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GOVERNMENT & MEDICINE

Physician volunteers "Reach Out" to care for thousands of uninsured

Relying on doctor volunteers and community work, health care projects throughout the country are providing care to uninsured and low-income people.

By Susan J. Landers, AMNews staff. Jan. 31, 2000

Washington -- Nilda Soto, MD, spends her days at a south Florida clinic, treating uninsured, low-income patients and training medical students, who often join a cadre of volunteer physicians recruited to provide care to the 3,000 clinic patients. They believe they're making a difference.

While Democratic presidential candidates Al Gore and Bill Bradley wrangle over their competing plans to increase health insurance access and congressional proposals to help Americans buy coverage languish, 11,000 physicians aren't waiting for the government to act.

Dr. Soto and the others are part of Reach Out: Physicians' Initiative to Expand Care to Underserved Americans, a program funded by the Robert Wood Johnson Foundation. During its five years of operation, the foundation has funded 39 physician-led projects that have provided free or low-cost care nationwide to nearly 200,000 low-income, uninsured patients.

Although the program meets the needs of only a fraction of the estimated 44 million Americans now without health insurance, it demonstrates that "physicians have an important role to play in helping to lift health care access barriers in their communities," said program director H. Denman Scott, MD.

Foundation funding of $300,000 over four years has ended, but most of the projects are expected to continue with the financial backing of community organizations and the continued participation of the volunteer physicians involved.

The projects were sponsored by a range of organizations, including medical societies, group practices and nonprofit or religious organizations.

"The work is always challenging. It keeps you fresh and is never boring," said Dr. Soto, medical director of the Good News Care Center in Florida City, Fla., a clinic that provides care each day for about 30 uninsured residents and migrant workers.

Dr. Soto works at the clinic full-time and receives a salary, as do a part-time nurse practitioner, who is in charge of women's health, and a podiatrist, who treats the many foot problems affecting the migrant laborers. Volunteer physicians provide the rest of the care.

The large nonprofit hospital system in the area, Baptist Health System, covers patients' hospitalization, laboratory, x-ray and prescription drug costs -- services valued at about $1.2 million last year, Dr. Soto said.

Start-up struggles

Establishing the center was very "labor-intensive," she acknowledged. One obstacle was finding a location for the clinic that was rent-free and would raise no objections among neighbors.

"Now that we have been here for three years, the neighborhood loves us," she said.

The Robert Wood Johnson Foundation welcomed a range of models. The majority of the projects focused on primary care, but Bill Schecter, MD, and Douglas Grey, MD, put together a coalition of 130 volunteers to provide free, elective, low-risk surgery to uninsured people in the San Francisco area.

Surgeons, anesthesiologists, primary care physicians, operating and recovery room nurses, and hospitals collaborate in the effort, which has served about 400 people since it started in 1994. It wasn't easy getting the coalition up and running, Dr. Schecter said.

"Paradoxically, it was easier for doctors to go to Guatemala or Southeast Asia to provide surgical services than in their hometowns," he said.

"We had to work out liability issues, union issues, credentialing issues, quality assurance issues," he added. "This took hundreds of hours to sort out."

With the help of a "remarkable board of directors," said Dr. Schecter, the problems were solved. Would he do it again? "Sure, I think it's part of my job."

Robert Beshear, MD, co-director of the Child Health Access Project in Montgomery, Ala., with Albert Holloway, MD, would also start all over again if need be. His work with the 4-year-old project, which provides care for children age 3 and younger, is "one of the most rewarding things I have done in my career."

The project is sponsored by the Gift of Life Foundation, which has operated a maternity health project in the Montgomery area since 1988 and saw the need for a child health program.

"We found that the infants born to low-income mothers were disappearing into the community and were getting health care only through emergency rooms," Dr. Beshear said. Now, 11 volunteer pediatricians see the 1,489 children enrolled in the project.

High success rate

The project has been "incredibly successful," said Dr. Beshear, who pointed to an immunization rate of 93% for enrolled children age 2 and older.

Personal visits were key to recruiting physicians for the project, Dr. Beshear said. Physicians often had to be convinced that the social problems that might accompany their new, low-income patients would not become their problems also.

The project employs social workers to enroll the newborns and ensure that transportation to appointments is available. A computer system is used to track every child in the project.

Belinda Chin, MD, is medical director of New Song Family Health Center in Baltimore. The center had operated on a shoestring since 1991 as an all-volunteer clinic in a church basement that was open one-half day per week.

The Robert Wood Johnson Foundation funding enabled the center to expand. It now has its own building and is open five to six days a week, eight hours each day.

The clinic is not free but bases its fees on patients' incomes. About 5,000 children and adults are registered.

Dr. Chin described the paid nurse practitioner who works at the clinic full time as the "glue" holding the operation together.

Volunteer physicians are asked to either come to the clinic once a month to see patients or to see one patient a month in their offices.

The project operates in a poor area, and "while you do see some negative things like crime and drugs," Dr. Chin noted, "you also see some amazingly strong people.

"We may not change the whole world," she added, "but [working with the project] has been a very valuable experience to me, and I hope it will inspire other doctors to do similar things."

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