In 1999, Kristie Schmidt, an internal medicine physician, opened a practice in Millerton, N.Y., just a mile from the Connecticut border. 

The office was located in a cozy, refurbished barn. Sharon Hospital provided her with a loan, which it eventually forgave, to help her get up and running. Her small staff included her husband at the time, who managed the billing, and a nurse who doubled as the secretary and knew every patient by name.