In the numerous small communities and counties of Montana, the primary care provider often has to assume by default the responsibilities of a traditional health department. To facilitate this role, the health department mobilized community partnerships and took action to address deficits in health care by establishing a community health center and later encompassing a residency program. By educating primary care physicians in a health department and community health center environment, the program is preparing resident physicians to practice in rural and underserved communities while simultaneously providing health care access to an underserved and uninsured population. Through this partnership, both patients and training physicians are informed, educated, and empowered about population health issues.

The aim of the Montana Model is to provide health care to the 11 percent of the county citizens living below the federal poverty level and the many more living in near poverty, while simultaneously providing a medical clinic with diversity and complexity for family practice residents to obtain enriched training with the public health perspective.

This relationship between the health department and the residency program has enhanced the provision of holistic health care to a population with high physical and mental morbidity, more than doubling the annual number of unduplicated patients and medical encounters.Thirty-one family practice physicians have trained at the DCHC, and 67 percent have located their practices in rural or underserved areas. The location within a health department gives patients greater access to the myriad functions that complement and support health care (WIC, MCH, hospice, environmental health, visiting nurse service, medication assistance program, Health Care for the Homeless, Breast & Cervical Health, HIV/AIDS services, School Nurse Program, vital statistics).