There’s something profoundly different about the manner and mission of Dr. Grace L. Keenan’s approach to medicine. Raised on an Irish potato farm in Canada, she has the grounding of the good earth in her touch. Familiar with diving into backbreaking work even if she doesn’t have all the answers, she has the confidence not to decline the toughest of challenges. Trained at a medical school in Newfoundland, she has a breadth and nuance of knowledge as vast as the windswept terrain she was taught to serve. She has a resoluteness of spirit that keeps her standards of care unyielding, and a common sense that most players in the health industry today are only beginning to wake up to.
Now the founder and CEO of Nova Medical & Urgent Care Center, Inc., a thriving, multi-facility, integrative medical provider in Northern Virginia, Grace grew her practice the way her parents accrued their own success—from nothing into something. Her father, the eldest of 15 children, grew up in a poor farming community and dropped out of school in third grade to help care for his younger brothers and sisters. Her mother, a teacher in a one-room schoolhouse, grew up the daughter of a butcher. When they married, they were gifted $100 in cash from friends and family. Her mother had her heart set on buying a bedroom set from the Sears catalogue, but her father insisted on using it to buy a flock of sheep. His new bride was in tears for weeks, though she would later come to realize that this was indeed a wise decision.
That winter, Grace’s father cleared a hundred acres of land that had been given to him. In the spring, he removed the stumps and planted a hundred acres of potatoes, which grew into a bountiful harvest. Once they sold the crop and the flock of sheep that had since multiplied, they had enough money to build a potato house to shelter future harvests. As time passed and their farming business grew, they moved into a large Victorian farmhouse on 500 acres of land. Over their lifetime, they amassed 5,000 acres for farming, a family plane, packaging plants, and a trucking company, building an impressive farming operation.
Grace’s father was the symbolic leader of the family venture, but her mother was the real mind and might behind the business. Deeply devout to her Roman Catholic faith, and known to speak with perfect diction, Grace remembers her mother as strong and unbreakable. She was also a quintessential lady of the era, keeping a copy of Emily Post on the kitchen counter for her daughters’ frequent reference. She believed the best thing she could do was raise them to be good wives and mothers, teaching them all manner of domestic skills. Grace didn’t mind cleaning or baking, but she hated sewing, and refused to learn how to darn socks. “I was filled with fury at the idea that any man would expect me to darn his socks!” she recalls. “My mother could never get over the fact that I didn’t learn how to properly sew until medical school.”
Grace grew up the youngest of eight siblings in a family that would meet at the table three times a day for meals, where the discussion revolved around productivity and the tasks each person hoped to accomplish. The nanny who cared for her through her girlhood was very gentle and taught her a great love for animals, lending a charmed air to her interactions with the world and a rich connection with nature. “She taught me that touch and humanity are integral to growth and healing,” Grace affirms. “We would heal animals on the farm at times, which kindled my interest in veterinary medicine. I also had an uncle who was schizophrenic, which sparked my interest in mental illness. Everyone else considered him an embarrassment and didn’t want to be around him, but I would sit with him through his psychotic episodes, asking him about his experiences and developing great compassion for him.”
This compassion was part of a larger thread running through the family. Each morning, the children would traipse down to the community bunkhouse, where the homeless sought shelter. Grace and her siblings brought breakfast and an invitation to work on their father’s farm to earn a day’s wage. Her father also employed inmates from the local jail, who came to assist with the backbreaking work of farm labor. The women of the household, in turn, prepared elegant meals for the workers, and Grace had the opportunity to get to know people from all walks of life. “I took an interest in different types of people and how they got to where they were in life,” she reflects. “I had this desire to help people improve the general caliber of their lives.”
Grace was twelve years old when her father had the first in a series of heart attacks. Her mother sat her down to discuss what would happen when they passed away. The farm would be split between her five brothers, while the daughters were guaranteed that their tuition for school would be paid for. “At a very young age, I understood that I would need to be responsible for my financial wellbeing,” she remembers. “I decided to rely upon myself to feed my children and put a roof over my head, committing myself to working hard.”
With only a limited understanding of the world, Grace imagined she had two options: business, or health and science. Having watched her own parents run the farm business, she was disillusioned with the former, so she considered the latter. She got a job in a pharmacy but found it exceedingly boring, and she didn’t want to follow in her sister’s footsteps to become a nurse. Her mother suggested she become a school teacher or a secretary, but neither appealed to her. She met with the family doctor in her hometown and asked if he thought she was smart enough to become one herself. “He said he didn’t know, but he explained to me what I’d have to do,” she recounts. “So I applied to the most prestigious school in Eastern Canada, Dalhousie University.”
After gaining admittance and earning her Bachelor of Science degree, she applied to medical school in Newfoundland, though she was fairly certain she had no chance of getting in. The program’s ten seats for residents of New Brunswick garnered around 500 applications each year. “I did not ever dream that I’d get in, but I did,” she says. “It was a true life highlight—an incredible moment that I’ve never forgotten. I imagined myself living a Norman Rockwell-type existence, romanticized and heroic.”
