dear reader, this post is a love story - but not the kind you're thinking of. it's a love story of rural family medicine training delivering on its promises to rural America, to provide quality family doctors to small towns. i've often said family medicine is the only place in western medicine that still has a heart. this story will show you why i believe that.
it's well known that doctors tend to stay (live and practice!) wherever they train for residency, which is a big reason that organizations like the Rural Medical Training Collaborative dedicate time, resources, and energy to developing and sustaining high quality community-based training programs in rural hospitals across the country.
and although results are generally good - most programs have graduates each year who stay in the area - i believe MAHEC Boone's Family Medicine Residency is an anomaly of its own. ALL four of the 2024 graduates stayed in the area to practice: one is new faculty, one will practice primary care in a nearby mountain town, and two are opening their own practice with a current PGY3.
seven peaks family medicine is a brand new practice in the high country, set to open in 2025, and it was borne of the hopes and dreams of doctors who met in residency right here in the high country. in this post you'll learn why they chose rural training in the first place, and how western north carolina's appalachian mountains and the people in them captured their hearts. they knew they had to stay here - and now, they're bringing their dream practice to fruition. they will start as a private practice to get their feet wet, and later will become a rural health clinic which carries a special status enabling them to apply for grant funding. with this funding, they'll work on programs to address the needs of their patients in Ashe County, ranging from food insecurity to increasing access to healthcare.
i especially loved learning about their journeys towards rural family medicine training. Dr. Karimy's might be my favorite:
In my heart, I wanted to live in a small community, be an old-school doctor, have a farm, maybe even accept chickens as pay, and I thought that type of thing didn’t exist. When I did family medicine rotations in med school, it was in Connecticut. There, family medicine is just a referral factory for specialists. They don’t actually do anything. So I reached out to one of my mentors - she was a rural family medicine doctor - and I told her about my dream. I said “I’m really late to the game. Is this real? Could I do this?”
i'm trying out writing this one article-style. i hope you enjoy.
In January 2025, three physicians will open a brand-new practice to care for whole people, for their whole lives, in a small mountain town in western North Carolina. Seven Peaks Family Medicine will be a private practice in West Jefferson, part of Ashe County, just 30 minutes east of Boone. The three doctors met during their residency, the three-year long training doctors-to-be must undertake before they are able to practice on their own. Two graduated in July 2024, and one is in his final year of residency. Family doctors Toria Knox, Jessica Stevens, and Jason Karimy are living examples of a rural residency delivering on its promises to the mountain towns it was created to serve.
All three wound up in Boone for their training, but their journeys to rural family medicine were vastly different. Dr. Knox always knew she wanted to train near where she grew up - she is from Appalachia in Virginia, and her family is from Ashe County and Wilkesboro - but she felt pulled to Boone for reasons she couldn't explain. On a road trip in her fourth year of medical school, she recalls being pulled here: "I felt something in my soul when I drove into town." Dr. Stevens has called Boone home since graduating from App State, where she met her husband. Although she initially thought she wanted to be in Asheville for her residency, she realized in her final year of medical school that she wanted to re-engage with the community she'd been a part of during undergrad. Dr. Karimy perhaps has the most eccentric journey to family medicine: initially a neuroscientist, slated for neurosurgery at Harvard or Yale (arguably among most rigorous and demanding specialties in medicine), he realized he wanted to be a small-town doctor. He recalls: "I did a deep dive on my couch one night and asked myself what I really wanted. I wanted to live in a small community, be an old-school doctor. I thought: does that type of thing even exist?" He called a family doctor friend to ask if he was "too late to the game" to pursue this kind of dream. His friend connected him to Dr. Benedum, the program director of the then-new residency in Boone. Dr. Knox, who is now his practice partner, actually interviewed him for residency! Little did she know he would be her lifelong practice partner just three years later.
Family doctors Jessica Stevens, Jason Karimy, and Toria Knox (left to right), at groundbreaking.
Each of them wanted a practice that was full scope, focused on community needs - addressing food access and taking on projects and initiatives to improve health outcomes for patients. The idea for their practice was brewing in each of their brains individually before it spilled over and combined to create something so much greater. Seven Peaks was forged over group dinners of vegan sushi at each others' houses after didactics, realizing how each of their personal visions for their futures overlapped.
