More than 3 million refugees have been resettled in the U.S. since 1975. Most of them fled their country of origin out of fear of persecution¹ and have histories marked by violence, trauma, and substandard living conditions in an intermediate country.^1–3

Refugees are provided with resources such as case managers, social workers, financial support, and housing immediately upon arrival in the U.S., but these services are generally discontinued before the refugees become fully self-sufficient.³ Refugees also often have limited health literacy and English proficiency and acculturation issues, along with complex or multiple medical problems, including tropical and infectious diseases and mental health needs.^1,3 U.S.-trained physicians are often not equipped to deal with these issues in a typical 15-minute office visit.^1–3 The result is an underserved patient population that experiences significant health disparities and poses unique challenges to the delivery of primary care.¹ The special care needs of refugee patients were outlined in a previous FPM article.³

In our clinic, more than 20% of patients are refugees, yet when we surveyed the physicians about how well they felt they addressed refugees' health care needs, they rated their care as only 5.5 on a 10-point scale (1 = terrible and 10 = excellent) compared with 7.3 for general patients in the clinic. In response, we created a refugee-specific clinic to better serve these patients and their complex needs in our practice. The refugee clinic is held two half-days per month, and we can see six patients per session, which is sufficient for our patient population. It operates within our family medicine residency's regular clinic facility and has been in operation for almost five years.

Here are six lessons we've learned about how to improve both the quality of care for refugees and physician satisfaction in caring for them by using the model of a refugee clinic.