For 3 years, an HBO Max documentary crew trailed James Graham, MD, around Fairfax, Oklahoma, interviewing him while he made house calls, struggled to save Fairfax Community Hospital from bankruptcy, and lobbied for government help for his patients at the Oklahoma State Capitol.

Throughout Country Doctor, a 38-minute film, we watch as Graham, who has been in practice for over 40 years in this small town of 1263 residents, copes with daily challenges, including staff shortages and 60-mile trips to a clinic that serves four counties, mirroring what’s happening around the country, where over 140 rural hospitals in America have closed since 2010.

And, while Graham’s hospital appears to have had a happy ending after Elizabeth Pusey, MD, Newport Beach, California-based radiologist, bought Fairfax Community Hospital in 2022, other rural hospitals aren’t as fortunate.

Read on as Graham tells Medscape Medical News what he hopes viewers will learn about rural medicine after screening the film — and what critical work remains to be done in rural areas throughout the US.

Medscape Medical News: What has the reaction been to the film since it was released earlier this month?

Graham: Most people are very appreciative of it. Everyone knows everyone in this town, and this is pretty much something we never could have dreamed of in Fairfax. It pulled the community and the hospital staff together. We’ve also been getting accolades from all over the country — calls and mail and cards. This is quite intriguing to us.

Medscape Medical News: It seems your hospital has had a happy ending after it was put up for auction in 2019 and, 3 years later, was bought by Pusey. Is everything continuing to go well?

Graham: It’s a Cinderella story. Pusey has come here and redone everything. Everything is brand new. We have a new generator, a new roof, new CT scanners, MRI services, and a new bariatric wing, and she continues to make improvements. She had a plan; she figured it out financially, and right now we’re making some money because we’re able to keep all 25 beds full. She bought in, and when she said, “I’m in,” she meant it. It’s rare. I’ve never heard of it happening before.

Medscape Medical News: What do you want your colleagues to know about the state of rural medicine today?

Graham: The first thing is that the quality of rural healthcare is pretty good. We have access to specialists, especially with telemedicine. At the same time, I also think there needs to be more recognition that we have problems here. There are over 750 hospitals on the verge of closing. In Oklahoma, we have close to 50 that are somewhat suspicious and just had one — Stilwell Memorial Hospital, Stilwell, Oklahoma — close a couple of months ago.

I’ve always thought the solution might be a rural health commissioner, someone who would look at rural healthcare all over the country. We’re a lower socioeconomic people; there’s less health insurance, certainly a lack of funding, and we have a hard time getting providers, doctors, and nurse practitioners to work here. It continues to be the same problem year after year — and it seems like we’re not doing anything about it.

Medscape Medical News: The scene where you go to the Oklahoma State Capitol to fight for better healthcare coverage is particularly upsetting given that Oklahoma is 48th in health outcomes in the US. Was that tough to film?

Graham: It was intimidating, to be honest. I went there when we were going to do Medicaid expansion in Oklahoma to get more people healthcare. At the time, they were on the hot seat about not doing that, saying that it cost the federal government too much. I wanted to speak with some people that might be able to help us, but they didn’t listen to my ideas.

A state senator, Bill Coleman, is a friend of mine. I think he means well, but it seems like we really didn’t get much done. I don’t think anything happened after that visit other than we got a few people extended on Medicaid.

Medscape Medical News: Given today’s political climate, what do you think should be done for people in terms of healthcare?

Graham: I believe everyone in America deserves healthcare. We need to get lawmakers to figure this out. They need to quit arguing and get something done.

Medscape Medical News: In one especially poignant scene, you discover that a patient has “paid” you in the form of produce left in your pickup truck. What was that moment like for you?

Graham: When people can’t pay you, but they bring you tomatoes, okra, squash, and corn, it really gets to you. That’s love from the heart. That’s the kind of thing you don’t forget.

Lambeth Hochwald is a New York City-based journalist who covers health, relationships, trends, and issues of importance to women. She’s also a longtime professor at New York University’s Arthur L. Carter Journalism Institute.