AAFP Foundation Grant Provides Hope for Patients of Volunteers in Medicine Clinic

It's known as the Treasure Coast, and, for many of its residents, the Atlantic coast of Florida is a paradise. But for others, the area's economic decline has led to job losses and strained financial circumstances. For those who have lost their insurance coverage along with their jobs, finding health care seems all but impossible. But that's where the nonprofit organization Volunteers in Medicine, or VIM, steps in.

VIM clinics provide free health care to the working uninsured in various areas of the country. The program brings together the medically indigent with volunteer health care professionals in a clinic setting that is supported by the surrounding community.

The first VIM clinic launched in 1994 in South Carolina. Since then, the program has grown to 84 clinics across the United States, including six clinics in Florida, where the newest clinic, Space Coast Volunteers in Medicine, or SCVIM, in Palm Bay, Fla., recently opened.

VIM clinics, which provide care only for patients ages 19-64 who are not eligible for government aid and who earn less than 200 percent of the federal poverty level, also are the newest project of the AAFP Foundation. The Foundation recently launched its Family Medicine Cares program with a $25,000 grant to the SCVIM clinic.

Family Medicine Cares is part of a new strategic direction for the AAFP Foundation, says Foundation President Richard Roberts, M.D., J.D., of Madison, Wis. The new direction aims to focus the Foundation's efforts so they have more impact and are more effective.

According to Roberts, an in-depth analysis of the programs supported by the Foundation led to the decision to "go to a more focused approach." The Foundation decided to concentrate on one to two signature programs for each of the three legs of its mission: humanitarian, scientific and education. The programs, it was determined, should be national in scope but with a grass-roots component, provide for chapter and member involvement, focus on a major need, and reflect members' philanthropic priorities.

In particular, says Roberts, members wanted the Foundation to focus on helping people who do not have access to health care. And, that need is great. According to Foundation figures, 50.7 million people in the United States were uninsured in 2009, and more than three-fourths of these individuals were part of working families who were earning low to moderate incomes.

According to a VIM statement (1-page PDF; About PDFs), although the Patient Protection and Affordable Care Act will help some of the uninsured, there will always be a need, and people without insurance are likely to postpone receiving health care. They often use the emergency room as their primary source of care and lack preventive care for chronic conditions. The result is uninsured patients are likely to be sicker when they finally do see a physician. "The number of preventable deaths among uninsured adults age 25-64 is estimated at 18,000 a year, making 'uninsurance' the sixth leading cause of death," says the statement.

The Family Medicine Cares program will gather all the resources AAFP members can provide, from financial support to volunteer support. "Family Medicine Cares is designed to bring (family physicians) together to help address this overwhelming need in the United States and to bring visibility to the caring nature and importance of family medicine," says the Foundation.

Eager as it was to get involved with helping the uninsured, however, the Foundation realized it could not establish and run free health care clinics on its own. After much deliberation and member input, the organization decided to find a partner it could work with to support free clinics across the nation.

"Volunteers in Medicine quickly and obviously proved to be the best partner for us," says Roberts. "They have a good track record, and they think through the process (of opening new clinics)." And VIM does have a good track record. Out of the more than 80 clinics it has launched, it has only seen two of those clinics fail.

Roberts says the careful research done by the Foundation will pay off in the partnership with VIM, but he notes "the Foundation will not be an ongoing bank for (individual) clinics," given that its focus is on new clinics and helping them get off the ground. "We cannot provide (clinics) with the money to keep them going, but we can provide seed money," says Roberts, adding that a clinic's ongoing success will depend on the level of community support it gets.

Not only are Family Medicine Cares grants provided only to new VIM clinics, the funds also have to be used to purchase tangible items such as examination tables, electronic health record systems and medical equipment. In addition, through its involvement, the Foundation plans to stimulate interest in volunteer involvement by AAFP members, including active and retired physicians, residents, and students. The clinics also provide an opportunity for involvement by family medicine residency programs and for relationships with local AAFP chapters and chapter foundations.

