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Winter 2010 issue (pdf)

Nice shoes & fresh vegetables

Alumni discuss economy’s effect on free medical care

Doing more with less has long been the forte of free medical clinics. And with the unemployment rate hovering near 10 percent, more Americans are in need of free medical services while fewer companies, governments and private donors are able to provide the financial support they had in the past. Clinics are becoming more and more reliant on their volunteer staff to assure that the influx of patients receive quality care.

Edward G. Kelly, MD ’67
Edward G. Kelly, MD ’67

“With the downturn in the economy, we have seen an increased volume, although we were busy from the day we opened our door,” said Edward G. Kelly, MD ’67, volunteer Medical Director for Catholic Charities Free Health Care Center in downtown Pittsburgh. “Most of the increase in volume has been the result of patients losing their jobs and, consequently, their benefits.”

After retiring from orthopaedic surgery in 2003, Dr. Kelly joined Operation Safety Net, a group of doctors, nurses and formerly homeless volunteers who travel the city in a van searching street corners, underpasses and riverbanks for homeless people who need medical help. He still volunteers with this group, affiliated with Pittsburgh Mercy Health System.

In 2007, he helped start the Catholic Charities Free Health Care Center.

Marsha Davis, MD ’93, GME ’97, visits with Eric Davis of Mequon, Wis., and his family at Davis Medical Clinic in Mequon. Dr. Davis was a long-time volunteer for Ozaukee County Free Clinic and now helps secure medical supplies for various area free clinics.
Marsha Davis, MD ’93, GME ’97, visits with Eric Davis of Mequon, Wis., and his family at Davis Medical Clinic in Mequon. Dr. Davis was a long-time volunteer for Ozaukee County Free Clinic and now helps secure medical supplies for various area free clinics.

“We’re seeing a population of patients that we didn’t see when we first opened,” Dr. Kelly said. “We’re seeing a fair number of people that had pretty stable employment situations. Then all of a sudden as the economy went south, these people who are college educated and live in suburban areas are without a job, without benefits.”

Clinic volunteers can often recognize this new group of patients by how they’re dressed.

“We have seen a fair amount of people come in who are described by the volunteers as ‘people with nice shoes,’” Dr. Kelly said.

According to George Schneider, MD ’70, GME ’75, founder and volunteer Medical Director of the Greater Milwaukee Free Clinic, the same type of newly uninsured are visiting free clinics in Milwaukee.
“We’re seeing more people who had jobs, had health insurance coverage six months or a year ago,” Dr. Schneider said. “They lost their jobs and never thought they would be coming to a free clinic.”

James Gauthier, MD ’93, MPH ’98, is the Medical Director for Occupational Health Group, a division of Health Group of Alabama, with offices in Decatur, Madison and Huntsville. He is a volunteer physician as well as President of the Board of Directors at the Community Free Clinic in Decatur.

George Schneider, MD ’70, GME ’75, examines a patient at the Greater Milwaukee Free Clinic, where he is founder and volunteer Medical Director.
George Schneider, MD ’70, GME ’75, examines a patient at the Greater Milwaukee Free Clinic, where he is founder and volunteer Medical Director.

The screening process that the Decatur clinic uses to verify financial eligibility reveals that many seeking free medical services lost jobs with local employers that have closed, such as Delphi, Pilgrim’s Pride and Wolverine Tube. Others lost jobs at companies that laid off workers. Demand for services has increased to the point that potential new patients are waiting three months for their eligibility appointment.

Paul Gregerson, MD ’84, is Chief Medical Officer of JWCH Institute, a private, non-profit health agency that operates six clinics and four family planning sites for indigent and underserved in Los Angeles County, Calif. JWCH was established in 1960 by the attending staff of physicians at the L.A. County hospital.

While he sees an increase in patients accessing care at JWCH because of lost benefits due to lost jobs, Dr. Gregerson also notes that some of the newly uninsured are patients whose spouse is covered by his or her employer’s health insurance, yet the co-payment to cover other family members has become unaffordable.

In Milwaukee, Dr. Schneider has noticed more people going without medical care longer than they should because they are uninsured. They think if they wait it out, their condition may improve. By the time these patients come into the clinic, their condition is more complicated.

“They know if they go to an emergency room, they’re going to get a big bill,” Dr. Schneider said.
“We see diabetics with blood sugars that are sky high. In any other situation, these people would be admitted to the hospital,” he said, noting they now wait until one of the two evenings a week that the clinic is open to be treated. “We manage to treat them as an outpatient and get good results.”

Free clinic leader James Gauthier, MD ’93, MPH ’98, reviews a patient’s X-ray.
Free clinic leader James Gauthier, MD ’93, MPH ’98, reviews a patient’s X-ray.

To help care for the growing number of patients, many free clinics now depend on physician assistants and nurses in certain areas to alleviate the demand on physicians.

An increase in demand for their services and cramped quarters prompted JWCH Institute to close its 8,000-square-foot Skid Row Clinic and move into a new 22,000-square-foot facility a block away and conveniently located alongside the L.A. County Departments of Health Services, Mental Health and Public Health. Hours were also expanded at their Bell Gardens and Norwalk clinics.

Some free clinics, such as the Decatur clinic and JWCH Institute, receive government support as well as private donations. Others, such as Pittsburgh’s Catholic Charities clinic and the Greater Milwaukee Free Clinic, are completely supported by private donors. Diversification among donors, however, has little advantage here since both government and private sector funding sources have dried up compared to the support they provided in the past. Most government budgets are stretched to the max while private donors are experiencing investment losses and other financial insecurities.

To handle the influx of new patients, the Community Free Clinic in Decatur has pursued new funding sources. They were successful in receiving $10,000 in donations from a fundraising letter, two additional grants and increased funding from the Decatur City Council.

For the opening of the JWCH Skid Row Clinic in Los Angeles County, JWCH Medical Director Paul Gregerson, MD ’84 (second from left) joins L.A. Mayor Antonio Villaraigosa (holding scissors) and members of the facility’s executive planning team.
For the opening of the JWCH Skid Row Clinic in Los Angeles County, JWCH Medical Director Paul Gregerson, MD ’84 (second from left) joins L.A. Mayor Antonio Villaraigosa (holding scissors) and members of the facility’s executive planning team.

Marsha Davis, MD ’93, GME ’97, an internal medicine and pediatrics specialist at Davis Medical Clinic in Mequon, Wis., volunteered at the Ozaukee County Free Clinic for eight years before shifting her volunteer efforts toward securing supplies for free clinics supported by various churches.

She regularly donates medications, and when she downsized her clinic, she donated much of her extra equipment to the free clinics in the Milwaukee area.

“We increasingly rely on the Patient Assistance Program to obtain expensive medications for qualifying patients,” Dr. Gregerson said regarding patients in L.A. County. “This is a program whereby the major pharmaceutical companies such as Eli Lilly and Pfizer donate medications to indigent and homeless patients who meet the poverty threshold.”

Dr. Schneider reports that patients often come up with their own low-cost medical solutions. “One patient told us about how he was able to get insulin, which has become very expensive, by trading with a friend who managed to get extra bottles,” he said.

Being among the shrinking population of private practice physicians, Dr. Davis is in a position to reach out to the uninsured with more than supplies. Some of the patients at her own clinic are uninsured, and she has been known to barter for her services. She reports that one of her patients pays her in fresh eggs and vegetables from his garden.

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