Moderator ventana Posted February 19, 2017 Moderator Share Posted February 19, 2017 Looking at volunteering in a free clinic anyone have any advice or experiences? Link to comment Share on other sites More sharing options...
DogLovingPA Posted February 21, 2017 Share Posted February 21, 2017 I volunteer about one night a month at our local free clinic. I work their acute care clinic so I only get a glimpse of the chronic care side. Lots of psychiatric co-morbidities. A lot of chronic pain. We have a pretty rigid no controlled substance policy (which I love). If they'll let you do joint injections, patients will love you. The couple providers at ours that do them are highly sought after by the patients. The $4 list will be used often. We have an on site pharmacy as well - med availability is often "interesting".... I'm not sure how they are acquired but because of the donations/contracts with other places, etc the meds that are considered expensive in the real world are often more available to us in the clinic (eg we can get avelox cheaper than zithromax). Often a long process getting into a specialist (the clinic has agreements with certain groups for pro bono work). I don't volunteer near enough but I like it. I'm spoiled in UC with on site rads and lab..... in the free clinic I have the history and exam. Reminds me to use my brain and really think through the differential. Link to comment Share on other sites More sharing options...
Moderator ventana Posted February 21, 2017 Author Moderator Share Posted February 21, 2017 anyone else? DoglovingPA - that sounds great Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted February 21, 2017 Administrator Share Posted February 21, 2017 My experience in PA school was quite similar WRT medication availability. I did one evening as a 2nd year, along with the 1st years who were seeing most of the patients, and the outpatient IM doc who was precepting me daytimes loaded me up with all the pharmaceutical samples he thought might help before I left for my evening in that clinic. Link to comment Share on other sites More sharing options...
overthehorizen Posted February 21, 2017 Share Posted February 21, 2017 Before I went to PA school, I believed that Free Clinics to help the poor and uninsured was a worthy effort and noble cause. Now, after having taken care of patients for several years who are poor and have or had either no insurance or the government provided insurance, I have come to the conclusion that people only respect and appreciate that which they pay for. When you give something to somebody for free, they neither value it nor respect it. So, I have reshaped my view so that the best way to care for poor and uninsured is to charge them in cash for the full measure of the services they receive. The patient will be happier and have more self respect as well as a greater respect for the provider. I honestly believe that there are no poor people in the United States. Everyone can afford basic medical care. They just choose to spend their money on things they value greater than medicine; cigarettes, street drugs, alcohol, cell phones, expensive cars, cable tv, expensive designer clothing, hairstylists/manicures/pedicures (females), gym memberships (men and women). When you add up all the disposable income that "poor people" really have, you'd be shocked that they don't or won't pay for their health care. Link to comment Share on other sites More sharing options...
cilantro Posted February 21, 2017 Share Posted February 21, 2017 Something to always keep in mind when reading: who is responding, and who the target audience are. The above comments are made by someone who earns 5X the minimum wage. Most people reading this will also eventually be making 5X minimum wage. If it is not too far off, recall trying to find hospital patient contact work pre-PA school. I applied to 60 positions per month, not a single call back, not even with all those pre-PA certificates like emt/ekg/etc. Volunteering in 4 free clinics, and signing up for hospital job training programs, is what finally allowed me a foot in the door to get the pct hours to apply. Money talks, and people with more of it may think they have a louder voice, drowning out those without a voice. Working an entry level job, the hardest part of the job was biting my tongue when nurses making 100k were saying they should not have to subsidize the healthcare cost of those uninsured, that the gubment should not be paying for people's health insurance. To me, this is short-sighted and wrong. Which is easier and less costly? free blood pressure checkups and diabetic meds, or amputating a leg? Some people will say amputating a leg pays your wage... edit: I apologize for the "political" tone, but the above comments, if unedited, struck a nerve. Satire is lost on me on a public forum, hence i did not quote. Link to comment Share on other sites More sharing options...
dht88169 Posted February 22, 2017 Share Posted February 22, 2017 I volunteer at a free clinic twice a month, I love it. The patients are very appreciative of the care we are provide. Our clinic is sponsored by the local rotary club, which is able to pay for all the medications a patient may need, and has the ability to refer for specialty care. Through a contract at a local hospital, we can order any labs or diagnostic scans we may need free of charge. Its a very rewarding experience and for me a nice break from hospital medicine. Link to comment Share on other sites More sharing options...
