The TAP-IN Blog

“Volunteers are not paid; not because they are worthless, but because they are priceless.”

So reads a sign in the break room of the Arthur Nagel Community Clinic in Bandera, Texas.

The clinic makes preventive and primary care available to Bandera County residents at no cost or low cost – depending on family income – to those who are uninsured. Chronic conditions, such as diabetes, high blood pressure, obesity and depression are all dealt with through Risk Busters, the clinic’s preventive healthcare program.

The Nagel Clinic fills a definite need in our county as evidenced by the fact that:

• There is no hospital or emergency care facility in Bandera County – a county with a population of more than 20,000.

• A report by the Texas Department of State Health Services indicated that there were 9,488 residents per direct-care physician in Bandera County. Statewide, there are 661 people per physician.

• The county has been designated a Medically Underserved Area since 1978.

• Those without insurance – estimated to be one in four Bandera residents – often do not seek medical care until they are seriously ill and must call the EMS for transport to emergency care in another county.

You may ask how a private not-for-profit clinic can operate in today’s high-cost medical marketplace without charging the outrageous fees characteristic of our nation’s for-profit health insurance system.

Make a visit to the Arthur Nagel Community Clinic on the campus of Helping Hand in downtown Bandera and you will find the answer in a single word: volunteerism. There is a sign in the coffee break room that reflects the operating philosophy: “Volunteers are not paid; not because they are worthless, but because they are priceless.”

Volunteers raised the money to build and operate the clinic. Pat Breedlove and his “Fun Raising” Committee raised $127,000 in Bandera County for the clinic’s first year of operation.

The clinic is operated by three employees and a volunteer staff of 20, half of whom are medical professionals. Here are some examples of just a few of the dedicated volunteers:

• Medical Director Saleh Jaafar, M.D., reviews patients’ charts. He takes time away from his own family practice to serve the Community Clinic without compensation.

• Cheryl Finch manages the Prescription Assistance Program and works two 10-hour days every week to make sure clinic patients have the medications they need.

• Donna Graham works long hours as a receptionist volunteers her time.

Our community clinic also benefits from volunteerism on a state and national level. As a member of the National Association of Free Clinics and the Lone Star Association of Charitable Clinics, the Nagel Clinic receives free equipment and free and low-cost medications. Both are nonprofit corporations, run entirely by unpaid volunteers who work with pharmaceutical companies to provide free and low-cost prescriptions to patients who otherwise would go without.

Hundreds of Bandera County volunteers are working right now to raise money to help pay the clinic’s 2009 operating costs. Some are selling tickets to the Jan. 24 and 25 stage production of “Always…Patsy Cline.” Others are signing up to compete in the February Stationary Marathon, hosted by Comprehensive Physical Therapy & Bandera Fitness. Every committee member and every donor is a clinic volunteer and part of the clinic’s healthcare team.

The Upside - the Good That Two Free Clinics Can Do

In North Carolina, these two clinics - the Community Care Clinic and the Good Shepherd Clinic - demonstrate the services that local people can't find anywhere else.

Franklin Downs of China Grove saw a dentist Wednesday for the first time in 30 years, thanks to the Community Care Clinic of Rowan County.

A friend told him about the Salisbury clinic, where people who qualify can get free medical and dental care. 

What would Downs be doing with his toothache if the Community Care Clinic and Dr. Jim Mitchell were not there to help him?

"Probably pulling my teeth myself, like I used to," Downs says.

Downs, 57, is part of a growing stream of people flowing into free clinics like the Community Care Clinic on Mocksville Avenue and the Good Shepherd Clinic on South Fulton Street. Both are nonprofit organizations that rely on donations, grants and volunteers to keep the doors open.

Sermo: Update on a Large Online Doctor's Community

At Tap-In, we believe that health care professionals interested in and engaged in volunteering at free clinics can benefit by interacting with one another via the Web. That's why we invite you to comment on these blog posts. Some question whether busy doctors, nurses and dentists can or will find the time to do so. But there's some strong evidence that doctors do use the Web to interact with one another.

This past October 22 and 23 in San Francisco, the third Health 2.0 Conference was held. Drawing from the widely used term "Web 2.0" this conference highlights the increasing use of social and interactive media in the health care industry. One of its presenters, who was interviewed on stage, was Daniel Palestrant, the CEO of Sermo, an online social network of physicians that was started about two years ago.

The business model of Sermo is to provide sponsoring companies - pharmaceuticals, medical products, and more recently financial news publishers - access to doctors and their conversations. There are no advertisements on the site and access is free as long as you can be verified as a practicing physician.

What makes Sermo newsworthy for Tap-In visitors and partners, is the assertion by Palestrant that it has over 90,000 member physicians and is adding about 7,000 new physician per month. And that "99.9%" of member visits are what is described as "peer exchange" rather than participation in surveys presented by commercial sponsors. As seen in this video of Palestrant's interview, he claims that almost 1/5 of the total number of physicians in America are registered members, and that contrary to expectations, the busiest doctors do join and log in.

