American College of Physicians: Internal Medicine — Doctors for Adults ®

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Free clinic's founder helps care for working uninsured

Created as a temporary measure, the facility keeps attracting more patients who can't afford health care

From the April ACP Observer, copyright © 2005 by the American College of Physicians.

By Janet Colwell

For Mohan M. Nadkarni, FACP, the desire to give back to the community began in the early 1990s during his residency at Charlottesville's University of Virginia. Disturbed by the steady stream of patients he saw filing through the university's free clinic, the young physician looked for a way to help those who were falling through the cracks in the health care system.


Dr. Nadkarni



The result was the Charlottesville Free Clinic, which now treats 1,200 patients in about 3,500 visits a year. The clinic serves working, uninsured patients who earn between $15,000 and $25,000 a year, too much to qualify for government assistance but too little to afford health insurance or even basic medical care. The free clinic Dr. Nadkarni helped found complements the university's own residential faculty clinic, which he directs and which sees patients with incomes below the poverty line.

Filling a need

"Back in 1991, I was constantly seeing people who had suffered from heart attacks because they weren't controlling their hypertension or were struggling with late-stage cancer because they couldn't afford preventive care," said Dr. Nadkarni, winner of this year's ACP Oscar E. Edwards Memorial Award for Volunteerism and Community Service. "There was and remains a great need to serve uninsured patients, the vast majority of whom have full- or part-time jobs." (For a complete list of ACP Award winners, see "ACP announces new Masters and service awardees.")

In 1990, during his first year of residency, Dr. Nadkarni and others launched a grassroots effort to get the free clinic off the ground. He and a few other residents enlisted the aid of a local pharmacist and a lawyer, who helped connect the volunteers to community supporters. They set up shop in an abandoned car showroom they renovated with donated materials.

In the beginning, Dr. Nadkarni and other core volunteers worked at the clinic nearly every evening. Today, hundreds of health care workers volunteer every year. An executive director now handles day-to-day operations, along with other administrative staff, while Dr. Nadkarni continues to serve on the board of directors. He also oversees the medical advisory committee and treats patients once a month.

In addition to primary care, the clinic provides psychiatric services, dental care and specialist referrals. Many community physicians have agreed to see referrals free of charge, while two local hospitals donate lab and ancillary services.

The clinic also provides free prescription drugs that it buys or receives as donations from drug companies. And it recently received a grant to hire a nurse practitioner and offer daytime hours. The grant also helps Dr. Nadkarni and others conduct research on the characteristics and growing needs of uninsured populations, using data gathered at the clinic.

Attracting volunteers

According to Dr. Nadkarni, the key to the clinic's success is its enthusiastic volunteers. "More than 150 doctors, nurse practitioners, medical students and others have volunteered over the past year," he said. "We have had a tremendous response."

Recruiting volunteers isn't always easy, especially with physicians' growing time constraints. Dr. Nadkarni said he tries to encourage participation by creating a pleasant, hassle-free work environment.

For example, he has implemented new review processes, allowing volunteer nurses—supervised by a medical director—to review all labs drawn at night so volunteer physicians can focus on providing care without having to track down test results. He has also arranged for local restaurants to donate meals for staff.

"Once we get volunteers on-site for one evening of care, most people return," he pointed out. "They feel they are giving back to people who generally are very grateful."

At his day job at the University of Virginia, where he is associate professor of internal medicine, Dr. Nadkarni spends part of his time treating underserved patients at the university's resident faculty clinic. He also coordinates a new course at the medical school that allows first-year students to volunteer in the community one half-day a week.

Focusing on chronic care

In many ways, the clinic he helped found is a microcosm of national trends, Dr. Nadkarni noted. For example, a growing number of the free clinic patients are coming in for chronic, not acute, conditions.

"We started out thinking that most patients would be seen once," he said, "but as time goes on, we're seeing many more patients with diabetes, hypertension or high cholesterol who don't have an ongoing source of care." The growing need for chronic care has forced the clinic to provide more preventive care and develop a network of other community providers. "It's a strain," Dr. Nadkarni said, "on a lot of free clinics."

