Two Physicians Just Put $2 Million Into a DPC Clinic in Rural Northern New York. They Have Practiced in the Community for Seven Years.

Two family physicians who have spent seven years caring for patients in the North Country of New York just broke ground on a $2 million clinic built from the ground up for direct primary care. North Country Now, which covered the announcement, describes North Core Medical as introducing the direct primary care model to the region.

The practice is the work of Dr. Thushyanthan Pathmalingam and Dr. Thivisa Rajagopal. Both are board-certified family physicians who have practiced in St. Lawrence County and plan to work at North Core Medical full-time. The announcement was reported August 1 by North Country Now. The clinic will sit on State Highway 310 in Canton.

The investment figure is the first detail worth sitting with. Two million dollars in a new medical facility is not a pilot program. It is a building.

Where Canton Is

St. Lawrence County sits in the far north of New York State, bordering Ontario along the St. Lawrence River. Canton, the county seat, has a village population of roughly 7,000. Ogdensburg, the county’s only incorporated city, lies to the west-northwest on the St. Lawrence River. The county itself is the largest by area in New York State, with about 108,000 residents dispersed across more than 2,800 square miles.

St. Lawrence County carries a current federal primary care shortage designation for its Medicaid-eligible population. The county’s southern and southeastern towns extend into the Adirondack Park, a geography that puts some of the most rural parts of the region well past what most primary care practices can serve with daily clinic hours.

Direct primary care — with its smaller panels, longer visits, and monthly membership fee rather than per-encounter billing — fits a different part of that problem. Whether a rural patient needs a same-day acute visit or a 60-minute chronic disease review, the model does not have a financial incentive to keep the appointment short.

The Physicians Behind It

Dr. Pathmalingam has practiced family medicine in the North Country and also serves as Medical Director of the Medication-Assisted Treatment Program at the St. Lawrence County Jail, a role serving the county’s incarcerated population. Dr. Rajagopal is board-certified in both family medicine and obesity medicine and has practiced in Canton. Both have been in the community for seven years.

Dr. Rajagopal described the motivation in language that echoes what many physicians say when they make this move: “We wanted to build a practice where physicians have the time to truly listen, develop meaningful relationships with patients, and focus on keeping people healthy rather than simply treating illness.” What makes that language more than a mission statement in this case is the follow-through. A purpose-built facility at a $2 million commitment level is a different kind of declaration than a brochure.

The Purpose-Built Decision

There is a meaningful difference between leasing exam rooms in an existing medical building and constructing a clinic from scratch. The floor plan is designed for the model before the first patient walks in — visit lengths, room configurations, staff flow — rather than retrofitted from a space originally built for fifteen-minute fee-for-service encounters.

The plan is to open with both physicians working full-time, alongside a receptionist and a nurse. Staffing may expand as patient demand grows, according to the coverage. That growth path is familiar for DPC practices: a panel fills gradually, and the model sustains the practice financially as membership builds rather than requiring a full panel from day one. North Country Now reports the practice plans to initially enroll about 250 patients per physician, with a hard cap of 500 per physician to preserve access and visit quality.

What This Means

For physicians practicing in rural communities who have heard that direct primary care only works in certain zip codes, the North Core Medical groundbreaking is a concrete counterexample. Two physicians who know St. Lawrence County — who have spent seven years in the community, and one of whom directs the county jail’s medication assistance program — looked at geography that seems like a poor fit for a membership-based model and decided to invest $2 million in it anyway.

Our July 26 look at the national DPC clinic map found the model concentrated in a handful of states, with much of the country showing few or no practices at all. Money moving toward rural St. Lawrence County cuts against that pattern.

The argument against DPC in rural settings is that it creates a two-tiered system where only patients who can afford a monthly fee get access to a physician with time for them. That argument does not disappear because North Core Medical is opening. But it gets harder to make when one of the physicians building this practice directs the county jail’s medication assistance program, and both have been serving the community for seven years.

For the North Country specifically: if this practice works, it becomes a data point that every rural county watching primary care access erode will want to examine. The model does not promise to solve rural health access in the abstract. But a physician-owned, physician-run practice with a small panel and longer visits is a different approach to primary care than the county’s established network of health system outpatient facilities and community health centers.

The build is underway. The opening is early 2027.