The Davis Mountain Clinic is not your typical rural medical clinic. It doesn鈥檛 have windows or a big waiting room, and there aren鈥檛 teams of physicians and nurses waiting on patients.
Instead, there鈥檚 one nurse, Carol Brewer, who connects patients to psychologists and physicians online. What鈥檚 even more remarkable is where Brewer runs the clinic 鈥� a renovated shipping container.
鈥淚t saves them time and the expense of traveling,鈥� Brewer said. 鈥淭hey don鈥檛 have to travel 30 miles to the closest clinic, or get an appointment two weeks later. They are more likely to drop in, as opposed to delaying care.鈥�
A lack of funding and the struggle to expand broadband into rural communities has pushed some healthcare providers to use more creative tactics to bring healthcare services to the areas that need it.
Brewer鈥檚 telehealth clinic in Fort Davis, a town with less than 900 residents, is just one example of how two organizations 鈥� in this case rival schools Texas Tech University Health Sciences Center and Texas A&M University 鈥� worked together to renovate and establish a telehealth clinic to bring much-needed healthcare services to rural Texas.
For years, telehealth has been looked at as the next frontier in healthcare, particularly in rural communities. Some say it couldn鈥檛 come at a better time as and the . And Texas due to high operating costs and not having enough patients to bring money in.
Lawmakers have noticed the problem. In June, Gov. announced the Texas Health and Human Services Commission made for eligible rural hospitals and health clinics to provide pediatric telehealth.
People in the medical field say funding for telehealth, or virtual care, is desperately needed to close the gaps in rural healthcare. According to Texas Health and Human Services, as of 2024, 143 counties in Texas lack a practicing pediatrician and only 4,899 pediatricians provide direct care to patients. It鈥檚 a big problem in West Texas, where Brewer鈥檚 clinic is. .
The Davis Mountain Clinic is set up for both physical and virtual care, but primarily serves as a conduit for residents who don鈥檛 have internet access. On the left side of the clinic is a telehealth camera to connect with physicians from Texas Tech鈥檚 Health Sciences Center. On the right is another telehealth camera to connect patients to counseling services provided by Texas A&M鈥檚 Telehealth Institute.
The land is owned by the county, so the clinic doesn鈥檛 have to pay rent or for utilities. However, they do pay for the internet services and other supplies that are needed. The clinic doesn鈥檛 accept insurance and charges a $30 flat fee for patients. Patients are not charged for routine or minor care that Brewer can take care of, such as administering wound care or showing newly diagnosed diabetics how to use glucometers.
Another retrofitted container clinic from the universities opened this summer in the small town of Burton, nearly 85 miles east of Austin. Adrian Billings, the chair for rural health at Texas Tech Health Sciences Center, said there are about 40 other counties in the state they want to launch the collaboration in. They have to find the funding first.
鈥淭he goal is to have some sort of healthcare access point in all 254 of our counties,鈥� Billings said. 鈥淭elehealth is a very important piece of healthcare, especially for our rural communities.鈥�
Billings is also a physician with Preventative Care Health Services, serving the rural West Texas communities of Alpine, Marfa and Presidio. He said the healthcare workforce is mostly found in urban areas, so telehealth clinics give them access to those physicians. While he believes every patient should have the opportunity to shake their physician鈥檚 hand, Billings said rural communities still need healthcare even if it鈥檚 not physically available.
鈥淚 firmly believe that we can鈥檛 give up on development of the rural healthcare workforce to be there in person, especially for urgent situations like childbirth and emergency care,鈥� Billings said. 鈥淚t will still be an access point for a rural patient.鈥�
Billings said broadband access in the Big Bend region has improved over the last 20 years. However, he said there are still dark spots where people don鈥檛 have access or can鈥檛 afford it, or don鈥檛 even have a smartphone to use internet service. That鈥檚 where telehealth clinics come into the picture, Billings said.
鈥淲hether it be a library or a container clinic, it鈥檚 important because patients don鈥檛 have to pay for that Wi-Fi and the infrastructure needed for telehealth,鈥� Billings said. 鈥淚 think if we can begin in places that do have it, maybe it will be easier for patients who live outside of broadband access to travel fewer miles where there is access.鈥�
Despite its struggle with expanding broadband services in rural areas, Texas has made progress over the years. The state鈥檚 broadband map . Most rural hospitals in the state all have broadband for quick access to physicians, radiologists and specialists. Zoom calls can now include digital tools, such as a stethoscope, to make examinations more robust.
