Claudsville, Virginia,native Dr. Richard Cole knew he wanted to be a doctor by age 5.
He started practice in his home Patrick County by the mid-'80s, and founded Patrick County Family Practice in 1991. Now, at age 70, Cole is the only doctor in Patrick County.
"My wife says it seems like over 100 hours a week," Cole says when asked how much he works. "It's hard to ever be totally off. The tasks and phone requests never stop."
Demand for health care intensified after 2017, when Pioneer Health Services closed the county hospital after it experienced years of financial troubles. At the start of 2020, Cole started Patrick Urgent Care, which offered expanded hours, plus an X-ray machine and lab work. The COVID-19 pandemic hit a few months later, triggering a 70% drop off in patient cases, followed by a surge.
"During COVID, urgent care was thriving. We were getting overrun," Cole says. "At one point we had 90 patients coming in there the same day with two providers."
And Cole wasn't just performing medical services. He also managed the family practice and urgent care's financial challenges, partnering with an accountable care organization and helping the practice become a Rural Health Clinic to keep it in business.
But Cole couldn't overcome another problem facing rural health care providers: the challenge of keeping staff.
"In the end, we lost our nurses and we lost our providers who resigned, and we couldn't replace them fast enough," Cole says. "So we ran out of personnel, was the reason we closed."
The closure was another blow to Patrick County.
"For rural communities and in Patrick County, any kind of reduction of workforce and closure is difficult to swallow," says Rebecca Adcock, executive director of the Patrick County Chamber of Commerce. Adcock has seen the loss of health care infrastructure just since she moved to the area in 2008.
"The hospital was open, we had some other medical facilities available," Adcock says. "A couple more dentists than we do now. Patrick County Family Practice is the only medical facility doctor's office in Patrick County."
But the closure of the urgent care facility in mid-November isn't the end of the story. There's still a free clinic for uninsured and underinsured patients, and a mobile facility that tries to meet people where they live.
There's also plenty of talk the hospital may reopen. After a previous company failed, Braden Health bought the hospital building in November 2024, and reportedly is trying to win regulatory approval to bring it back. On a recent day, there was plenty of activity at the hospital. Braden Health CEO Larry Henson was on site, but he declined comment.
Meanwhile, Cole is making moves. Patrick County Family Practice has about 38,000 patients —more than twice the population of Patrick County. Patients come from nearby counties in Virginia and North Carolina. About half are Medicare or Medicaid recipients. For now, the practice is offering expanded hours and moving to hire additional nurses and other staff.
"It's myself, I'm the only doctor in the county," Cole says. "We have two physician assistants and five nurse practitioners. We have two nurse practitioners hired that are waiting to get all their credentials. So I have a new doctor coming in August of 2026, I have a doctor coming three years from now, one maybe in two years, one for sure in six years, one maybe in five years."
Cole plans to reopen the urgent care facility once more of those providers arrive – not as urgent care, but another rural clinic that will be called Stuart Family Practice.
"I've never seen so much interest in young doctors in wanting to come here and practice," Cole says. "It opens up the door for me to finally retire."
But even at age 70, that still seems a ways off.
"I'm hoping to gradually kind of slow down," Cole says. "I'm fine right now indefinitely. I still enjoy the practice."
So for now, just as he has for 40 years, Cole continues to serve the people of Patrick County.