The free clinic has also seen a gradual rise in patients' average incomes, with more than 90% of its patients coming from working households. When the clinic first opened, Dr. Nadkarni said, he hoped it might be a temporary solution. But with the ranks of the uninsured growing locally as well as nationally, that prospect is unlikely.

At the same time, part of the satisfaction of starting the clinic is seeing it grow to a point where it no longer depends on him.

"It's become a stable, nonprofit organization that goes on absolutely fine without me," he said. "It's been gratifying to see it move to the next level and become a valuable community resource."

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Looking for ways to volunteer? Offer help before it's needed

The recent tsunami in Asia and Africa underscored the importance of gearing up for emergencies before they happen. While relief agencies were overwhelmed with offers of help following the disaster, most groups turned first to their existing corps of volunteers, many of whom had previous experience or training in emergency response.

That's because most relief organizations have application processes, specific requirements and sometimes training sessions for new volunteers. Experts say that if you're thinking about volunteering overseas or at home, consider signing up now so you'll be ready to help when needed.

Here is a list of some leading charitable organizations looking for physician volunteers. (The College's volunteering Web page also has information and more resources.)

  • Medecins Sans Frontieres/Doctors Without Borders. The organization prefers applicants with flexibility, experience working in developing countries or on community service projects, adaptability to basic living conditions, and foreign language skills.

    Doctors Without Borders is looking for physicians with at least two years professional experience in a relevant field who are available for at least six months. (Surgeons and anesthesiologists may be accepted for a minimum of six weeks in the field.)

    To apply, submit an online application form along with a letter explaining your motivation and a current resume. Successful applicants are interviewed in New York or Los Angeles and are placed in the pool of active volunteers after a reference check. Placement may take from two weeks to six months, depending on need, and training may be suggested for the first mission.

    More information is online or by calling the New York office at 212-679-6800 or the California office at 310-399-0049.

  • National Disaster Medical System (U.S. Department of Homeland Security). The National Disaster Medical System (NDMS) manages and coordinates the federal government's medical response to major emergencies, as well as to federally declared disasters including natural and technological disasters, major transportation accidents and acts of terrorism.

    The NDMS oversees the formation of regional disaster medical assistance teams by sponsoring local organizations, such as medical centers or nonprofit groups. Local sponsors recruit members, arrange training and coordinate team dispatching. Disaster medical assistance teams arrive at the affected sites within 72 hours and help local medical services triage patients and provide care.

    Physicians must have appropriate certification and licensure within their discipline that will be recognized by all states. Members of disaster medical assistance teams are considered part-time federal employees while they are serving and they are compensated for their time. They are also protected by the Federal Tort Claims Act.

    To organize a disaster medical assistance team, contact the NDMS at 800-872-6367. More information is online.

  • Doctors of the World. Doctors of the World has opportunities here and abroad for licensed, board-eligible physicians and other health care professionals.

    In the United States, the group's human rights clinic volunteers work in New York, New Jersey, Arizona, California and Colorado. The group's medical advocacy project also operates throughout the country.

    The oversees volunteers provide technical assistance, training and direct care. The organization usually has more physician volunteers than can be placed overseas at one time. Once your name is added to the group's volunteer database, you will be notified via e-mail about suitable opportunities.

    To work with Doctors of the World, you must volunteer one to two days a month for U.S. assignments, or one to 12 months for overseas assignments. More information is online or by calling 888-817-4357.

  • Project Hope. Project HOPE is still accepting volunteer applications to provide medical aid to tsunami survivors in South Asia.

    The nonprofit group supports the U.S. Navy's humanitarian assistance mission on the USNS MERCY, with teams of medical volunteers trained and deployed over the next several months. Volunteers must have a current U.S. license, experience in medical practice, board certification and previous experience in emergency situations.

    Project HOPE also has an ongoing need for volunteers in the 32 countries where it provides medical education and health care training. Its greatest needs are for international volunteers in infectious diseases (HIV/AIDS and tuberculosis), women's and children's health, health professional education, health systems and facilities, and humanitarian assistance. More information is online or by calling 540-837-2100.

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