Coal company doctors once provided a large part of the primary medical care West Virginians received, especially in the state's southern coalfields. As the Children's Bureau of the U.S. Department of Labor noted in a 1923 report, most mining communities were too small to support a regular medical practice. Thus, the coal companies had to bring in their own physicians. The companies devised a system whereby they assessed their miners so much per month, deducting the amount from their pay checks. In the 1923 survey, the bureau found that single miners paid $0.75 to $1.25 a month, while married miners paid $1.50 to $2. The fees covered all medical care except for birthing babies and surgical procedures.

Some companies gave the doctor the entire checkoff collected, while others held back 10 percent to 20 percent as reimbursement for collecting the fees. Many doctors covered more than one coal camp, but the camps were almost always no more than several miles apart. None of the doctors in the 1923 survey provided care for more than 150 to 200 families. However, the total travel involved in making house calls in even a compact territory might be considerable. One doctor listed in his records that during some years he traveled as much as 20,000 miles, averaging well over 1,000 miles a month.

The early coalfield physician was educated differently than his colleagues today. Although requirements increased as time passed, a person could obtain a medical degree in 1880 by spending two years in a preparatory academy followed by two years at a medical school. Once educated, the doctor's career was shaped by the isolation and the poor transportation on the narrow roads of the coalfields. These doctors had to be strong and self-reliant, and they had to be ready to travel in all kinds of weather, often for hours to get to the sick or injured. The kitchen table in the patient's home often became a surgical or birthing table. The ability of the company doctor to improvise was an important characteristic, for he was usually completely on his own. He did not have a nearby hospital or colleague to turn to for help. Sometimes a relative or friend of the sick would give assistance.