Physicians Helping the Underserved

Abstract

In the current health care environment of competition and market forces, concern has arisen that the classic principle of serving disadvantaged persons may not be fulfilled due to pressures from managed care. Reach Out, a $12 million national program of the Robert Wood Johnson Foundation, was developed to recruit leaders from among practicing physicians to organize projects to care for the uninsured and underserved. Physician volunteerism was a key component of all projects. Thirty-nine Reach Out projects were implemented and carried out across the United States, with average funding per project of $300000 distributed over a period of 4 years. Seven model types emerged, the most common of which, the free clinic and the referral network, accounted for two thirds of the total. At the program's conclusion, 199584 patients were enrolled and 11252 physicians recruited. Project execution was more complex than initially supposed, and major progress commonly was not evident until the third or fourth year, but at least two thirds of the projects are likely to continue with local support. With strong physician leadership and a funded administrative core, organized community efforts can develop and sustain an effective program. Programs such as Reach Out cannot solve the national problem of access to health care, but they can make a small but important impact on the number of uninsured and underserved persons without access to health care.

Resilience among doctors who work in challenging areas: a qualitative study

“…32 Doctors in the US National Health Service Corps -which places student loan recipients in approved services for the poor or marginalised after graduation -are more likely to stay beyond their 2-year tour of duty if they have higher salaries and greater job satisfaction. 33 In the present study, the relatively low levels of reimbursement for working in the field was rarely mentioned as a barrier by participants; however, this population with their varied careers could afford to carry low-paid work, as it was offset by other work.…”

Quality of Care for Uninsured Patients With Diabetes in a Rural Area

“…Charity care is difficult to quantify (11), and although current foundation (28) and federal grants (29) are targeting this important source of care for the uninsured, recent work suggests that the provision of charity care is threatened by the penetration of managed care (30).…”

Physicians’ Perceptions of Volunteer Service at Safety-Net Clinics

“…These results concur with previous studies that show positive perceptions towards volunteering by US physicians, 10,15 as well a commitment of physicians to social justice and the mission of helping underserved populations. 18,[23][24][25] The physicians in this study reported feeling appreciated at their safety-net clinics, which has been shown to be associated with resilience in community clinics.…”

“…[10][11][12] A nationwide study of volunteer physicians in community clinics in 2000 revealed many barriers to volunteering at safety-net clinics, including administrative burdens; a lack of supplies, equipment, and medical follow-up at the clinics; a lack of social services for patients; patient noncompliance; insufficient time to volunteer; and concerns about malpractice insurance. [13][14][15] The resulting deficiency in volunteer physicians means that recruitment and retention of volunteers is a pressing concern in such clinics. The problems above are not unique to volunteers in safety-net clinics.…”