Federally Qualified Health Centers (FQHCs)

Reprinted with permission from APMA News, July/August 2026

For many podiatrists, career paths are shaped by opportunity, training, and geography.

But for some, they are defined by something more enduring: need. In rural and underserved communities across the country, that need is driven by high rates of chronic disease, limited access to specialty care, and complex social challenges. For physicians like John Abordo, DPM, and Tommy Jacobs, DPM, answering that call has led to careers rooted not only in medicine, but in service. Both began their podiatric careers in private practice but pivoted to Federally Qualified Health Care Centers.

The first FQHC was established by H. Jack Geiger, MD, and Count D. Gibson Jr., MD, at Columbia Point in the Dorchester neighborhood of Boston in 1965, and a rural center in Mound Bayou, MS, soon followed in 1967. A legacy of President Lyndon B. Johnson's War on Poverty, FQHCs were designed to provide high-quality primary care for the most impoverished and ill-served areas of the U.S. At least 51 percent of the governing board of an FQHC must be patients, which ensures medical care standards remain high. More importantly, this requirement ensures that FQHCs are more responsive to patients and incorporate their voices in health care. Put simply, FQHCs have helped democratize access to health care.

Since their inception, FQHCs have grown in number to around 1,400 and now serve over 32 million patients. Over two-thirds of the patients served by FQHCs are below the Federal Poverty Level ($31,200 in 2024 for a household of four), and over 60 percent are patients of color. Sixty percent of FQHCs serve patients in medically underserved urban areas and 40 percent served patients in rural areas. Nearly one-third of FQHC patients are children.

Almost two decades ago, Dr. Abordo learned that his parents’ local health center in the Central Valley of California serving a population with high rates of diabetes, had no podiatrist, so he stepped away from the private practice he was running in Northern California to help out temporarily—at least that's what he thought. "I thought I would just help out for three months," he explained. "That was almost 19 years ago" What he discovered was that, "This is a place where you can truly make a difference," and his time at an FQHC has been his most rewarding as a podiatrist.

The Central Valley's agricultural workforce and large underserved population create a significant demand for foot and ankle care. Yet, like many rural areas, it struggles to attract specialists. "Many providers prefer urban settings," Dr. Abordo explained. "But the real need is here." Dr. Abordo described how “many patients delay care, and by the time they come in, the condition can be quite severe.” Some patients can't treat their problems because they don't have time off from work or live too far from treatment, so they only come into the clinic when they have no other option. Dr. Abordo also described how the FQHC is an ideal space for expanding one's medical knowledge because of the diverse, advanced cases that present themselves: "You see a wide range of pathology at FQHCs. It's an incredible learning environment."

Dr. Abordo recalled treating a farmworker with a serious heel infection who, despite the severity of his condition, needed to return to work the next day to support his family. "You have to adapt your care to the reality of their lives," Dr. Abordo said. Many of his patients are agricultural workers who can't miss time off from work and must be on their feet to do their jobs. While mobility means independence for many patients, for Dr. Abordo's patients, mobility is a prerequisite for earning a living. Without mobility they would lose their ability to put bread on the table and a roof over their heads. Dr. Abordo is sensitive to these unique realities working in an agricultural region, and he takes pride in helping resolve problems with the most important tools these workers have: their feet.

Dr. Jacobs also works at an FQHC in California, Western Sierra Medical Clinic, but his patient population differs from Dr. Abordo's: “We treat a wide range of patients, including homeless individuals, elderly patients, people with disabilities, and working-class patients. In many cases, we're their last stop for treatment and the very last safety net in society.” Many of Dr. Jacobs' patients suffer from substance use disorders, chronic disease, and inconsistent access to care. For many patients, health care is Just one of several competing priorities, and Dr. Jacobs explained that “People are focused on survival. and your goal is to help them stay functional.”