Despite the expansion of broadband in rural areas, some counties still lack reliable internet service, such as Wheeler in the Panhandle, where nearly 2,000 residents still don鈥檛 have service. Patients all over the state 鈥� both in-person and virtual 鈥� need a connection to the internet to access records. But access largely comes down to where someone lives and if they can afford internet service.
鈥淚f you don鈥檛 have access to the internet, you can鈥檛 get to your patient portal, get your lab results, you can鈥檛 go online and schedule an appointment,鈥� said Nora Cox, CEO and founder of Texas e-Health Alliance. 鈥淭here鈥檚 so many things missing if you don鈥檛 have connectivity.鈥�
Cox said broadband, which provides high-speed access to the internet, has gotten better in some ways. However, she said there are still pockets of consumers who either don鈥檛 have internet or don鈥檛 use a smartphone, and they need to be taken care of better.
鈥淚f you are lower income and using a track phone with limited minutes, what happens if you run out in the middle of talking to your doctor?鈥� Cox said. 鈥淲e tend to think everyone has an iPhone, but it鈥檚 a problem when all people have is a track phone from Walmart.鈥�
Thomas Kim, a psychiatrist who has been working on telehealth development for the last 20 years, said expanding pediatric telehealth with the grant is beneficial, but also misses the point.
鈥淚 think in telehealth, we should move away from this idea that a single grant should target a specific-use case because that鈥檚 not really sustainable,鈥� Kim said.
Kim said grant funding should be used to support areas with proven success in the field, such as the Texas Child Health Access Through Telemedicine, or TCHATT, at Texas Tech鈥檚 Health Sciences Center. The program is in collaboration with more than 200 independent school districts across Texas, and connects pre-K through 12th grade students with free mental health services.
鈥淚t鈥檚 something I hope gets their slice of this most recent investment because we鈥檙e in trouble,鈥� Kim said. 鈥淭he healthcare crisis is real in so many ways. It would be nice if we took seriously the fundamental flaws we have in the financing and delivery system.鈥�
Cynthia Jumper, executive vice president for health policy and strategic initiatives at Texas Tech鈥檚 Health Sciences Center, said she would like to see telehealth expand into more healthcare fields. Telehealth has expanded into practices such as psychiatry and mental health counseling, ophthalmology, even dentistry to an extent.
But telemedicine has its limits. It can鈥檛 see patients who have critical physical ailments, such as abdominal pain, changes in consciousness or losing vital functions.
鈥淭here are many ways to use this, and we continue to push that limit in order to get care where it needs to be provided,鈥� Jumper said. 鈥淣ot everybody鈥檚 in a city with a level one trauma center, so trying to get more care to the patient where they are is really how telehealth is working.鈥�
In 2021, the Texas Legislature put $150 million in grant funding toward the Next-Gen 911 program. This allowed another expansion into telehealth, Jumper said, where paramedics can also use telehealth equipment in the back of ambulances. If a paramedic thinks the patient can be treated in the ambulance instead of enduring a long drive, then they will be able to connect a camera to a physician to walk them through treatment.
鈥淲e are doing that to try and prevent emergency room visits which are costly,鈥� Jumper said.
As far as the Davis Mountain Clinic, the community has welcomed Brewer and the clinic with open arms. Brewer calls it old frontier medicine. People bring her plants, snacks 鈥� someone even made her a quilt that is displayed in the clinic. In the more than 30 years of her career, Brewer said it鈥檚 the best job she鈥檚 had.
Brewer said the clinic plans to expand its services to other rural communities. This fall, they are hoping to use the community center in Valentine, a town of about 70 people 40 miles west of Fort Davis, a few times a month for patients in the area. The clinic might also have a Texas Tech healthcare student serve as a physician鈥檚 assistant later this year.
鈥淭his clinic is serving in part as a model for future clinics they鈥檙e planning,鈥� Brewer said. 鈥淎nd the convenience of having access has been crucial for people out here.鈥�
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