Volunteers in Medicine Now Has Clinics in 22 States

An article on the web site "A Highly Placed Source" describes the growth and status of Volunteers in Medicine (VIM), an organization begun in 1992 with a single clinic on Hilton Head Island, South Carolina. As described in the article, VIM is "an organization whose mission is to promote and guide the development of a national network of free clinics, is utilizing retired medical professionals and lay volunteers to care for the uninsured within a culture of caring."

Today, with clinics serving 66 communities in 22 states, VIM claims to have used the volunteer services of "250,000+ retired physicians and 350,000 retired nurses" to provide health care to the uninsured.

“No community can be truly healthy if a significant portion of the population is excluded from basic health care services,” says Amy Hamlin, executive director of Volunteers in Medicine. “In the absence of a national health policy that includes health care for everyone, concerned citizens need to find other solutions to provide the medically under-served with the health care services they desperately need. Volunteers in Medicine delivers on such solution.”

The article goes on to describe the grim health care scenario facing the country - a situation that will only be worsened by the current economic downturn.

Even if everyone were to become insured tomorrow, there is not enough current or future primary care capacity to provide health care to all Americans. Over one-third of active physicians are over age 55 and with many choosing early retirement, there will be a deficit of primary care physicians by 2020. Faced with lower reimbursement rates, excessive work loads, and rising medical school costs, fewer graduates are choosing primary care. “Empowering retired physicians to practice the ‘pure medicine’ they crave without the ‘business’ of medicine is the common sense approach that Volunteers in Medicine provides. This is one solution to improving the long term health of our country,” continued Hamlin.

Some 313,000 of the active physician population are over 55. This means that 36% of active physicians are set to retire by 2020 while at the same time there are only 105,000 physicians in residency training. Contrary to predictions in the 1980’s and 1990’s, there will not be a surplus of physicians in the 21st Century but rather we will face a physician shortage. “The statistics on current and projected physician numbers further support the ongoing effectiveness that the VIM model will have in improving the healthcare of our country long term,” continued Hamlin.

Medical Volunteer Finds "Sense of Purpose"

Volunteering in a medical capacity can be satisfying for anyone, regardless of profession or background. Here's an example of a 70-year-old Oklahoma woman, who first began working at a hospital when her husband was dying, is happy with her role supporting families awaiting outcomes of surgery on their loved ones. Bea Edwards provides comfort, empathy and conversation to worried and nervous relatives and friends.

“I really act as a go-between for the surgeons, doctors and families,” she said. “I keep track of where the family is at. I talk to both and tell them where each one is at. I reassure them that things are all right with their family member. I keep a log of when they go into surgery and when they come out. I hope I make them comfortable and let them know they matter to the hospital. Anything I can do for them.”

Edwards said she doesn’t have any problem helping worried family members stay calm.

“I’ve had a lot happen to me in my own life, so I’ve learned to take it as it flows,” she said.

A Profile of the Uninsured in Minnesota

A writer for Minnpost.com did some research and focused on the artist community in the state to debunk some commonly held beliefs about who make up the ranks of the uninsured in the state. In an article titled Just who are the uninsured in Minnesota?, Casey Selix interviewed the executive director of St. Paul-based Springboard for the Arts to flesh out a profile that counters the conception that many people seem to have formed of their uninsured neighbors.

Artists are mostly self-employed, creative workers whose income levels don't allow 14 percent of them to pay for health insurance. One of the most important functions of Springboard has become health care research, finding affordable access to preventative treatments and screenings for artists who, at best, can afford to pay for policies covering only catastrophic care. In addition, Springboard is working with a local community clinic to provide vouchers to help artists pay for health care services, and sponsors periodic "health fairs" where artists can get flu shots and other preventative screenings.

Like others in the estimated 7.2 percent of Minnesotans without health insurance, artists are subject to stereotyping. The reporter's research found the following to be true about the state's uninsured, contradicting public generalizations:

• The uninsured are not slackers.
• They're not primarily people of color and immigrants.
• They're not all low-income.
• They're young, yes, but not necessarily invincible.
• MinnesotaCare and public assistance aren't sure bets.

AMA Presents Grants to 16 Community Clinics

Citing them as "outstanding free clinics," the American Medical Association has announced the awarding of grants ranging from $12,000 to $25,000 to clinics located across the nation, from Pennsylvania to California, from Michigan to Texas.

"We are pleased to honor the exceptional achievements of these free clinics and their dedication to providing quality, affordable health care," said Jean Howard, AMA Foundation President. "As the AMA advocates to expand medical coverage for the uninsured, the AMA Foundation supports their efforts by recognizing free clinics that demonstrate excellence in physician and community volunteerism, resourcefulness, sustainability, and leveraging partnerships."

The clinics receiving the 2008 Healthy Communities/Healthy America grants are:

• Community Health-In-Partnership Services, St. Louis, Mo.
• Community Volunteers in Medicine, West Chester, Pa.
• DuPage Community Clinic, Wheaton, Ill.
• Ebenezer Medical Outreach, Inc., Huntington, W.Va.
• Free Medical Clinic of Greater Cleveland, Cleveland, Ohio
• Health Care Access, Inc., Lawrence, Kan.
• Hope Medical Clinic, Inc., Ypsilanti, Mich.
• Hope Within Community Health Center, Elizabethtown, Pa.
• Kansas City Free Health Clinic, Kansas City, Mo.
• Martin Luther King Health Center, Shreveport, La.
• Milan Puskar Health Right, Morgantown, W.Va.
• Mountain View RotaCare Free Clinic, Mountain View, Calif.
• Open Door Health Center, Homestead, Fla.
• San Jose Clinic, Houston, Texas
• Social Welfare Board, St. Joseph, Mo.
• The Clinic, Phoenixville, Pa.