AbeTheBabe Posted February 22, 2017 Share Posted February 22, 2017 Before I went to PA school, I believed that Free Clinics to help the poor and uninsured was a worthy effort and noble cause. Now, after having taken care of patients for several years who are poor and have or had either no insurance or the government provided insurance, I have come to the conclusion that people only respect and appreciate that which they pay for. When you give something to somebody for free, they neither value it nor respect it. So, I have reshaped my view so that the best way to care for poor and uninsured is to charge them in cash for the full measure of the services they receive. The patient will be happier and have more self respect as well as a greater respect for the provider. I honestly believe that there are no poor people in the United States. Everyone can afford basic medical care. They just choose to spend their money on things they value greater than medicine; cigarettes, street drugs, alcohol, cell phones, expensive cars, cable tv, expensive designer clothing, hairstylists/manicures/pedicures (females), gym memberships (men and women). When you add up all the disposable income that "poor people" really have, you'd be shocked that they don't or won't pay for their health care. You really think people making minimum wage can afford any of these things? We're talking $20K a year. The Blue Cross PPO premium through my job costs more than that (no joke, luckily I have Kaiser through my wife's employer). Alcohol is cheap, and many cable channels are free, but any designer clothing you see on a truly poor person is guaranteed a knockoff. Link to comment Share on other sites More sharing options...
Dono Posted February 22, 2017 Share Posted February 22, 2017 Overthehorizen, I disagree with you. I was an indigent patient and was beyond thankful for the care and compassion I was shown. I was a full-time college student, paying my way with grants, scholarships, loans, and part-time jobs. I was not eligible for public assistance or tax credits (tried 4x). I do not have family support like many individuals had and I was not going to give up my dream either. I had to persevere through many hardships. This experience has been my driving force behind wanting to volunteer in a free clinic. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 22, 2017 Moderator Share Posted February 22, 2017 I have volunteered at a local free clinic on/off depending on my schedule for around 15 years. 4 hr shifts, 1-2/mo. nice folks. real sickness. the place does not do std's, psych, or pain management(these are all done elsewhere in the community), so it's a nice place to volunteer. Link to comment Share on other sites More sharing options...
BruceBanner Posted February 22, 2017 Share Posted February 22, 2017 As much as I'm disillusioned and burnout with medicine in general, if I were to retire or move on to something else I still think I would volunteer a shift or two a month at a free clinic. We have a skill set and a fund of knowledge that can help many people with many different conditions. It has nothing to do with whether they "deserve" or appreciate your care. That's missing the boat. Hell, half the people we see in normal practice pay massive premiums to see us, and they are as ungrateful and demanding as ever. I'm very far from liberal in most of my views, so I tend to despise social subsidies that enable the lazy and stupid. But volunteering isnt a gubment handout. You do it out of the goodness of your heart to help someone else in need. That's it. Link to comment Share on other sites More sharing options...
DogLovingPA Posted February 23, 2017 Share Posted February 23, 2017 In my experience, the patients seen at our free clinic are for the most part very nice and thankful for any care they receive. Our clinic also refers out std/women's health (local health department) and psych management. We will do some chronic pain management (no narcotics). Mostly it's a lot of DM, HTN, obesity, attempts at smoking cessation and then acute complaints of course. Link to comment Share on other sites More sharing options...
Randito Posted February 27, 2017 Share Posted February 27, 2017 I'm currently looking into volunteering. Curious about how to keep everything legal and remain protected. Things like delegation of services agreement and malpractice policy? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 27, 2017 Moderator Share Posted February 27, 2017 I'm currently looking into volunteering. Curious about how to keep everything legal and remain protected. Things like delegation of services agreement and malpractice policy? same as a regular job. at my free clinic they did all the paperwork for me, got me a doc to be designated collaborator, got me a free malpractice policy, etc Link to comment Share on other sites More sharing options...
