In Fort Davis, Texas, a town of fewer than 900 residents, primary care arrives through a renovated shipping container staffed by a single nurse. Carol Brewer, the clinic's head nurse and director, runs the Davis Mountain Clinic, handling in-person care while connecting patients to physicians and psychologists through telehealth cameras mounted on opposite walls.
The model exists because the alternative is a drive. "It saves them time and the expense of traveling," Brewer told the Texas Tribune. "They don't 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."
That last point is the clinical argument for the whole arrangement. Delayed care in rural areas frequently converts a manageable problem into an emergency department visit or a hospital transfer, and Texas leads the nation in rural hospital closures, a trend MedicalDaily has tracked through the loss of rural obstetric services. A clinic a patient will actually walk into changes the calculation before that escalation begins.
The Physician Gap the Model Is Filling
The shortage is documented. According to Texas Health and Human Services, 143 counties in the state lacked a practicing pediatrician as of 2024, and only 4,899 pediatricians provide direct patient care statewide. In West Texas, where Brewer's clinic is, nearly 82% of counties did not have a pediatrician in 2024.
The Davis Mountain Clinic is a collaboration between Texas Tech University Health Sciences Center and Texas A&M University. One telehealth camera connects to Texas Tech physicians. The other connects to counseling provided through Texas A&M's Telehealth Institute.
The economics are deliberately minimal. The county owns the land, so the clinic pays no rent or utilities, though it does pay for internet service and supplies. It does not accept insurance and charges a $30 flat fee. Routine or minor care Brewer handles herself, including administering wound care and showing newly diagnosed diabetics how to use a glucometer, is not billed at all.
A second container clinic opened this summer in Burton, nearly 85 miles east of Austin. Adrian Billings, chair for rural health at Texas Tech Health Sciences Center, said the collaboration has identified about 40 more counties where it wants to launch, and needs funding to reach them.
"The goal is to have some sort of healthcare access point in all 254 of our counties," Billings said.
The Services That Still Require a Transfer
Telemedicine has boundaries. The Tribune reported that it cannot serve patients with critical physical ailments such as abdominal pain, changes in consciousness, or loss of vital functions. Those presentations still require in-person evaluation and, in the Big Bend region, a transfer.
Cynthia Jumper, executive vice president for health policy and strategic initiatives at Texas Tech's Health Sciences Center, framed the model as an attempt to extend reach rather than replace facilities. "Not everybody's 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," Jumper said.
Billings, who also practices as a physician with Preventative Care Health Services serving Alpine, Marfa, and Presidio, was direct about what the model does not replace. "I firmly believe that we can't give up on development of the rural healthcare workforce to be there in person, especially for urgent situations like childbirth and emergency care," he said, describing the clinic as an access point for rural patients rather than a substitute.
The Connectivity Problem Underneath
The clinic exists partly because home telehealth does not work for many of its patients. It functions as a conduit for residents without internet access, providing the bandwidth and equipment they lack.
Billings said broadband in the Big Bend region has improved over the last 20 years, but that dark spots remain where people cannot access service, cannot afford it, or do not have a smartphone. "Whether it be a library or a container clinic, it's important because patients don't have to pay for that Wi-Fi and the infrastructure needed for telehealth," he said.
Statewide, the picture is better than it was. Texas's broadband map shows most of the state at least 75% served, most rural hospitals have broadband for quick access to physicians and radiologists, and video visits can now incorporate digital tools such as a connected stethoscope to make examinations more robust.
Gaps persist. In Wheeler County in the Panhandle, nearly 2,000 residents still lack service. Nora Cox, chief executive and founder of the Texas e-Health Alliance, pointed out that connectivity affects more than the visit itself. "If you don't have access to the internet, you can't get to your patient portal, get your lab results, you can't go online and schedule an appointment," Cox said. She noted that assumptions about universal smartphone access fail for consumers using prepaid phones with limited minutes.
The Funding Debate Over What Comes Next
In June, Gov. Greg Abbott announced that the Texas Health and Human Services Commission had made $10 million in grant funding available for eligible rural hospitals and clinics providing pediatric telehealth.
Not everyone considers targeted grants the right instrument. Thomas Kim, a psychiatrist who has worked on telehealth development for the last 20 years, said single-purpose grants are not sustainable and that funding should support areas with proven success. He pointed to Texas Child Health Access Through Telemedicine, a Texas Tech program working with more than 200 independent school districts to connect students from pre-kindergarten through 12th grade with free mental health services.
Brewer said the clinic plans to expand, 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 this fall. A Texas Tech health care student may serve as a physician's assistant there later this year. MedicalDaily has reported on other rural systems weighing similar tradeoffs, including a Michigan hospital that closed despite federal support.
Readers should note a disclosure carried by the original reporting: Cynthia Jumper, Texas A&M University, and Texas Tech University Health Sciences Center have been financial supporters of the Texas Tribune, which states that supporters play no role in its journalism.
Key Questions Answered
What is a container clinic? A shipping container renovated into a medical facility. The Fort Davis clinic is set up for both physical and virtual care, with two telehealth stations, one connecting to physicians and one to counseling services.
Who works there? One nurse, Carol Brewer, who is also the clinic's director. Physicians and psychologists participate remotely through Texas Tech and Texas A&M.
What does it cost patients? The clinic does not accept insurance and charges a $30 flat fee. Routine or minor care the nurse provides directly, such as wound care or glucometer training, is not charged.
What can the clinic not handle? Critical physical ailments, including abdominal pain, changes in consciousness, or loss of vital functions, require in-person evaluation and transfer.
Why is a physical clinic needed if telehealth is remote? Many residents lack internet access or a suitable device. The clinic supplies the connection, the equipment, and a nurse who can handle the in-person portion of care.
Is the model expanding? A second container clinic opened this summer in Burton. Texas Tech has identified about 40 additional counties as candidates, contingent on funding, and the Fort Davis clinic hopes to begin serving Valentine this fall.
How severe is the physician shortage in the region? Texas Health and Human Services reported that 143 counties lacked a practicing pediatrician in 2024, and nearly 82% of West Texas counties had none.