Though her experience as a doctor would be a far cry from the idealized concept she emulated at her journey’s start, it lends credence to the refrain that beauty is truth. In Newfoundland, she was trained to care for big city residents and rural Inuit people alike. The Inuit patients didn’t speak English, and Grace wrestled with cultural differences that compelled mothers to cancel necessary treatment regimens when their children didn’t like the taste of the medications. She was taught to think of medicine as caring for all parts of the patient, and with minimal equipment and support.
Grace completed medical school in 1985 and her residency in Ohio, where she was trained as an internal medicine specialist. In that capacity, she learned to care for complex patients in both hospital and outpatient settings. “I was essentially functioning as an intensive care doctor at the time,” she remarks. When she came to Loudoun County, Virginia in 1988, she was a 28-year-old board certified internal medicine specialist credentialed to work in the ICU. “I was a foreigner with a British background who dressed like a French girl and seemed culturally out-of-place,” she reflects. “No one wanted to hire me, so I decided to take out a $30,000 line of credit, lease a 1,200-square-foot space, and start my own practice.”
Grace had no idea how long the money would last, and she hadn’t done a market analysis, but she compared all challenges to a winter in Newfoundland, certain they would be less difficult. With no idea of what to expect, she put an ad in the local paper. She didn’t have a graphic artist, so her contact at the local paper offered to design a rudimentary advertisement featuring Grace’s graduation photograph, a brief biography, and a note that she was accepting new patients.
Much to her surprise, the phone began to ring off the hook. A sizable population of local residents had previously been stationed at a US Naval Base in Argentia, Newfoundland, and Grace’s picture conveyed the familiarity of a long-past lifetime in its wholesome, unassuming invitation. “They’re very loyal, and immediately became my patients,” she remembers. “On the day I opened the doors of my practice, I had eight appointments. The patients had to walk over boxes to get in, and I couldn’t believe all those people wanted to see me.”
Though business continued to escalate, Grace found time to give birth to her first child, David, in 1990. She returned to work a month later, leaving David in the care of a nanny. Several months later, however, she walked in on the nanny shaking the baby, and vowed to never leave her child at home again. With that, she rented out the 1,500-square-foot commercial space next door to her practice and turned it into a nursery. Each day, her patients would come in for their appointments and then go see the baby.
Three years later, Grace’s practice had outgrown its location, so they moved down the street to a 9,000-square-foot space spread between two floors. There was an urgent care center at a hospital a half-mile down the road. She asked them to refer those patients that didn’t have a primary care physician, but they refused because she wasn’t affiliated with their building. With that, she decided to open her own urgent care practice in 1991, which became Nova Urgent Care. “I modeled Nova Urgent Care after the cottage hospitals I had seen in Newfoundland, where the small rural towns didn’t have ICUs,” she says. “It wasn’t realistic to transport people hundreds of miles away for care, so excellent and holistically-minded medicine was practiced in these little cottage hospitals. I didn’t see the point of admitting someone to the ICU for an asthma attack. Rather, the patient could be put on the right medications and monitored in the urgent care to prevent unnecessary expense and hassle. Almost always, they didn’t need further hospital care, and thousands of dollars were saved.”
Patients were drawn to the one-stop-shop model that her practice endorsed, and they were drawn to the simple customer service skills she had learned as a waitress and bartender through medical school. “Customer service is often lost in medicine,” she remarks. “It has always been important to me to do little things that respect the dignity of each person I serve, such as offering a patient a nice warm blanket, or learning some rudimentary Spanish and attempting to speak the language as needed, and enlisting the patient’s opinion in their care.”
As the Nova Medical and Urgent Care model expanded, its culture and brand were maintained by Grace’s hiring standards. “I strive to hire people who feel the same way I do about medicine,” she notes. “If a person does not share the same mission, vision and values, he or she is not a good cultural fit for us. We are dealing with patient lives, and I take great pride in that. I often tell prospective employees that I cannot pay them for what they’re expected to do, so their drive has to be genuine and inherent. I expect people to care genuinely about our patients and protect their best interests. I ask our staff to serve our patients as their authentic selves. Our patients deserve it.”
Amidst continued growth and expansion, Grace’s personal and professional life came in ebbs and flows. Having learned what love was when David was born, she was committed to having more children, but faced complications that led her to consult a reproductive endocrinologist. She was put on an overzealous regimen of medications and treated like a number, giving her a vantage point of the patient experience that revolutionized her capacity for empathy. “I spent a year in bed, thinking I could just go to these specialists and they’d have the magic sauce,” she remembers. “I learned a lot about medicine from the patient’s eyes as I was being charged exorbitant amounts while being treated horribly. I almost died several times, and I ended up losing the twins at age 39.”
