The Bakersville Community Medical Clinic, nestled in the Blue Ridge Mountains of western North Carolina, opened its doors in November of 1974, with more than $13,000 raised by more than 2,000 local residents. Bakersville was the fourth primary health center to receive funding and technical assistance through the Office of Rural Health, which provided the clinic with a $25,000 state grant to help start its operations. Initial capital funding also came from the Appalachian Regional Commission.

The Bakersville health center has a long history of caring for its people, a catchment area of about 9,000, mainly in Mitchell and Yancy counties, but stretching west to Unicoi, Tennessee, and south to McDowell County.

The clinic was initially staffed by Olive Wise, a nurse practitioner who was a nurse midwife in India before obtaining NP training at the University of North Carolina. Dr. Jerry Cade and later Dr. Arch Woodard, who both still practice with the group, joined the clinic in the next few years to form a full-service primary health care center.

In 1977, the center received a four-year $280,000 grant from the Robert Wood Johnson Foundation through its innovative Rural Practice Project, which aimed to help small rural communities recruit and retain primary care physicians through the use of a stable leadership team of physician and administrator.

"From day one, the practice had a manager and placed a lot of importance on that," said current administrator Reid Duncan, who has been with the Bakersville clinic for more than 23 years.

The Bakersville clinic remains vibrant today, its three-building complex taking up an entire block in downtown Bakersville, the county seat with about 500 residents and two stoplights. In the Fall of 2000 the clinic purchased the property and bank building across the street. The building now serves as the site for the Toe River Children's Dental Clinic. The clinic is operated by Spruce Pine Community Hospital and provides dental care for low-income children in the Tr--County area. The current medical staff offers a full spectrum of primary care and inpatient care at Spruce Pine Hospital, 20 minutes from Bakersville, and consists of five physicians (and one is currently being recruited--three of whom practice obstetrics), a nurse practitioner, a chiropractor, and a midwife. The clinic also serves as a teaching site for medical students and residents from the Mountain Area Health Scholars Program, sponsored by the Office of Rural Health.

With five physicians in its group, the Bakersville clinic is the largest practice in a five-county area and one of the area's largest employers. In 2005 its budget reached $1,300,000.00 for the first time, and since becoming computerized in 1985, the clinic has entered more than 30,500 patients into its system. The staff has averaged about 1,800 patient visits each month.

Although the clinic began with state and other grants, the clinic's community-based Board of Directors set self-sufficiency as a top goal from the beginning and still aimed to maintain good service and serve all surrounding residents. Currently, the patient mix at Bakersville is about one-third Medicaid, 18 percent Medicare, and the remainder self-pay and third-party insured. The clinic offers residents with modest incomes to apply for a structured sliding fee scale and helps them keep with up their medical bills, Duncan said.

The strength of Spruce Pine Hopsital also is key to the success of the clinic, Duncan said. About 20 percent of the clinic's revenue comes from inpatient care, and the high quality of the hospital enhances the clinic staff's practice, he said.

Overall, the clinic's administrative and clinical goals remain constant: provide good service, price services at a reasonable cost, and to be paid for services rendered.