[3][4] Less than twenty years after graduation, Francis had become "the leading Colored physician of Washington, D.C."[4] In April 1894, he was appointed first assistant surgeon at the Freedman's Hospital.

As the hospital's interim chief surgeon from April 16, 1894 to June 30, 1895,[3] he reformed patient care, established a training program for nurses, and advocated for more government funding.

While the Francis Sanatorium catered to physically sick or convalescent patients from the city's Black middle class, the clinical staff also treated poor African Americans.

A contemporary lauded the sanitarium as "being the only place of its kind in the United States, established, owned and managed by a colored man.

[2] He served as pallbearer at Frederick Douglass's funeral in 1906, represented D.C. at the National Conference of Charities and Collections in 1909, served on the committee for construction of the Carnegie Library at Howard University in 1909, became a member of the National Medical Association in 1910, and joined the Howard University board of trustees in 1912.