Three young doctors choose community over bustle at their practice in a small mountain county.
Prospective students to UNC Chapel Hill School of Medicine sometimes stress their interest in practicing medicine in the state’s small towns during the admissions process, says, Dr. Jessica Stevens.
“And then they go into something like cardiothoracic surgery,” she says with a laugh. “So at the end, when we were all graduating, someone was like, ‘Remember when we all said we were going to do rural primary care?’
“And I was like, ‘Wait, y’all were joking?’”
Stevens wasn’t joking. She is a partner with Jason Karimy and Toria Knox in Seven Peaks Family Medicine, located in West Jefferson in Ashe County, 90 miles northwest of Winston-Salem. In April, the three physicians started providing primary healthcare in the county of about 27,000, joining about 8 other peer doctors there.
The three became friends while completing three-year residencies, mainly at Watauga Medical Center and AppFamily Medicine in Boone. They discovered a shared commitment to rural healthcare, but realized starting a medical practice wasn’t a traditional tool in a young doctor’s bag.
“The business of medicine is not something that they teach you in medical school,” says Knox, “and none of us have business degrees.”
They say they couldn’t have done it without lots of help, aided by Community Care of North Carolina, a nonprofit based in Wake County that partners with independent primary care practices. The trio received advice on securing a low-interest loan to build their 5,000-square-foot office, create a business plan and connect with various resources such as real estate agents and builders. They declined to provide startup costs.
The residency program through Mountain Area Health Education Center prepared them for family medicine. “The idea of it was if you were to be in a town with no other doctors, you would be able to do enough to help your community,” says Karimy. “They call it ‘Cradle to Grave’ so you can do prenatal care, you can deliver babies, take care of kids and pediatrics, all of adult medicine up to end up life care.”
Ashe County residents have welcomed the doctors, convincing them that they made the right decision on where to launch their careers. “They have done amazing things for us. They have supported our families and introduced us to all kinds of things and brought us things just because that’s neighborly, and that’s how the community is here,” says Knox.
Since opening on April 1, Seven Peaks has gained several hundred patients. They want the patient count to grow to 1,000 per doctor.
Annual compensation for primary care physicians varies widely, but $150,000 to $200,000 is common, according to various staffing agency websites. The trio declined to share their expectations for income.
Money, says Knox, “has never been the primary goal. Our goal is to live a fulfilling life.”
But being their own bosses has its advantages, they say. Shared decisions determine the direction of the practice. They also see a direct line between productivity and output, noting in August that they had started drawing paychecks.
Being in charge gives the doctors a chance to move quickly to do what they think is right. When an elementary school needed to provide free physicals for students so they could participate in sports, the doctors performed the tasks, adding taco food trucks and hair and face painting.
“It also just makes it so much easier to flex to meet a need that we find in the community,” says Knox. “It’s just nice to have the power to say, ‘Yes, we can do this.’”
Next year, the doctors plan to incorporate a community garden into their practice and work with area farmers and the faith community to help provide more fresh produce and a more holistic approach to health. They’re helping ensure that Ashe County children entering the foster care system get medical evaluations. Another goal is a foundation to sponsor health education programs.
Mostly, the doctors hope Seven Peaks can be a model for others to increase access to rural healthcare.
Knox and Stevens finished their residency program in 2024, and both took temporary jobs while waiting for Karimy to finish earlier this year. Stevens took maternity leave after finishing her residency, which gave Knox a headstart.
It’s hard to believe what has been built in a short amount of time, Karimy says.
“When we came in, I think every word that came out of our mouth that wasn’t medical related was, ‘Oh, my word, can you believe this is real and we’re doing this?’ We’re just so happy. We’re like, this can be the rest of our lives.”
JASON KARIMY, MD
BOARD CERTIFIED FAMILY PHYSICIAN
SEVEN PEAKS FAMILY MEDICINE [FEATURE STORY]
WEST JEFFERSON
Age 38
Karimy, 38, is about eight years older than Knox and Stevens. He had a more circuitous route to primary healthcare, initially hoping to be a scientist and later, a neurosurgeon.
After earning a bachelor’s degree in his home state of Colorado at the University of Colorado, Denver, he earned a master’s degree in molecular medicine at the University of Maryland, Baltimore. He completed medical school at Quinnipiac University in Connecticut, then had a neurosurgery fellowship at Yale School of Medicine.
His trajectory toward a career as a neurosurgeon was interrupted by what he calls a “come to Jesus” moment in 2022.
“I was like, if I didn’t have all this momentum for neurosurgery, what would I actually want to be? And in my heart, it was I’d go back to the 1800s and I’d be a community doctor and just care for my community, for whatever they needed.”
TORIA KNOX, DO
BOARD CERTIFIED FAMILY PHYSICIAN
SEVEN PEAKS FAMILY MEDICINE [FEATURE STORY]
WEST JEFFERSON
Age 30
Knox has a personal connection to Ashe County because her grandmother is a native of its Grassy Creek community. She would visit her extended family in Ashe County to participate
in the annual tradition of decorating family gravesites.
Knox grew up in Boones Mill, Virginia, a town of about 250 people that is 15 miles south of Roanoke. She was inspired to practice rural medicine because of her life experience.
“We had the same problems a lot of rural communities have,” she says, “where doctors would come, they’d be there for a little while and then they’d leave. So there was no continuity, somebody who really knew you.”
She earned a bachelor’s degree at Virginia Tech University and remained in Blacksburg to attend Edward Via College of Osteopathic Medicine. She expected to return to practice in Virginia, but felt drawn to Ashe County during her residency.
“Family medicine made the most sense for me because I wanted to see the whole family,” says Knox. “I wanted to be able to do a lot of procedures, but I also wanted to be able to do counseling, give them an injection and also take care of their grandma and their baby.”
JESSICA STEVENS, MD
BOARD CERTIFIED FAMILY PHYSICIAN
SEVEN PEAKS FAMILY MEDICINE [FEATURE STORY]
WEST JEFFERSON
Age 30
Stevens grew up in Apex in Wake County, and earned her undergraduate degree at Appalachian State University. She and her husband met in college and both fell in love with the mountains. It’s where they wanted to raise a family.
“We’re not city people,” Stevens says. “We wanted a community. We wanted outdoor exposure. We wanted a yard for the baby to play in and to raise our kids in a little bit more of a laid-back environment.”
She and Karimy first bonded over a shared interest in food insecurity, while she and Knox became close friends during their residency experience.
Their son was born earlier this year. Dr. Karimy was her pre-natal doctor and helped in the delivery room. ■