Steven Vanderby, M.D., is the family physician in the leadership group at SCVIM who made the grant award possible, and he's grateful for the Foundation's generosity. "It was a momentous occasion," says Vanderby about receiving the grant award, which was used to establish a complete women's exam room and for other essential medical equipment. "We couldn't have opened the clinic without (the grant)."

He credits his wife, Kathy, with getting him involved in the clinic. A chance encounter with a VIM recruiting effort at the couple's favorite local watering hole led Kathy to a volunteer role at the SCVIM, and when the opportunity came up to apply for the Family Medicine Cares grant, she enthusiastically volunteered her husband.

Vanderby says he sees the need for a free clinic in his practice nearly every day. The local area is heavily dependent on the nearby Kennedy Space Center and the jobs it generates. However, with the impending end of NASA's space shuttle program, massive layoffs are ongoing in the region. Vanderby estimates that almost 40 percent of the local community may be in need.

"There are a lot of people falling through the cracks," he notes. "In my own practice, I have a large group of patients who have been laid off and lost their insurance." The clinic will help close the gap so people can get their medications and the continual care they need.

The VIM Clinic in Stuart, Fla., 70 miles south of Palm Bay, is an example of the good such clinics can do in a community.

Founded in 1995, the VIM Clinic, which has 1,200 active patients, racked up 13,900 patient visits in 2010, up from 8,000 visits in 2007, according to the clinic's Executive Director, Mary Fields.

There has been a big increase in demand, says Fields. Although many of the clinic's patients work part time, a lot of them are recently unemployed. In fact, according to county statistics, the unemployment rate in Martin County, which is the area covered by the VIM Clinic, has soared from 4.1 percent in 2007 to 11.6 percent in 2010.

"A lot of our patients have never been to a doctor, or, at least, not often," says Fields, adding that many of them are dealing with chronic health conditions such as diabetes, hypertension, chronic obstructive pulmonary disease and congestive heart failure.

The VIM Clinic, however, is well-equipped to handle those chronic problems. It provides ongoing care for its patients with a focus on preventive medicine. "Patients always see the same physician or nurse practitioner, so they have continuity of care," says Fields.

And for physicians accustomed to dealing with the daily hassles of ensuring their patients receive the care they need, this place would be a welcome break. Patients spend as much as an hour and a half with the health care professional they see on their first visit, says Fields, and clinic staff ensure that relationships with other health care entities are in place upfront, so patients can receive all the care they need, including medications, laboratory and diagnostic testing, and subspecialist care.

Fields notes that the clinic has an excellent working relationship with the local hospital and other health care providers in the area. The hospital provides all of their laboratory and diagnostic testing for free, and they receive medications from pharmaceutical companies and from local physicians who send the clinic their samples. In fact, according to the clinic's 2011 budget, the facility expects to provide more than $9 million in health care services at a cost of about $700,000 this year. That is thanks to the generous contributions of the community, says Fields.

However, it can be a taxing proposition to ensure agreements are in place to serve clinic patients for free no matter what the problem. "Someone has to absorb those costs," says Fields. Services have to be free for patients. Why the insistence on free services when so many clinics charge on a sliding scale? According to Fields, services have to be free to maintain the clinic's sovereign immunity, which allows physicians to volunteer at the clinic without having to worry about malpractice. According to Florida law, these physicians cannot be sued for providing reasonable care.

And for patients like Shirley Kingsley, all the preparation pays off. "They take really good care of me," she says of the clinic staff. Kingsley is dealing with a number of chronic conditions, many of which are exacerbated by the stress of caring for members of her extended family.

Nurse practitioner Carol Jarzyn, A.R.N.P., works with Kingsley to improve her health in a variety of ways, including by counseling her on stress relief and diet and through coordinating Kingsley's numerous medications. The result is a patient who is on the road to a healthier lifestyle instead of a patient who is in and out of the emergency room numerous times because of the lack of continuity in her health care.