cc56 Posted February 27, 2017 Share Posted February 27, 2017 Cilantro : In PA school I volunteered in free clinics run through UC Davis. The first was more for middle easterners and the other for homeless people. Both clinic were run in separate areas, the homeless was run in a homeless shelter, I think the salvation army (been a while). The Middle eastern one by a mosque in another part of Sacramento. I got a lot more satisfaction with the middle easterners as a whole. I was frustrated by the homeless as I felt most were trying to take advantage. Most wanted notes so they could stay in the barracks/living area all day and not have to leave as required by the shelter. I felt a chunk would fake illness for it. The patients at the other clinic had real illness and were thankful for a script to get labs with minimal treatment until they got their labs back. Point of my post is that I can see how the places you work and what you have done will really shape how you feel about charity VS Govt regulation mimicking charity VS govt regulation. I have gone back and forth since school. I did most of my training in Stockton California in one of the only clinics that took MediCal (medicaid). A lot of abuse for narcs to sell, waste of services, lack of interest in self care, abuse to staff for outrageous stuff, and other anger inducing behavior. Then I saw a few who really cared and it made it a little better. I will fully admit I was frustrated with people and upset with MediCal. Now I just want to take care of people and hate insurance across the board, whether private or public or Gov. I also have not volunteered since school. Link to comment Share on other sites More sharing options...
Katera Posted February 28, 2017 Share Posted February 28, 2017 Before I went to PA school, I believed that Free Clinics to help the poor and uninsured was a worthy effort and noble cause. Now, after having taken care of patients for several years who are poor and have or had either no insurance or the government provided insurance, I have come to the conclusion that people only respect and appreciate that which they pay for. When you give something to somebody for free, they neither value it nor respect it. So, I have reshaped my view so that the best way to care for poor and uninsured is to charge them in cash for the full measure of the services they receive. The patient will be happier and have more self respect as well as a greater respect for the provider. I honestly believe that there are no poor people in the United States. Everyone can afford basic medical care. They just choose to spend their money on things they value greater than medicine; cigarettes, street drugs, alcohol, cell phones, expensive cars, cable tv, expensive designer clothing, hairstylists/manicures/pedicures (females), gym memberships (men and women). When you add up all the disposable income that "poor people" really have, you'd be shocked that they don't or won't pay for their health care. Troll post? "Everyone can afford basic healthcare" What? Mercy... Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 28, 2017 Moderator Share Posted February 28, 2017 Troll post? "Everyone can afford basic healthcare" What? Mercy... I see lots of folks at the free clinic who CAN NOT afford basic health care and work multiple part time jobs without benefits. these folks have real problems and are not trying to work the system. the working poor are not the folks driving fancy cars and using Iphones. you can not raise a family and afford health care on the equivalent of 2 full time jobs at minimum wage. these folks make "too much" to qualify for Medicaid, so when they get sick it's "do I pay rent or do I go to the doctor". I make more in 1 shift than some of these folks make in a month. I know there are folks out there gaming the system and using federal benefits to buy luxuries, but you won't see those folks at a typical free clinic. Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 2, 2017 Author Moderator Share Posted March 2, 2017 I see and here that there are sort of two type of people accessing these clinics - the "ideal" ones - hard working, just can't make ends meet, and the not so hard working one's that want you to make their ends meet..... I have done work in Honduras and they are all the former and was a joy - hoping I can find an appreciative group up here my hemisphere..... but if not - well I will just move on and try again.. Thanks for all the input - certainly will not to pain management,or opiates, or any controlled unless I cause the pain - ie excision or reduction..... Link to comment Share on other sites More sharing options...
overthehorizen Posted March 4, 2017 Share Posted March 4, 2017 Troll post? "Everyone can afford basic healthcare" What? Mercy... I should clarify the statement "everyone can afford basic healthcare." Instead, I will say everyone can afford basic preventative primary care by paying cash. I think Emed said that his experience at free clinics is mostly than, diabetes, smoking cessation. For that kind of care, the person who cannot afford insurance can pay cash to a direct pay primary care provider for management of those issues. Ina sense, free clinics are crowding out a viable market alternative , the direct pay primary care model, that can service these patients at the free clinics. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 4, 2017 Moderator Share Posted March 4, 2017 DPC is thousands of dollars/yr.... Link to comment Share on other sites More sharing options...