While on bed rest, Grace ran her company from her home and coached her staff through a massive influx of patients when the competing urgent care center down the street went bankrupt. They outgrew their space yet again and moved into an old emergency room nearby. To pass the time, she decided to take a Harvard distance learning course on complementary medicine. The material covered alternative forms of medicine she had never considered, but which resonated deeply with her. Since the 1940s, homeopathic medicine had been systematically removed from the healthcare landscape. Yet alternative forms of medicine, including naturopathy, had been scientifically proven to be effective. “I was so impressed with the idea of working with teams of people with such different philosophical approaches to help patients,” she says. “And mind-body care really emphasizes the power of belief in medicine. Patients and doctors need to trust and believe in each other if things are to go anywhere. I think that without believing in something, we don’t get better. Medicine is a science, but there’s also an art to it.”
After five years of failure with reproductive endocrinology in Northern Virginia, Grace sought the care of Dr. Schoolcraft, a doctor in Denver who had grown up on a Kansas wheat farm. After the first treatment, she was pregnant with her daughter, Beatrice. One year later, at 42, she was pregnant with twins. “There’s a 2 percent chance that a woman over 40 will give birth to twins, and it has a much smaller chance of happening for someone with the kinds of challenges I had,” she explains. “It was a sad story turned into a happy one, and I feel that belief played a role. You can’t just wish and make anything come true, but there’s a lot of power in positive thinking.”
A month before she gave birth to her twins, her company suddenly found itself in need of a new location in Leesburg, so they moved into an abandoned pet shop space in town. “It was a simple rectangular space with windows at one end, and I remember drawing up the plans for the architect while on bed rest,” she laughs. “That was the new site in Leesburg for Nova Urgent Care, and we weren’t sure if anybody would want to see us there, but pretty soon, we had so many patients that the hinges wore off the doors.” The operation now includes four locations: Gainesville, Leesburg, Ashburn, and Sterling.
Through that time, Grace’s company hadn’t only grown vertically, but also laterally. After growing fed up with rent culture, she purchased a 60,000-square-foot building in Ashburn, Virginia, to house the medical group operation she relocated from Sterling to Ashburn. She turned the rest of the building into a condo regime, retaining 75-percent ownership. Around that time, she launched a third component to her company, The Medical Spa at Nova. “We needed a facility where people could heal, not through the sole help of prescription drugs, but instead with a focus on diet, lifestyle, exercise, and other key solutions to chronic disease eradication,” she says. “The question was, were we going to keep treating reactively with drugs and surgeries, or were we going to treat proactively by focusing on prevention? The latter made sense to me.”
Integrative care is commonly accepted today, but when the spa opened in the early 2000s, naturopathic and other alternative approaches to medicine were not as common. When the practice opened, patients who had exhausted all other options began to see results, giving them the power to reclaim their lives. “Many times, your health is directly connected to the whole story of your life,” Grace points out. “You look at the age of the patient, the time symptoms occurred, and what else was happening in their life at that time. You begin to piece together the parts like a car mechanic, connecting the dots to reveal new discoveries about a patient’s condition.”
Now, Grace’s four locations employ approximately 270 people, who serve between 500 and 600 patients each day. A 100-percent Employee Stock Option Plan company, Nova operates with an emphasis on ownership, accountability, and the company’s core values: compassion, excellence, collaboration, and integrity. It has naturally attracted tremendous diversity, with 36 languages represented in its staff. Its success draws not from over-prescribing and over-charging, but rather from the good will and loyalty inspired by the team’s commitment to cut costs and deliver practical, thoughtful, intentional care. “Not everyone needs to have an MRI scan or an expensive procedure,” Grace says. “If you have good bedside diagnostic skills and you know how to use a stethoscope, you don’t always need a lot of expensive technology.”
Good business and management practices, compelled by good hearts and minds, lead them to provide $60,000 in free care to Loudoun County residents who can’t afford treatment. “We don’t turn away people who are suffering if they don’t have money,” she affirms. “We feel that it’s important to give back to our community, and we support a number of local fundraising efforts and events. We also host an annual breast cancer awareness event at our spa in October, and have worked with beneficiaries including the Tigerlily Foundation and Breast Cancer Network of Strength. This year, we’ve selected the Cherry Blossom Breast Cancer Foundation as our beneficiary.”
Her sensitivity to the woman’s experience is straightforward and comes without frills, informed by a lifetime of observing various gender norms. “I feel very strongly about gender equality, both for men and women,” she says. “I’ve never felt that I was a woman in a man’s world—all my mentors were men, and we got along great.”
In advising young people entering the working world today, Grace encourages a harmony between passion and practicality. “It’s important to pick a career that will put food on the table,” she says. “I think it’s wholly possible to love what you do and do what you love while also providing for yourself and your children. Always be true to your authentic self, even if that means making hard decisions and rerouting your life’s course.” Leading by example in this regard, she remains fiercely motivated by the opportunity to see each patient as an individual, with their own story, beliefs, afflictions, and solutions. Her work is not merely about prolonging life, but optimizing it. It’s not only about making people well, but also about making them whole. “Recovering from afflictions in life, whether physical, emotional, or psychological, is a complex process,” she remarks. “Maybe we don’t ever fully recover to that naïve person we were before we experienced the affliction. But maybe true healing is recovering into something more wonderful when we weather difficulties. Maybe those hardships help us understand what’s really important in life. At its root, that kind of wholeness is what I work to bring my patients every day.”