North Carolina Web Site Directs Uninsured to Care

If you're a North Carolinian without insurance or a regular source of health care, you can look up your nearest options using this new Web site provided by the North Carolina Institute of Medicine. Using simple dropdown menus and checkboxes on a Web page, someone looking for care enters their location, their insurance status and the kind of care they're needing. The system searches its resources and provides them with the name, address, hours and phone numbers of clinics or other facilities that meet their needs, plus a map showing the exact street location.

Given the undercapacity of so many medical care facilities, information and referral systems like these should be available everywhere. Finding facilities is half the battle.

A recent study found that only about half of the uninsured were aware of community services that could help them.

"We wanted to put together a resource so people would know what's available in the community," said Pam Silberman, president and chief executive officer of the Institute of Medicine. "It also helps communities know where there are gaps" to establish new programs.

HOW DOES IT WORK? It lists each county and sorts for various services such as pharmacies, free clinics, mental-health programs, and doctors and dentists who take Medicaid, the federal insurance coverage for the poor. About 250 organizations are listed.

WHO PAID FOR IT? The effort was funded by grants from the Duke Endowment and Blue Cross & Blue Shield of North Carolina Foundation.

WHAT PROMPTED THE IDEA? A task force formed by the institute studied the services available to people in the state who don't have insurance and recommended in 2005 that the Web page be developed.

WHY NOW? More and more people in North Carolina have no insurance and are struggling to find health-care services, Silberman said. In 1999-2000, the rate of the state's uninsured increased 25 percent, she said, while it rose nationally 12 percent. The primary reason was a loss of employer-based coverage, she said.

 

Dentists, Hygienists and Winnebagos

If you can't get to - or afford to go to - the dentist, in the Puget Sound area of Washington state, the dentist may very well come to you with Medical Teams International's mobile dental clinic. Uninsured adults can get free dental surgery through the clinics, where over 300 dentists and 600 dental hygienists count themselves as volunteers. As the Seattle Times reports,

They roam aboard one of 10 converted Winnebagos — three in the Puget Sound area and seven in Oregon — and, for no charge, they clean, drill, fill and pull teeth inside the mouths of grateful patients.

Dr. Stephen Knoff says, "The need out there is so huge, and the supply is so minimal," even giving "one day a month will make a huge difference."

Many Medical Teams dentists are retirees. One such person is Dr. Allen Brown, a Seattle dentist who closed his practice after 45 years and donated his equipment to the group.

On Wednesday, Brown worked on a first-time patient, Marty Askelson, in a well-equipped, if cramped, white Winnebago in the parking lot of Northshore Senior Center in Bothell. The Winnebago features two dental chairs and an X-ray machine; dentists can handle root canals and extractions and anything that doesn't require general anesthesia. Medical Teams charges a fee only for dentures, which are sold at steep discounts.

Askelson, 74, of Kenmore, marveled through a numbed mouth that he got a cavity fixed for $15 (charged by Northshore, not Medical Teams). He described Brown as "very thorough, very professional" and grinned that the price was unbeatable.

Askelson planned to return for treatment of two remaining cavities.

Online Networking: More Advantages for Clinics

Community clinics must run tight budgets both in money and time allocations, so it's crucial that they don't waste time re-inventing wheels, i.e. solving administrative problems that have probably been solved by other clinics before. Sharing earned knowledge should be part of the standard operating procedure for volunteer-staffed clinics. The Web is the idea platform for facilitating that sharing.

Every week I get the email newsletter "What's New on the Community Clinic Voice!" And with every newsletter I get at least one more example of how such a communications organ can make life simpler for each of the clinics that receive it.

I've described the Voice and its host organization before, here and here. The newsletter directs its readers to a members-only online discussion community. In the current issue of the newsletter I find these pointers to online discussions where mutually valuable knowledge is being shared:

Patient No Shows – Policy and Procedures – Do you have a patient no show policy you can share? Or information on charging patients a no show fee after a certain number of no show visits?  Some info has been posted, if you have more to share please post here!
http://www.communityclinicvoice.org/webx?14@@.eeaeda3

Vacation and Sick PTO – Have you instituted a paid time off policy to replace your existing vacation and sick time policies?  If so, do you have recommendations or experiences to help avoid any pitfalls that could create problems?   How was the existing Sick time handled? Please post here with any advice!
http://www.communityclinicvoice.org/webx?14@@.eeaed86

Work Load Distribution – Do you employ multi-function staff at your site?  If so, how do you go about ensuring a balanced work load distribution?  If you have info to share, please post it here!
http://www.communityclinicvoice.org/webx?14@@.eeaea0d