overthehorizen Posted March 4, 2017 Share Posted March 4, 2017 DPC is thousands of dollars/yr.... I have no affiliation with these practices. I only became aware of them by research. If you look at the fees, they are NOT in the "thousands of dollars/yr." I just picked two examples but there are many others. Let's say you are a 22 year old kid from a poor family. So you cannot get on your parents insurance because they don't have insurance either. You work at Walmart but need someone to manage diabetes for you. The practice below (again, i have no relationship with this practice, just an example) would charge him $360 per year for the following. Same-day or next-day appointments. Unlimited number of visits with no co-pay. Comprehensive wellness prescription and care plan. A typical appointment is 30-60 minutes. Visits to your office, for the busy professional. Visits to your home, if necessary. Visits to assisted living, nursing facilities, and similar settings. 24/7 provider access via phone, text, or email. No phone tree or waiting on hold. Convenient scheduling with no long waits in the waiting room. Access to wholesale pharmacy and discounted lab testing. http://www.dpceugene.com/ Why is this not considered an outstanding alternative to insurance for poor people? Here is one more. Again, no affiliation with these people. Here , the 22 year old would pay $600 per year for all of his primary care needs. Click on the link to see that he gets free office visits, free labs tests and discounted meds. http://www.acchealth.com/ Now, I ask you, how much is a monthly cell phone plan with unlimited voice, text and data? About $360- 600 per yearHow much is a cable tv subscription package? Around $600 per year How much at a pack of cigarettes every day? About $1800 peryaer. I cannot tell you how many "poor" people I see smoking cigarettes and talking on cell phones. This seems to be a contradiction. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 4, 2017 Moderator Share Posted March 4, 2017 this 360-600/yr only covers outpt primary care. need a prescription? not covered. need a derm apt? not covered need an ER visit? not covered need a hospitalization or a surgery? not covered. this is not a good deal. I have insurance through my work that covers everything above. I have copays $20 for pcp and 50$ for specialist. know what I spend at my pcp's office every year? 20 bucks once/year. health care is more than seeing your pcp once/yr. it's also all the stuff that happens unexpectedly like car accidents, lacerations, heart attacks, appendicitis, new rx for fill in the blank chronic health problem, dental visits, glasses, hearing aids, etc Link to comment Share on other sites More sharing options...
overthehorizen Posted March 4, 2017 Share Posted March 4, 2017 Emed, Agree with everything you have said in your previous post. That was why I tried to clarify that preventive primary care can be paid with cash because it isn't expensive. I also demonstrate that most people (even poor people) have money to pay for primary care in cash. You are correct in that people do need coverage for catastrophic injury or illness. You may have noted though that Direct Pay Primary care does alot of "urgent care" stuff than ends up in fast track at ERs costing much more. I'm not affiliated with direct pay primary care movement or the practices mentioned. I just think there are two distinct forms of coverage. One is truly insurance based because it covers they unexpected. That is what you argue for. The other is not unexpected. It is anticipated and should be paid for out of earnings. We pay for insurance for our car in case it is stolen or in a crash. Most people don't have insurance that covers tires, oil changes, wiper blades, battery replacement etc. It is expected that you will have these costs. You don't expect to be t-boned in an intersection. Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 5, 2017 Author Moderator Share Posted March 5, 2017 overthehorizon Rather it costs $400 or $2000 per year it is too much for some people I am not attacking her - but stating what I see as a basic misunderstand of the true "working poor" that this country has. On patient I saw the doc see - was middle aged, CNA, husband lost corp job about a year ago, they have used up their retirement, spent everything they have while he aggressively job hunt - and they have run out of money - they qualified for medicaid (and she was embarrassed and humiliated at once) and was having some major medical stuff go on. VERY appreciative of the clinic being there and helping in a horrid time........ (she is working two jobs 7 days a week - at something like $10/hour.... with three kids) Then there was the single mom working two jobs - literally 15+ hours a day, family helping with day care, just no extra money - - no she did not have a cell phone or smoke, she was doing everything right and just no money - no difference if the DPC is $300 or $30,000 a year - it is to much for her (and doesn't cover anything besides office visit) Needless to say it was eye opening, and indeed I will do more of it Clinic founder will be my CP, Sounds like free license, free malpractice, and free state controlled (sure on the license and malpractice unsure on state controlled) So, I am going forward with it to share my knowledge and help out the community because it is the right thing to do!! Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 5, 2017 Moderator Share Posted March 5, 2017 most free clinics have a no narcotics policy so you may not need to controlled substances certification. Link to comment Share on other sites More sharing options...
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