Above and Beyond

How often do you volunteer your time outside of the office to assist in medical clinics? Accept uninsured patients during normal business hours? Lend a hand at soup kitchens or shelters? If you're like many physicians, you probably do a lot more charitable work than doctors are usually given credit for.

"I think it is common for physicians ... and others in our practice to do a fair amount of volunteering in the community," says James T. Dove, founder of Prairie Cardiovascular Consultants in Springfield, Ill., named the 2004 Practice of the Year by Physicians Practice.

"Some work at facilities that assist developmentally disabled and other shelters," and they perform nonmedical charity work. "They ... work through their churches or synagogues to aid the disadvantaged."

Physicians volunteer for a variety of reasons, says Sue Fredricks, community relations manager at Hope Medical Outreach Coalition in Omaha, Neb. Her organization, which connects low-income, uninsured patients with volunteer physicians and other healthcare professionals, recently conducted a survey of physicians in her area concerning their attitudes toward volunteer work.

Like people in all walks of life, the biggest motivator is simply the personal satisfaction that comes with helping one's community. In addition, many doctors are charitable by nature, and indeed, became physicians because of a desire to serve. They also feel obliged to help, more than other kinds of professionals, because of their specialized skills and knowledge, as well as the importance of the work they do.

"They feel it is their duty and responsibility to their profession to provide medical care to all," she says.

Barbara Dickie, executive director of St. Mary's Clinics of St. Paul, Minn., echoes this sentiment: "What I frequently hear from physicians is, 'This is what I went into medicine for.' They are here because they want to help. ... They feel very blessed and view this as giving a gift rather than a sense of obligation."

There's still another reason that many physicians are drawn to charity work. Doctors are community leaders, and volunteering is a way of demonstrating solidarity in your community, says Khoi Hoang, a nephrologist at Internal Medicine/Nephrology in San Jose, Calif., and a volunteer officer with the Vietnamese Physician Association.

Physicians say overwhelmingly that personal satisfaction is the driving factor in their decisions to volunteer.

"I believe the majority of physicians are idealistic and altruistic," he says. "Therefore, they would volunteer if they could."

These converging attitudes have led to increases in physician volunteerism, at least in some places. Fredricks says she's been heartened by the positive response Hope's recruiting efforts have received. "We have seen an increase of 85 new volunteers in the past two years," she says. 

Community support counts

How can you get involved in volunteer work in your own community? And where can you find the time? The American College of Physicians (ACP) offers some suggestions for places to support physician volunteerism:

• At work. Share opportunities and stories of volunteerism with medical students and residents and with your colleagues.
• In your community. Help out at a free clinic or other program in your area. Write about volunteerism in letters to the editor of your local paper.
• In your ACP chapter or that of another physician group.
  Most communities have free clinics with active, participating physician volunteers on site, and these clinics are usually looking for new recruits. It's often possible to choose between seeing patients only at the clinic, or to accept some patients referred by the clinic at your office. In addition, many physicians have developed charity or reduced-price care at their own offices. (For guidance on how to do this, see the article "Treating the Uninsured?" by Bob Keaveney in the October 2004 issue of Physicians Practice or online at www.PhysiciansPractice.com, using the Search by Author function.)

Physicians who volunteer suggest helping out with organized groups such as churches, organizations for the developmentally disabled, educational programs for disease prevention, and by attending health fairs. And groups that seek physician volunteers say they rely largely on word-of-mouth in their efforts to recruit doctors to help.

"The majority of our physician volunteers are recruited [as a result of] appeals sent directly to their offices, referrals from the local medical society and from our Web site, and through colleagues who are already volunteering for us," says Fredricks. "We have revised our recruiting materials, held two annual volunteer recognition events, two volunteer baseball games, and are currently working on a volunteer newsletter -- all with the idea of generating enthusiasm for our organization within the volunteer base, hoping that word-of-mouth from volunteer physicians will generate a desire for others to join them."

Finding time

One of the major barriers to physician volunteerism is time. Doctors are by nature charitable, but their time is stretched thinner than ever before, and many say they just can't squeeze in any more working hours while still maintaining a personal life.

"Time is a huge issue and physicians have a terrible time balancing the demands of their patients with volunteer activity," says Dove. "Given the demands of a busy practice, time is the most precious commodity."

How do they do it? "Most physicians I know just squeeze it in," he says. "It becomes an add-on to their usual 60- to 80-hour week. Frequently they schedule these volunteer activities during a week of vacation."

The good news? Most organizations that want your help are happy to take whatever you can give, even if it isn't much, and are willing to be flexible about the time commitment and how you fulfill it.

"We have over 500 volunteers and the amount of time they donate depends on what their availability is, their specialty, and what types of referrals for services we receive and what type of services they are donating," says Fredricks. "It really depends on the individual physician's commitment, his practice's acceptance of his volunteerism, and the demand for his specialty."

Fredricks' Hope Medical Outreach refers patients directly to the offices of volunteering physicians; the doctors "probably average about one patient appointment per week," she says. At Barbara Dickie's free clinics in St. Paul, physicians typically staff one or two clinic sessions a month, each one lasting four or five hours. Most just donate whatever time they can spare, and she's grateful to get it.

Physicians who do charity work say it's important to establish a realistic balance between their professional obligations and their volunteer endeavors.

"I usually put in a weekend day per month to do volunteer work," says Hoang. He also occasionally assists in radio talk shows on health-related topics. "I wish I could do more, but there are not enough hours in a day for me to have a family life, care for my patients, and volunteer more than I do."

Time management means balancing all the aspects in your life --  from family, to work, to personal involvements. As Hoang puts it, "Sometimes you have to sacrifice one or the other."

Quality care

While charity-care programs are generally grateful for whatever time you give them, the quality of care provided to patients shouldn't differ based on the patient's payment status. Whether a physician is getting paid or not, her obligation to quality is the same.

And, unfortunately, so is her exposure to malpractice lawsuits and queries by physician review boards. Although some states have Good Samaritan laws that offer limited legal protections to physicians providing charity care, for the most part doctors should assume no difference between a charity patient and any other, when it comes to documentation, follow-up, and other risk-management steps.

A study conducted by the American Medical Association (AMA) in March 2004 revealed that 74 percent of physicians surveyed believe they can provide acceptable quality of care to uninsured patients.

"In our practice, [uninsured patients] are seen freely and the physician is encouraged to see these patients by the fact that they individually are not penalized for taking care of the patient," says Dove. "The cost of seeing that patient is absorbed by the practice because of the practice's mission to provide quality care to all."

Erin Romanski can be reached at editor@physicianspractice.com.

This article originally appeared in the January 2005 issue of Physicians Practice.