Engineer-turned-doctor seeks to improve access, efficiency and affordability for rural residents
Dr. David Brown is seen March 26 at his newly opened clinic at Trimble Crossing in Hermosa. (Jerry McBride/Durango Herald)
HERMOSA – The practice of a doctor traveling to a patient’s home to deliver care – as opposed to the patient traveling to a medical campus or visiting a doctor in an office – is largely bygone.
According to a 2004 study in the New England Journal of Medicine, house calls accounted for 40% of doctor-patient visits in the 1930s, but dwindled to less than 1% by the 1980s.
In rural northern La Plata and San Juan counties, Dr. David Brown, alongside his wife, Yvonne Naughton, is bringing that old-school practice back – and proving how beneficial that style of care is to residents who may not have had easy access to health care otherwise.
In January 2025, they opened San Juan Clinic in Silverton, and a year later, a second location in Hermosa.
“Access is huge,” Brown said. “When you’re rural, it’s really important that you’re not just confined to the brick and mortar.”
The clinic provides a range of essential care to rural residents – including telehealth services, primary care, pediatrics, labs, referrals, wound care and an on-site pharmacy. Additionally, Brown offers sports medicine, internal medicine and weight-loss treatments.
“Here I do everything. (Yvonne) does everything. And then we have part-time medical assistants,” he said.
At-home care helping Silverton residents access health care
The reason home visit doctors have become an increasingly rare breed is largely because of advances in medical technology and doctors becoming more specialized in their fields – think cardiologist or optometrist – as opposed to being a jack-of-all-trades physician, according to “Why Did Doctors Stop Making House Calls?” a March 17 article in History Facts.
That shift, which took place throughout the 20th century, concentrated health care to large medical campuses, the study said.
And, according to “Bridging the gap: Addressing health inequities in rural communities,” a 2024 National Rural Health Association article, that is problematic. Rural areas are often poorer, more geographically isolated and have less access to the same resources urban areas do, the article said.
Dr. David Brown on Thursday sits in his newly opened clinic at Trimble Crossing in Hermosa. (Jerry McBride/Durango Herald)
“Rural communities contend with a significant scarcity of health care providers, with 68 physicians per 100,000 people compared to 80 in urban areas,” the article said. “This shortage underscores the struggle to access vital medical services, particularly specialty care.”
Silverton Chamber of Commerce Executive Director Deanne Gallegos – who is also one of Brown’s patients – said there has not been a hospital in Silverton since Miners’ Hospital closed in 1959.
“If you needed an actual doctor’s office, you needed to either go to La Plata or Montrose counties,” Gallegos said. “For us to have a pediatrician and an internal medicine doctor who has an on-site pharmacy is a game-changer for our community to have direct access to health care without having to travel 56 miles over two mountain passes.”
She said access to steady health care has been a main concern among residents when discussing how they want Silverton to grow, mainly because it would allow residents to live there longer. Brown is helping address that need.
“(Having health care) just creates an environment of growth of stability that makes it more attractive to young families or seniors moving into the area,” Gallegos said. “We have a very high senior population, and not having medical service available within our county was always an impediment to people being able to age in place here.”
An engineer becomes a doctor
Brown said he designed his business model to streamline expenses for patients. That, he said, comes from his former career as an engineer, when he was paid to think through inefficiencies in systems.
He volunteered at a hospital, where he became inspired to go into health care. He then attended medical school at Trinity College Dublin in Ireland.
“It just seemed like you were more in touch with what was going on,” Brown said about health care work. “But I never got the engineering out of me.”
After he transitioned into health care, Brown said he worked at a hospital in Oregon for several years and began to notice ways the system could be improved. His solution? His own clinic, which uses a care management model.
He said his model is a win-win-win for him, insurance agencies and, most importantly, his patients. Accessibility is where Brown’s clinic shines: One can do walk-ins, schedule an appointment or do virtual visits, he said.
Additionally, Brown said he uses care management in his practice – a relatively new program meant to coordinate patient care that goes beyond more traditional in-office visits.
A 2016 study in the National Library of Medicine titled “Implementation of Care Management: An Analysis of Recent AHRQ Research” defined care management as “a promising team-based, patient-centered approach ‘designed to assist patients and their support systems in managing medical conditions more effectively.’”
The study concluded that care management can both “improve outcomes and decrease costs” for patients, providers and insurers.
Brown said the goal is to efficiently track how a patient’s condition and care progress, which – particularly for patients on Medicare with chronic conditions like diabetes – allows a more streamlined way to track medications and visits. The program is optional.
“We can take part in a shared savings or risk model with the payer, where we get a bonus next year for the good work we did this year,” he said. “Some of those metrics are: Is your diabetes controlled? Is your blood pressure controlled? Have you been able to be kept out of the hospital?”
He said that if, for example, a patient enrolled in the care management program goes to the emergency room seven times one year, but only twice the next year, that signals improvements in their condition.
Additionally, accessibility is a huge issue for Brown. He said his clinic is focused on not only providing increased access to health care, but making sure it is affordable.
Connect for Health Colorado – the state’s official health insurance marketplace created under the Affordable Care Act – found in 2025 that health care premiums are becoming more expensive at a faster rate in rural areas than they are in their urban counterparts.
“Marketplace customers who currently receive financial assistance will experience average net premium increases of 100%, with some rural areas seeing increases of over 200%,” its analysis said.
Brown’s clinic sets a high “charge” price – roughly $220 per visit – for insurance purposes, but insurance companies determine the actual payment, which is typically much lower, only around $115, he said. Additionally, if a patient is out-of-network or cannot pay, his clinic avoids collections, may offer repayment plans or forgive costs.
“I have a sliding fee schedule for folks below, at or near the poverty limit. And if someone just walks in without insurance, my cash pay is typically 85 bucks,” he said. “The biggest thing is to not put up more barriers to care.”
Brown said he wants his clinic to be available to anyone who needs it.
“The last thing you want – and I know it’s very, very difficult now with some of the changes that have taken place – is for someone not to seek care because they can’t afford their deductible or out-of-pocket,” he said.
sedmondson@durangoherald.com
