On a resort island, volunteerism makes a difference
Retired physicians in Hilton Head, S.C., give their time to help residents with little or no insurance
From the December 1997 ACP Observer, copyright © 1997 by the American College of Physicians.
By Deborah Gesensway
Doris Beatty, ACP Member, who will be 68 this month, found it easier to accept the idea of retirement once she knew she wasn't going to give up medicine entirely. She was going to volunteer at a free clinic.
Dr. Beatty is one of the 44 retired doctors who work at least a half day a week at an all-volunteer medical clinic on Hilton Head Island, S.C. As of September, there were also 51 nurses, 10 dentists, 15 mental health professionals and numerous subspecialists working at the Volunteers in Medicine (VIM) Clinic, plus lay volunteers who staff the front desk and raise money.
For three years, the clinic has been taking care of the uninsured or underinsured who live or work on Hilton Head or Daufuskie islands and earn less than 200% of the federal poverty limit ($26,664 for a family of three). By the end of this past September, the clinic had served about 3,000 patients at a cost of $35 per patient visit, which is roughly half of what the private sector charges, according to Bret C. Williams, MD, the clinic's executive medical director. Dr. Williams, an internist, is one of VIM's five full-time, paid staffers.
The clinic was the brainchild of Jack B. McConnell, MD, a retired physician and medical researcher who made a name for himself directing the programs that led to the development of Tylenol and the Tine test for diagnosing tuberculosis. In 1992, after he had retired to Hilton Head Island, he got the idea of starting a free clinic for the medically underserved on the island, one that would rely on free labor from the many physicians who had retired to the golf and beach resort community.
Although Hilton Head is an affluent community, the clinic founders found that more than 8,000 people who work at the hotels, restaurants and golf courses—plus the farmers and long-time residents—had little or no access to medical care outside of the Hilton Head Hospital emergency room. "Resorts don't work without a huge staff of low-paid workers to hold them up," Dr. Williams said.
To get the clinic going, Dr. McConnell lobbied the South Carolina General Assembly to pass legislation creating a special volunteer license that retired doctors could easily get and afford. He also negotiated a special deal with the state's largest malpractice carrier enabling doctors to volunteer at the clinic without having to buy expensive, individual malpractice insurance.
He then worked with the town of Hilton Head to lease a 1.1 acre building site for $1 a year and raised $500,000 in private money to build a 7,000-square-foot clinic, which opened debt-free in June 1994. Dr. McConnell's dream was to have a clinic that does not accept any government money. To date, the clinic has been able to do just that.
Volunteerism like that at the VIM clinic is attracting a lot of interest among internal medicine leaders. This fall, ACP created a special task force to catalogue the types of volunteer efforts going on across the country. The ACP Council of Associates has been encouraging residents to do community service during their training, and the American Board of Internal Medicine has been exploring whether volunteerism should be part of board certification.
Dr. Beatty embraced volunteerism after a full career in internal medicine. She began teaching and seeing patients at the University of Cincinnati College of Medicine and then moved on to private practice in Short Hills, N.J. Her husband, Joseph Lindner, ACP Member, was working as a health care consultant and physician recruiter. The couple had built a house in Hilton Head with the idea that they would use it for vacations and eventually retire there, but five years or so down the road.
"The winters in New Jersey were very bad the last few years and my husband was really anxious to get down here, but I wasn't quite ready to give up the practice of medicine," she said. "But since there was a clinic down here I felt at least I could continue practicing. So we came a little earlier than we thought."
Dr. Beatty works every Tuesday morning at the clinic and fills in frequently when another doctor is out of town or something comes up. Dr. Williams said he likes the doctors to commit to working at the clinic on a regular schedule.
"Over time we've steered away from real short-timers because it is too much trouble," he explained. "We prefer people who volunteer units of one-half day in an ongoing fashion. That way they get some continuity in the patients they take care of."
One day last month, Dr. Beatty's day was pretty typical: "I worked from 9 a.m. to noon and saw 10 people," she said. "It's not too hurried a pace." At the screening desk, a lay volunteer gets some basic information from the patients, most of whom have appointments. A nurse then decides if the patient has a general medicine problem or a surgical one.
"If it's not obvious, then one of us—an internist or a general medicine doctor—will see the patient and will determine that this is somebody that may be helped by the dermatologist," Dr. Beatty said.
Dr. Williams said the clinic has a disproportionate number of subspecialists volunteering, and that there are a lot of other doctors who have contacted the clinic that he unfortunately can't use. "Surgeons, for example," he said. "We don't have too much they can do here besides take off cysts."
The clinic doctors do not have credentials to admit patients to the hospital. Explained Dr. Beatty, "I had a patient recently who came in with abdominal pain and it turned out to be an acute appendix. I had to send that patient to the emergency room at the hospital."
Dr. Beatty said she sees the same kind of complaints she treated in private primary care practice such as bronchitis, pneumonia and psychiatric problems. "And sometimes if the pediatrician isn't there, I'll see the kids too," she said, "although I don't feel too comfortable doing that."
The doctors, she said, do a complete history and physical as well as basic screening lab work. If the patients need more, the clinic finds a physician in the community who is willing to see them.
Dr. Beatty, who has worked at the clinic for two years, is now the head of its quality assurance committee. The volunteers on that committee, she said, started out eight months ago to identify deficiencies in the medical records they were keeping. The incentive was not to get paid, but instead to improve the quality of the medical care they were able to provide.
"I think that no matter whether you are having somebody looking over your shoulder and going to reimburse you for doing it, you need to do this," she said. "It's just good medicine."
Over a six-week period, they reviewed all the charts for a complete history, a complete physical, a legible signature, a plan, Dr. Beatty said. "We found a few deficiencies that seemed to be a problem and we wrote letters to all the physicians and said let's see if we can improve on this. . Now we are responding to some feedback that our history form was a little cumbersome and the patients didn't understand it. We've revised that, and we're developing a problem list that's easy to use. Eventually we would like to get into talking about the best treatment for certain diseases, setting up some protocols."
Doctors at the clinic can also attend a weekly continuing medical education conference that features a speaker from the hospital, someone in practice or someone who addresses these documentation initiatives.
The clinic is attractive to retired physicians, Dr. Beatty said, because it allows them to remember why they became doctors in the first place.
"We didn't go in to make money. It's a way of making a living, but it's not the goal, and we would like to continue to serve," she said. "This is a wonderful opportunity to not be working full-time, not be worrying about insurance forms and all that business, to just practice good old-fashioned medicine like we were trained to do. It's been a wonderful experience."
For information about the clinic, call 803-81-6612 or visit its Web site at http://www.hiltonheadisland.com/vim.htm.
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