• Here to Help: Launching Free Clinic Is Culmination of a Dream

    One of the reasons -- probably the biggest reason -- I chose a career in medicine was to help people. I know it sounds trite because we all write about "helping people" somewhere in our medical school applications or our residency personal statements. But for many family doctors, helping people is truly a life's pursuit, a calling.

    I first realized I wanted to be a doctor when I was in high school, and for a long time, I have wanted to find a way to give back to my hometown. Two years ago, I started taking steps to make that long-time dream a reality. The mayor of Falmouth, Ky., approached me about improving access to care in my home county of Pendleton, and that opened the door to discussions about free health care for the residents of the county.

    Back in 1997, my junior year of high school, flooding along the Licking River submerged the city of Falmouth under several feet of water. Costs for repairs and rebuilding were in the millions, and many of the town's 2,000 residents left, never to return. The city and the surrounding county lost more than buildings and money. They lost hope.

    To add insult to injury, the burden of chronic disease has increased in the area in recent years. For example, nearly 30 percent of the population smokes cigarettes. It doesn't help that according to the Health Resources and Services Administration (HRSA), there is just one doctor for every 7,349 residents in the county. Before the flood, access to care was an issue, but enticing new physicians or even hospital-related services became harder when businesses started closing down and the population declined.

    As the mayor and I discussed these depressing statistics, we quickly realized that improving the health of the population would require more than just a free clinic. There's more to health than simply not having a chronic condition such as diabetes, taking the right medication, or even seeing your doctor on a regular basis. Health encompasses all aspects of our lives, from the food we eat to our ability to have a safe and restful place to sleep. The goal for the project became meeting not only the physical needs of the population, but building a sustainable culture of health by helping folks better communicate with each other and use their talents to support each other.

    My vision, as I speak with representatives from groups like the health department or the Cooperative Extension Service, involves tapping the resources of individuals that utilize the clinic. Every person has something they can contribute to build community. If a middle-aged, self-employed father of three with hypertension comes to the clinic for treatment, the plan is for one of the registration staff to ask him about any special talents or skills he might possess. Let's say he's a carpenter, and he's willing to volunteer his skill and time in that area if a need arises. It's not a requirement for getting medical care, and we are taking great care to make sure patients understand they have no such obligation. But let's say he volunteers. This means that next week, when elderly Mrs. Smith, who's otherwise healthy but is virtually stuck in her home because she can't navigate her front stairs any longer, comes into the clinic for her arthritis, I would have a resource to tap to help build her a ramp.

    While this is just an example, the idea of citizens helping each other forms the foundation for the project. Rather than assuming I know everything or have everything that people need, the plan is to help the members of the community discover how they can help each other. Too many times, free clinics open to provide only disease management, forgetting about health.

    Like most things I tend to write about, this story doesn't have an ending yet. The group involved with the clinic has grown from two or three people to encompass multiple individuals, local organizations, and even city and county governments. We recently learned that the building we've been hoping to use as a base of operations will be ready for business in early December. As the process continues, I plan to post updates, mostly as an encouragement to others to continue giving their time and talents to help underserved populations.

    Although time pressures and financial demands can make the process of providing free care daunting, multiple entities exist to help physicians -- particularly primary care physicians -- provide low-cost or no-cost care in urban and rural areas with the highest need. Via the National Health Service Corps, HRSA provides grants, loans, loan repayment, and scholarships for physicians agreeing to practice in federally designated health professional shortage areas. The federal government also extends medical malpractice coverage to free clinics via the Public Health Service Act, Section 224(o), and the Federal Tort Claims Act through an application process.

    The AAFP Foundation provides assistance to no-cost clinics via the Family Medicine Cares USA program. The foundation offers grants to purchase equipment or supplies for new and existing free clinics in underserved areas. Applications for the program can be found on the Foundation's website, and the deadline for the next award cycle is March 15.

    The plan for our group involves utilizing all of the above and even seeking some outside-the-box sources of funding, such as federal telemedicine grants. We're now working thanks to the generosity of private donations of time and money, but to maximize efficacy, the team is considering multiple different funding sources. We may eventually pursue creating a federally qualified health center.

    My story, thank goodness, is not unique. Hundreds of doctors, medical students and allied health professionals across the country serve the needs of underserved populations. As new physicians, time and economic pressures may hinder us from helping others beyond the scope of our everyday practice, but multiple groups exist to help alleviate those stressors. I encourage you to check out the links above, whether you're already providing indigent or no-cost care or want to start. And feel free to add other resources for physicians in the comments field below.

    Gerry Tolbert, M.D., is a board-certified family physician who practices in northern Kentucky. A lifelong technophile, his interests include the intersection of medicine and technology. You can follow him on Twitter @DrTolbert.


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