The primary objective of this study was to explore clinic group culture surrounding Reach Out and Read (ROaR) at a pediatric clinic recognized as successful in ROaR implementation. In ROaR-participating clinics, pediatricians give books and information to families at well child visits to promote daily read aloud practices deemed necessary by many experts to build early literacy skills. The program is known to be most effective when implementing clinics demonstrate positive group culture, yet additional understanding of cultural elements is needed. To explore clinic group culture, we collaborated with a ROaR regional representative and a pediatrician leading high-quality ROaR implementation to create a semi-structured interview protocol regarding staff perceptions and feelings surrounding ROaR. Then we conducted the semi-structured interview with twelve non-physician staff members in the pediatrician's clinic. A two-phase grounded theory analysis revealed an ingroup/outgroup relationship that created two distinct cultural groups related to ROaR. Participants described themselves as ingroup members and the patients receiving ROaR as outgroup members. The ingroup included community organizations, doctors, and study participants, working together to give books and information to parents and medical students, who made up the outgroup. Ingroup members assumed that outgroup members needed their services. Participants' descriptions of literacy resources in their own family cultures were different from their descriptions of the needs they perceived of members of the outgroup. Descriptions of outgroup members' literacy needs included multiple stereotypes that could serve to perpetuate, rather than ameliorate, existing literacy inequities. Empathy promotion within ROaR-implementing clinics is discussed as a potential strategy to increase equity.