I trained in the early 2010s, in a network that had quietly stopped naming the things it would not do. The intake forms used the language of breadth — comprehensive primary care, integrated behavioral health, women's health — and the front desk used the language of triage. The two languages did not match. A patient whose preconception counseling was nominally part of women's health would find herself, on the day, with a clinician who had not done a full prenatal visit since residency. The intake had not lied. It also had not told the truth.
Six of us — five clinicians and a clinic administrator named Maritza Polanco who keeps the practice from drifting — opened Pharos in October 2019. We took the lease on the second floor of a three-story building at 110 Abeel Street, two blocks uphill from the Rondout Creek and one block from the lighthouse keeper's old house, in a part of Kingston that has been called the Strand for two centuries.[01] The building had been a chandlery in the bluestone era and a bookbinder's shop in the cement era; the brick still bears the name of the original owner above the ground-floor lintel. We are the third or fourth tenant to do something useful in it. We have tried to be precise about what we mean by that.
What a formulary is, and why we made one of ourselves
A pharmaceutical formulary is a deliberate document. It names the drugs that an institution will stock, the indications for which it will stock them, and the specific contraindications under which it will not. The British National Formulary publishes a new edition every six months, in March and September; it has been doing this since 1949.[02] Each entry has the same fixed fields, in the same fixed order: indications, dosage, contraindications, cautions, side-effects, interactions, professional notes. You read a BNF entry the same way you read a tide table. The fields are stable; the values change.
What we have done is take that fixed-field discipline and apply it to the practice itself. Every service — adult primary care, pediatric and adolescent care, behavioral health, reproductive and gender health, office procedures, and acute and after-hours care — is published as a numbered monograph with the same fields in the same order. CCH-001 through CCH-006. When something material changes — when, for example, the USPSTF moved aspirin for primary prevention to a D recommendation in adults age 60 and older in 2022 — we update the relevant monograph, write down what changed, and write down why. The previous text remains accessible, dated, in the errata page. None of this is novel. It is, in fact, ordinary library science applied to clinical practice.[03]
The reason we do it this way is not transparency for its own sake. The reason is that a clinic which has actually decided what it does and does not do can answer the front-desk telephone correctly. It can give an honest answer to can you take care of my elderly mother's heart failure on the first call. (The answer is: yes for outpatient management, in concert with her cardiologist; no if she has had a hospitalization for decompensated heart failure in the last twelve months, in which case we will refer to NYS Office for the Aging-coordinated home-based primary care or to the MidHudson Regional Hospital heart-failure clinic.) That answer is in CCH-001 § Contraindications. Maritza reads it from the screen. The patient is told a true thing inside thirty seconds.
Five clinicians and a small panel
We are five clinicians. Maren Vanderlyn, MD (medical director) is family medicine, with focus on adult chronic disease and gender-affirming hormone therapy on the informed-consent model. Otis Thackeray, MD is family medicine with a substance use disorder concentration; he carries the practice's SAMHSA-recognized buprenorphine practice and is one of two clinicians here who initiates MOUD. Helena Rey, FNP-BC is a family nurse practitioner with pediatric and lactation focus, certified by IBLCE. Salim Okonkwo, PMHNP-BC is a psychiatric mental health nurse practitioner; he holds the behavioral health panel. Tessa Voorhies, DO is family medicine with osteopathic manipulation training and operates our office-procedure list and obstetrics-coordination workflow.
Our active panel is 1,640 adults and 410 children, with an integrated behavioral health panel of 312. The panel has been at this size, plus or minus four percent, since 2023; we will not enlarge it without enlarging the staff first. Continuity of care — meaning the proportion of visits in the rolling twelve months in which a patient saw their assigned principal clinician or that clinician's named partner — is 82% across the panel.[04] The number is published quarterly, audited internally, and is in CCH-001 § Outcomes. We will never report it as over 80%. The actual number, this quarter, is 82.1%.
What we will not do
This is the section that gets cut from most clinic websites, which is one of the reasons most clinic websites are useless. The full list is in each monograph's § Contraindications. The summary, here, is:
- We do not provide intrapartum obstetric care. We coordinate prenatal care through 28 weeks and refer to the MidHudson Regional Hospital Obstetrics & Gynecology service or to the NYU Langone Maternal-Fetal Medicine service for high-risk care. (See CCH-004 § Contraindications.)
- We do not provide individual therapy for our behavioral health panel. We co-treat with named community therapists and, where the panel cannot accommodate, with the NYS Office of Mental Health directory. (CCH-003 § Contraindications.)
- We do not initiate stimulant therapy for adult ADHD without an objective neuropsychological evaluation completed within the last five years. We have a referral relationship with Benhome Medical Evaluations in Poughkeepsie. (CCH-003 § Adverse Effects, item 3.)
- We do not provide chronic opioid therapy outside of the SAMHSA-aligned MOUD pathway and a small palliative-care list maintained jointly with Hospice and Palliative Care of Ulster County. (CCH-001 § Contraindications.)
- We do not write disability paperwork for patients who have been with the practice fewer than ninety days. (CCH-001 § Contraindications, item 7.)
We say no in writing because saying no in writing makes it possible for us to say yes, in writing, to the things we are good at — and to be answerable to those promises afterward. A clinic that writes only what it does is operating in a half-language. We are interested in finishing the sentence.
Why Kingston, why the Rondout
The Rondout is a working neighborhood and has been one for two hundred and twenty years. It was the eastern terminus of the Delaware and Hudson Canal until 1898; it was a Hudson Valley cement and bluestone center until the cement industry moved south after the First World War; it has been, in the last twenty years, a neighborhood that quietly absorbed a generation of artists, tradespeople, and former-elsewhere parents who wanted a town with a working harbor and a working library. The Hudson River Maritime Museum is two blocks east. The Kingston Library, where Maritza got her MLIS, is a mile uptown.
Kingston was originally Wiltwijck, a Dutch settlement, which has nothing to do with how we built this practice except that the etymology of polder — a low-lying tract of land that survives because it is actively maintained — has been on the wall of our staff room since the first week. The clinic is a polder. The maintenance is the practice.
Where to read next
If you want to read the operational text, start with the monograph index. If you want to know who you would actually be seen by, the clinician roster includes each of our hours, panels, and panels-not-currently-accepting. If you want to know how things go wrong here and how we deal with it, read the case logs or the errata page. If you have already decided to come, the intake form is three pages long.
— Maren Vanderlyn, MD
Medical director
For the practice
Kingston NY · 22 April 2026