Dr. Karimy recalls: "I told myself if I was going to leave Connecticut to do family medicine, I was going to do it for a good reason. I was focused on the ways we live our lives that make us sick; and it's more than that, it's poverty, not having a consistent person in the community, all the turnover." He also remembers thinking, "If nobody does anything about preserving the rural way of life that I know is so beautiful, the whole world is just going to become one big city."
Dr. Knox always thought she would practice in Virginia, where she is from, because she knew first hand what it was like to lack access to a consistent family doctor. Her inspiration to pursue medicine was so that she could be the doctor her town didn't have: a doctor who stays, who knows you, your family, and is involved in the community.
Dr. Stevens was more reluctant about starting a practice. "I didn't want to do it. I initially wanted to partner with Dr. Karimy to do a program for food access, something to enable access and education to food and nutrition in a clinical setting." While studying at App State, she volunteered at the FARM Cafe in Boone, a place where everyone is fed, regardless of means, with nutritious and delicious food. She also worked for an organization that donated imperfect produce from supermarkets to low-income folks, and offered educational cooking demos of how to prepare the veggie for meals. When daydreaming about her future, she envisioned creating and working at an FQHC-look alike in Ashe County that would be affiliated with the Boone residency program.
Left: Dr. Stevens and Dr. Karimy representing the residency at a conference; Center: Dr. Stevens gardening; Right: MAHEC Boone, Class of 2024
But ultimately, they converged on the idea of creating a practice that would give them the freedom to pursue their dreams and meet the needs of Ashe. The structure of their clinic is very intentional. They rejected the FQHC model due to worries about emphasis on metrics and performance that would impair their ability to practice creatively and autonomously, and affect their ability to dedicate energy and resources to community-based projects. Initially, Seven Peaks will be a private practice clinic, but later, they'll transition to Rural Health Clinic status. This special status will give them the ability to pursue grant funding. Dr. Karimy is excited about this prospect: "With my research background, and all the granting I had to do for years, that's familiar to me. This is an opportunity for me to repurpose my skills I developed over those years, to fund programs that will help our patients." The doctors already have a long list of how they'd use grant money: supporting uninsured patient care, funding food boxes and vegetable prescriptions, and providing salaries for support staff, like behavioral health, dietetics, and social work.
If creating a practice sounds like a lot of work to you, the doctors certainly agree. "None of us had any money," says Dr. Stevens. They worried about the administrative burdens of running a practice, and learning the business and logistical aspects of how to create a practice, all while in residency was (and is) a lot of work! But they say it's a challenge worth conquering. "We are going to have the ability to structure our clinic the way we want to, and focus most on Medicare/Medicaid patients and sliding scale for cash-pay [uninsured] patients," comments Dr. Stevens. Under their self-designed practice model, they get to decide how many patients they see in a day and what metrics they decide to measure and focus on improving. They'll spend their excess time being involved in and finding ways to better serve their community. They've already started conversations with local farmers about partnerships to connect patients to nutritious local foods. "We trust each other. We want to take this on as a team. With that behind us, we feel ready to just go for it," says Dr. Karimy. They also emphasize that working towards a goal they all share is immensely satisfying - and makes the hard work worth it.
They don't just have each other to lean on, though - the support of the community has been overwhelming. "Our groundbreaking was the pinnacle moment, when we had family, friends, and the community come out to support us in person," recalls Dr. Knox. "There's a small town feeling in West Jefferson, and there's this energy to create and connect that you don't always see in Appalachian towns. They are always celebrating something about this place." Indeed, when Dr. Knox was getting ready for her wedding, her mom was picking up flowers from the local florist. The owner and other customers excitedly told her about the new medical practice opening in town. She said, "That's my daughter!" The doctors say that's just one example of the magic of Ashe. Locals have been writing about the new practice on social media, too.
Left & Center: groundbreaking; Right: the new practice, built!
Key to their satisfaction and continued momentum is the theme of self-determination and autonomy over how they will get to care for their patients. Seven Peaks is not another corporate entity - it's a community practice. "We all know healthcare isn't doing what it's supposed to do," comments Dr. Karimy. "It's a business model, not centered around the community. But we're focusing on the family physician who really knows you - not a primary care doctor who just adds medications and shuffles patients around." This is the difference between selling health care as a commodity, and serving as someone's personal physician: it's rooted in relationship and reciprocity, concern for what comes after, not just the transaction at hand.
