During the week, Serafino Garella, M.D., heads the Department of Medicine at the 608-bed Advocate-Lutheran General Hospital in Park Ridge, Ill., an upper middle-class suburb of Chicago. On Saturday mornings, though, Garella usually can be found several miles and a lifestyle away at Community Health, a free clinic on Chicago's impoverished west side.
Garella founded the clinic in 1993. Amid all the talk of healthcare reform of the early '90s, Garella realized that healthcare for the underserved was a problem he should and could do something about.
"Despite all the pressure that physicians are complaining about, I feel the medical profession is something that can be enjoyed and gives great privilege and power to the people who are in that profession," says Garella, who earned his medical degree from the University of Pisa Medical School in Pisa, Italy, and immigrated to the United States in 1964. "Therefore, they acquire responsibilities. One of the responsibilities is to give back."
Today the clinic is housed in a 12,300-squarefoot building and operates on an annual budget of about $800,000, funded solely through private donations, Garella says. Between 130 and 140 physicians, including generalists and specialists, volunteer at the clinic on a regular basis. Patient visits totaled 14,000 in 2000 and are expected to top 15,000 this year, Garella says. Most patients come for primary or preventive care; common problems are diabetes and high blood pressure.
"The certainty is that these patients would have a lot of complications from their diabetes if they did not receive proper medication," Garella says. "Many of these patients don't even know that they have diabetes when they first come to the clinic."
Garella's gift of volunteering is not unique. His desire to give back is shared by physicians across the country who donate their time in free clinics, homeless shelters, referral networks and countless other avenues to help care for some of the country's 42.6 million uninsured.
Volunteers in Health Care is a national, not-for-profit organization based in Pawtucket, R.I., that offers technical assistance in setting up free healthcare programs, such as clinics or referral services. Its database consists of 3,000 volunteer programs, according to deputy program director Joanna Bell. Most are headed, operated or initiated by physicians.
VIH has given about 1,200 of those programs assistance ranging from helping a free clinic get malpractice insurance to providing various how-to manuals on such topics as starting a free clinic or recruiting and retaining medical volunteers.
"It's great to see just how much interest there is out there for caring for people at the community level that don't have health insurance," Bell says.
The program is an extension of an earlier project, "Reach Out: Physicians' Initiative to Expand Care to Underserved Americans." That program was initiated in 1993 by the Robert Wood Johnson Foundation to examine whether private practice doctors would get involved in community projects.
The five-year demonstration project helped fund 39 volunteer programs involving physicians. When the five years were up, rather than continue funding the projects, the foundation decided to fund a national resource program to share the lessons learned by the participants of Reach Out.
"There were skeptics everywhere who thought, 'This is never going to work.' This isn't something that private practice docs are motivated to do," says Bell.
Despite those initial fears, however, many physicians were interested in applying for a grant for the Reach Out project, and the foundation received 400 applications for the 40 slots available.
Bell says the project, which ended in 1999, found that getting doctors involved in leadership roles with free clinics or referral programs is essential to the success of any free healthcare program.
"We saw through Reach Out that physicians are the leaders in their communities around something like this. We found it over and over again," says Bell.
Bill Schwartz, M.D., is a retired internist who is on the clinical faculties at the University of California at San Francisco and Stanford University. He volunteers half a day each week at Samaritan House Medical Clinic in San Mateo, Calif.
Schwartz helped to found the clinic with his friend, Walter Gaines, M.D., in 1992, about a year before Schwartz retired. The two physicians responded to a letter about the need for a medical clinic in a San Mateo County Medical Association bulletin written by John Kelley, director of Samaritan House. The not-for-profit organization serves the needy with meals, clothing, tutoring and shelter.
Around 80% of Samaritan House's funding comes from individual donations, and the rest comes from private grants. Only about 3% to 4% comes from the government.
Schwartz says his motivation for volunteering comes from an obligation he feels to help the working poor whose minimum-wage jobs don't cover the $1,600 to $1,800 monthly rent for a two-bedroom apartment in the area.
"It started out in one room, and we met at the clinic one night a week for about a year," says Schwartz. Eventually the frequency grew to six nights a week, and the clinic was moved to a rented 1,850-square-foot facility where about 30 physician volunteers, including primary care doctors, pediatricians and OB/GYNs, now see about 600 patients a month on an annual budget of $250,000, Schwartz says. Most of the doctors who volunteer are retired. Lab work and X-rays are donated by hospitals.
Patients are seen first by community workers from Samaritan House who evaluate their needs in order to qualify them for the clinic services. Generally, Schwartz says, patients with an annual family income of $12,000 or less and no insurance qualify.
"These are the people that clean our houses and do the gardening and work in the restaurants and make things run smoothly," he says.
But Schwartz says the volunteers sometimes get more than they give.
"They love it because they get to see patients. They can take as much time as they wish," says Schwartz, adding that there is also the professional luxury of not having to get requests for lab tests approved. "There's no review. They just go ahead and order them as they see fit."
Barb Tylenda is executive director of Health Care Network, a not-for-profit agency in Racine, Wis., that provides healthcare access to the low-income and uninsured. She says she believes volunteering enables physicians to practice medicine the old fashioned way--without all the pressure to see a certain number of patients and fill out lots of paperwork.
Health Care Network is a referral program with 85 physicians representing 23 specialties. Patients are referred to doctors in the network by social workers.
The physicians agree to see patients in their offices at no charge and can see as many patients as they choose.
Each patient is screened for eligibility by HCN staff. In order to qualify, patients must be residents of Racine County and have monthly income of less than $1,044 for a single person and $2,131 for a family of four. Once the patient has completed a visit, the physician mails a form to HCN confirming that the patient kept his or her appointment.
Tylenda says the volunteers like the simplicity. "There's no bureaucracy in our program. There's no paperwork," she says. "They can just provide care in its purest form."
Lisa Simonds, M.D., and her husband, Jim Simonds, M.D., both family practitioners, have been volunteering with HCN for the five and a half years they have worked for All Saints Health Care System in Union Grove, Wis. They each see about five patients per week at no charge, says Lisa Simonds. Sessions last 15 to 30 minutes.
Simonds says she began volunteering as a way to give back to the community; she continues to do it because she knows her pro bono patients are very appreciative. "Sometimes those are the most thankful patients of all," she says.
The We Care Network in Leon County, Fla., was one of the original grant recipients of the Reach Out program. We Care is now funded by various public and private organizations, such as the Jefferson County Health Department, Brandeis University, Tallahassee Rotary Club and Wyeth-Ayerst Laboratories.
According to James Stockwell, M.D., who started the referral network, a $50,000 budget generates about $1 million in care, including the service of the 280 volunteer physicians, plus lab and other test work donated by hospitals.
Stockwell, a gastroenterologist, is a strong advocate of physician volunteering.
He believes that at a time when physicians are beleaguered by the pressures of the profession, they are also drawn to volunteering as a way to preserve part of the tradition of medicine.
"The reason these programs are so important is they help remind the physician why he went into medicine. And despite all the stressors around him, he gets reminded of that spirit of giving, compassion and caring. He's there to heal and decrease suffering," Stockwell says. "I think such efforts are critical."