In 1983, the Lexington Primitive Baptist church that Fletcher attended ordained him as a lay minister. In 1984, he opened a family medical practice in Lexington. Along with former classmate Dr. James D. B. George, he co-founded the South Lexington Family Physicians in 1987. For two years, he concurrently held the title of chief executive officer of the Saint Joseph Medical Foundation, an organization that solicits private gifts to Saint Joseph Regional Medical Center in Lexington. In 1989, Fletcher's church called him to become its unpaid pastor, but over the years, he grew to question some of the church's doctrines, desiring it to become more evangelistic. Consequently, he left the Primitive Baptist denomination in 1994 and joined the Porter Memorial Baptist Church, a Southern Baptist congregation.