When asked what advice they have for aspiring family doctors who wish to embody these same values in their own future careers, the doctors have much wisdom to share.
Dr. Stevens advises to get connected to locals when you're ready to start a practice. "Most people come from the outside to exploit small towns - to buy and build giant houses just to have, not to live in. Locals like our realtor, Joe, who believed in our practice and knew this was a need the community wanted to be met, went above and beyond for us." Their realtor found land for them, off market, and introduced them to local contacts to support their endeavor.
Dr. Knox thinks reflection is essential. "You have to know what it would mean for you to self-actualize. What would it mean for you to look back on your life and know that you lived purposefully? What are the tiny things you could do right now to get closer to that?" Dr. Karimy agrees, and he also recognizes how hard it is to balance studying and learning medicine with day-to-day life - let alone to find time to reflect or daydream. "Everything in medicine is hard. It's time consuming, and when you're a student or resident, you're always at the bottom of the mountain looking up. Taking on something else just makes the hill steeper and longer. But the biggest thing is to find that piece that's going to make you self-actualize. When you do that, it's not work anymore - it's feeding your soul. It breaks up the monotony, the idea that you'e living your life twenty-minute-visit to twenty-minute-visit and typing notes in-between."
His final words feel perfect to end upon:
"Find what gives you purpose, and if you are lucky enough to find people you love to do that thing with, hold onto them like your life depends on it."
Seven Peaks will open in West Jefferson, NC in Ashe County, in the heart of the high country of western North Carolina, in early 2025. Website pending; but once it's up, I'll share it here!
BIOGRAPHIES
Toria Knox, D.O.
I was born in a small town called Boones Mill, Virginia and saw firsthand the effects limited healthcare access and low health literacy has on my community throughout my childhood. I was called to become a doctor toward the end of high school, and thus attended Virginia Tech studying biochemistry, “medicine and society,” and Spanish while volunteering at the Blacksburg Volunteer Rescue Squad. I, then, became involved in several community and public health initiatives while attending Edward Via College of Osteopathic Medicine -Virginia Campus, and I determined family medicine was the specialty that would best allow me to self-actualize as a primary care physician in rural Appalachia. I grew into an independent physician through training at MAHEC-Boone Family Residency Program. In the High Country, I found an extremely supportive network of people who continue to encourage Jessica, Jason, and me in the creation of our private practice in Ashe County. I just moved to Jefferson, NC with my husband, Patrick, and our cat, Freddie, where we are excited to put down roots.
Jessica Stevens, M.D.
I grew up in Apex, North Carolina, but fell in love with Boone while attending Appalachian State. I came for the mountains and was captivated by the vibrant community, stunning landscape, and wonderful people I met both on and off campus. During my time at ASU, I studied cellular biology with a minor in chemistry and medical humanities. I participated in plant ecophysiology research, studying the effects of environmental changes on Fraser fir tree physiology. I had a passion for medical science, but also had the opportunity to volunteer at local organizations, where I developed an interest in different ways to support health and wellness within the community. After graduating, I attended UNC Chapel Hill for medical school and completed my third year at MAHEC Asheville. I particularly enjoyed volunteering as a hospital doula at UNC and working at free produce markets in western NC. These experiences, as well as my passion for lifestyle/preventative medicine, community advocacy, and sexual health led me to family medicine. My husband, Will, and I were thrilled to be able to move to Ashe County live and work in this place we love. My other interests include vegetable gardening, reading, trail running, hiking, backpacking, brewery visiting, skiing moderately well, sitting on porches, and anything involving my dog, Sam.
Jason Karimy, M.D.
I am originally from Littleton, Colorado where I grew up playing music, snowboarding, backpacking, reading, and writing. Eventually, I moved to the East coast where I found a new love in SCUBA diving. There is an indescribable feeling when you take your first breath underwater. Highly recommend. But, while, I love SCUBA and the ocean, my heart belongs to the mountains. Which is why when I came to Appalachia for the first time, I knew this was my home. The hiking and camping here is breathtaking and so accessible as it is in our backyard. Apart from my love for the outdoors, I have a passion for rural communities, poverty, food insecurity and how it relates to chronic illness. Our program’s leadership have a vested interest in these communities and have fostered an environment where residents can actually come in and make an impact. I hope to stay in Western North Carolina as a rural family medicine physician and care for the communities that have become such an important part of my life.
