It’s OK to be Scrappy: On the Front Lines of Rural Women’s Health

A World Away

Tehachapi, CA, sits in a remote stretch of central California, about 40 miles east of Bakersfield and a world away from the nearest medical specialist. The town has roughly 15,000 residents. The surrounding communities, including Mojave, Ridgecrest, and the rural expanse of Kern County stretching out toward the Nevada border, add tens of thousands more people in need of essential healthcare services. For many of these individuals, their source of comprehensive healthcare services is a federally qualified health center, or FQHC, that serves patients regardless of their ability to pay. These safety-net clinics are often the only consistent point of medical contact for low-income, uninsured/underinsured, and underserved communities like Tehachapi, they carry an extraordinary share of the region’s health burden.

Christine McLemore, DO, is an ABFM board-certified family physician practicing at one such clinic. She arrived in Tehachapi five years ago wanting to do what her training had prepared her for: full-spectrum family medicine in a community that needed it. What she found was a region where the nearest medical sub-specialists were at least an hour away, where the presence of tortuous mountain roads and inhospitable weather conditions could make that distance feel much longer. Local women, who had limited options or resources to make this journey, would often arrive at Dr. McLemore’s office door with medical histories that reflected decades of neglect.

Upon her arrival, Dr. McLemore encountered women in their 30s who were unfamiliar with the benefits of basic gynecological care, such as Pap smear screenings, as well as women in their 50s who had never received a mammogram. The community faced high rates of preeclampsia, preterm births, and prolonged NICU stays. Years of inadequate healthcare interventions had eroded expectations, leaving many no longer anticipating better care.

“I was absolutely mortified by the lack of women’s health care when I got up here,” Dr. McLemore said. “Women shouldn’t be dying of cervical cancer anymore. This is so easy to prevent.”

The population she serves reflects the complexity that FQHCs routinely navigate. Her patient panel includes low-income families, uninsured workers, agricultural/seasonable laborers, and a substantial population of Afghan refugee women living in nearby Mojave. Each group came with its own barriers to care: geographic distance, financial constraints, distrust of the medical system, language differences, and in some cases, deeply ingrained cultural dynamics that required a different approach entirely. For the Afghan women in her practice, that meant respectfully including spouses or a male family member in health care conversations and working to earn the trust of the household, not just the patient, before a cervical cancer screening could even be discussed.

Dr. McLemore is trained to do colposcopy, deliver babies, and manage high-risk obstetric cases. In more populous settings where she had practiced earlier in her career, those skills saw limited use. In Tehachapi, they are essential. With no OB-GYN accessible without significant travel, she stepped into the role by necessity.

“It was either me or no one,” she said. “So, I got scrappy pretty quick and pulled those skills back into practice.”

In five years, she has diagnosed two patients with cervical cancer and many more with CIN 2 and CIN 3 precancerous changes that were caught and treated before they progressed to late-stage cancer. The number of those case findings in this rural setting far exceeded anything she had seen while practicing in more urban environments. The numbers told her something was way off, so she decided to do something about it.

Closing the Gap

Her ABFM Performance Improvement activity focused on cervical cancer screening rates in her patient panel, which stood at just 33 percent as of 2025. For Dr. McLemore, the project was less a basic obligation of the job and more a reflection of her professional commitment to providing a higher standard of care as a board-certified family physician. At its core is a commitment to lifelong learning and continuous growth as a physician.

The reasons women were not being screened ran the full range: the distance to the nearest clinic; distrust of healthcare professionals based on prior bad experiences; sexual trauma; anxiety surrounding the gynecological exam itself; and a widespread belief among older women that screening was no longer necessary after menopause. Addressing all of this requires more than a mere automated reminder system.

She started by empowering her medical assistants (MAs). Rather than waiting for her to flag overdue patients, she trained her MAs to identify screening gaps and initiate the “reminder” conversation themselves. If the visit was straightforward and the patient was willing, they moved forward with scheduling the appointment without waiting for her. If the patient declined, that opened a conversation with Dr. McLemore. The approach gave her MAs genuine authority and made screening a team-wide priority rather than one more item on the physician’s list.

“The MA I work with has been at this clinic for 15 years,” Dr. McLemore said. “She knows these patients. Giving her that authority, that buy-in, makes a real difference.”

For older patients who believed they had aged out of screening, she offered education without confrontation. For patients with trauma histories, she centered their comfort and control throughout the exam, using smaller instruments, offering to stop at any point, and never shaming a patient who declined and needed more time. The goal was to keep the “door of opportunity” wide open. Every visit was another opportunity.

Start Where You Are

The data from her performance improvement activity reflects what that persistence looks like over time. By early 2026, her cervical cancer screening rate had climbed to 47 percent, a 14 percentage-point gain over the prior year. She now exceeds her organization’s corporate benchmark of 44 percent, a result that carries weight coming from a small rural clinic that has historically operated below the radar of its larger parent organization.

For family physicians who put off the performance improvement requirement, Dr. McLemore has a straightforward message: it does not have to be complicated. Her project had no sophisticated data infrastructure, no quality department to lean on, and no elaborate methodology. She tracked her initial cohort on a simple Excel spreadsheet with 25 patients. She set a target and worked on the problem consistently over time. She acknowledges that the requirement can feel like one more obligation on an already demanding schedule but argues that the instinct to over-engineer it is exactly what makes it feel harder than it is.

“It’s OK to be scrappy,” she said. “I think sometimes we’re such perfectionists and such scientists that we think we need a double-blinded peer review. But you don’t have to get that complicated. Write it down, try it with 25 people, see what happens.”

She knows why early screenings are important. At 40, Dr. McLemore was diagnosed with breast cancer. It was found in time, and she has been a cancer survivor for nearly eight years. That experience shapes the way she talks to patients who resist screening, and she uses it deliberately. One patient in her 50s fought her for two full years on mammography. Dr. McLemore brought up her own diagnosis at every visit. Eventually the patient relented. The mammogram found stage one breast cancer.

“Those are huge celebrations,” she said. “It’s stage one breast cancer and I come in like; this is the best gift you could have.” She hopes the culture of screening she has built with her MAs will continue to grow, that the habits and the conversations will become part of how the clinic operates regardless of who is practicing there. What she built in Tehachapi was not a program with a name or a budget. It was what needed to be done, assembled with a spreadsheet, a lot of persistence, and a firsthand understanding of what it means to catch something early.

“No one ever has to die of cervical cancer,” she said. “No one ever has to have their uterus removed because of cervical cancer. But we have to find it first.”

The American Board of Family Medicine thanks Dr. McLemore for her dedication to her patients, her community, and the ongoing pursuit of excellence in family medicine.