Dr. Jacobs’ career arc reveals a potential benefit more podiatrists may want to consider in the latter stages of their careers. After decades in private practice, Dr. Jacobs and his family wanted to leave Georgia for California to be closer to family. Dr. Jacobs had plenty left in the tank, and he wanted to continue serving patients, but he was seeking a change. "I still wanted to work," Dr. Jacobs said, "I just didn't want the burden of running a practice anymore." Dr. Jacobs discovered the perfect balance at an FQHC, where he now works part-time across multiple clinics. "There's no overhead, no staffing concerns, no billing issues," he said. "You come in, see patients, and go home. It's fantastic for podiatrists that are not ready to retire yet and want to keep serving patients. There is a lot of flexibility working at an FQHC; some people work part-time a couple of days a week in order to spend more time with family. Some people still need money, but they are getting close to retirement and don't or can't maintain a full-time schedule anymore. There's a great need for our medical expertise at FQHCs, so you can find the right fit for your life or shape your work commitment. If you want a predictable schedule, you can have it," Dr. Jacobs said. "That flexibility is very hard to achieve in private practice.”

But that wasn't the best part of Dr. Jacobs' transition to an FQHC The integrated, team-based model has reshaped how he approaches care. Dr. Jacobs explained that, "I work alongside providers from multiple specialties and it's made me more holistic in my thinking. You're not practicing in isolation. You're part of a team. I share a large open-air office with other doctors and advanced practice providers, and I am always learning from the other physicians in the room. This collaborative environment has been a revelation for me, and I have expanded my medical knowledge and helped teach others using my expertise in podiatry." FQHCs typically include primary care, behavioral health, dental, pharmacy, and social services under one roof, which creates a collaborative environment that supports complex patient needs. Dr. Jacobs described how this unique practice setting has allowed him and his colleagues to deliver better care to patients that leverages the knowledge of multiple specialties at once.

Dr. Jacobs felt a sense of community working at an FQHC with other medical advanced practice providers and physicians, something he didn't realize he was missing when he was running his own practice. Dr. Abordo emphasized, "You're part of the community. Not just a provider." Working at an FQHC means becoming part of the fabric of the community, and many providers are also patients. Dr. Abordo said, "This makes working at an FQHC special. It becomes more than a profession. You embed yourself with the community and it makes the work so meaningful."

Policy, Advocacy, and Education

Sustaining rural health care requires more than individual commitment—it depends on consistent policy support, and funding for FQHCs and rural clinics remains a critical issue. KFF reported that in 2024 FQHC revenue increased 6 percent. but this was not enough to outpace the increase in operating costs. In 2024 net margins decreased a little over 2 percent. "Legislative support is essential," Dr. Abordo says. "Without it, services can be reduced." Both physicians also stressed the importance of grassroots advocacy like building relationships with local policymakers and ensuring they understand the realities of rural care "It's not a one-time effort," Dr. Abordo said. "You have to stay engaged." Medicaid is by far the most important funding source for FQHCs: Over 60 percent of patient care revenue came from Medicaid, which accounted for 45 percent of total revenue.

Dr. Abordo also described how education is crucial for making more young people aware of the profession as well as introducing podiatric medical students and young physicians to this career option. Dr. Abordo has worked with local schools to introduce students to podiatry, helping build a pipeline of future providers. "Many people don't even know this path exists," he said. As a part of the community, his words carry more weight, especially since many students he speaks to attend his clinic or others in the region. When family members receive high-quality care at an FQHC. it provides a perfect opening to introduce them to podiatry and all it has to offer.

As the health-care landscape continues to evolve, rural and underserved settings are likely to play an increasingly important role in the future, and FQHCs offer a chance to align clinical practice with broader purpose. "Diabetes and foot compli-cations aren't going away. There will always be a need, and this need is prominent in FQHCs which serve lower-income populations,·said Dr. Abordo.

Dr. Jacobs succinctly summed up working at an FQHC when he said, "This model offers flexibility. purpose. and a chance to make a real difference."