Fund.
KFF Health News is a national health policy news service. This is an editorially independent program of the Henry J. Kaiser Family Foundation, not affiliated with Kaiser Permanente.
