Erin Romanski

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 

"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.  

How can you get involved in volunteer work in your own community? And where can you find the time? The 

 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 

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."


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."

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." 

This article originally appeared in the January 2005 issue of 

Articles

Why physicians volunteer and how to get involved

Above and Beyond


As a physician, you might assume you're in the know when it comes to receiving the best possible healthcare. With all of the resources at your fingertips, it would be almost impossible not to. But "physicians are so busy taking care of others that they neglect their own needs," says Steven H. Farber, MD, a cardiologist in The Woodlands, Texas, and author of Behind the White Coat: Intimate Reflections on Being a Doctor in Today's World. "It's very easy not to follow your own advice."

A busy schedule is no excuse for neglecting to get regular healthcare, as you have probably emphasized to your own patients. Physicians, though, may be among the most reluctant people to play the role of patient.

Based on a study conducted in October 2003 by the Journal of the American Medical Association, "a physician-patient's ... trust or acceptance of medical advice may be difficult. Physicians have greater than average death anxiety and although they may actually grasp the significance of the information much faster than the average patient, their rational understanding does not necessarily translate into emotional comprehension." The study goes on to note that physician-patients are expected to take a more passive stance in matters of their own lives and deaths.

So it should come as no surprise that, given their lack of time - and even lack of trust - many physicians tend not to have their own physician.

A similar study in the Archives of Internal Medicine in November 2000, asked 915 physicians whether or not they have a regular source of care or primary-care physician. Researchers hoped to determine the predictors of not having a primary doctor, and if having one is associated with the subsequent receipt of preventive services. 

According to Cary Gross, MD, assistant professor of medicine at Yale University School of Medicine and principal investigator of the study, "We were surprised that a full third of MDs did not have a [regular source of care], and that internists in particular seemed unlikely to have one. I think that internists don't have primary-care docs because they mistakenly believe that because they have the training to be primary-care doctors for other people, then they can also care for themselves."

The study results showed that 39 percent of internists reported having no primary-care physician; surgeons followed close behind at 34 percent. Pediatricians (78 percent) and psychiatrists (79 percent) were the most likely to have a primary-care physician. 

Data from the Archives study indicated a direct correlation between physicians' personal health beliefs and their use of a primary doctor. "Respondents who were more fatalistic about their health were almost twice as likely to lack a [physician]," according to Gross. "In contrast, those who expressed faith in the ability of physicians and other authority figures to influence their health outcomes were far less likely to lack a [physician]."

Do the health habits of these physicians then influence how they counsel patients? Apparently so, based on another study in JAMA.
The study, conducted in 2002 by Kenneth Wells, MD, and associates, looked at the link between physicians' personal health habits, and their practices of counseling patients on smoking, maintaining a healthy weight, exercise, and alcohol use.

The conclusion? The more bad habits physicians have, the less likely they are to effectively counsel patients, and vice versa.
According to Wells, "Physicians with poor habits in all four areas are unlikely to counsel even patients with liver disease about alcohol. In contrast, physicians with good habits in all four areas routinely counsel all patients who drink about alcohol."

"Doctors are so used to being in control, and there is a sense of detachment that they have in order to distance themselves from diseases," says Farber. "They are hiding behind their role as doctor and are just as capable of denial as anyone else." This can lead to problems like addiction. 

"It is so simple for doctors to become addicted," says Farber, who also runs a Web site, 

, that features a physician-to-physician bulletin board. "The temptation is there; you can prescribe almost anything for yourself. I would say 10 [percent] to 15 percent of physicians have problems with addiction." 

When they find themselves in health trouble, physicians "need to get away from the mentality of being too busy - and the reminders need to be there," says Farber. He claims his own experience with illness was an eye-opener.

"I am a patient with a chronic illness, and as a result, I can empathize with my patients and relate to them on their level. I feel that this experience has made me a better doctor," he says.  

There are no reliable methods of encouraging physicians to use a primary-care doctor and get regular preventive care. Efforts thus far tend to target mostly medical students and residents.
Deborah Danoff, MD, associate vice president, division of medical education, at the Association of American Medical Colleges, believes the importance of teaching young medical students good health habits - for themselves and their patients - cannot be overemphasized. "You have to assure that you bring to awareness the importance of health prevention. Most medical students are so young they don't even yet think about health prevention topics themselves," she says.


One impending change in the medical school curriculum, says Danoff, is the incorporation of the "Healthy People 2010" goals - a set of nationwide health objectives coordinated by the Department of Health and Human Services and other federal agencies. "Nobody changes a curriculum overnight, but it's already an ongoing effort," she says. 

"Medical schools are more conscious now to the problems faced by doctors, and there are more attempts being made to teach doctors how to take care of their own needs," says Farber.
For those physicians out in the trenches, wellness committees commonly sponsored by state and county medical societies are one resource to help physicians obtain better health information.
 


When you do visit another physician for care (or you treat a fellow colleague) it's important to be aware of the issue of professional courtesy, or providing discounted (or free) services.

"I remember years ago where physicians or their families had expected or requested professional courtesy," says Brad Fenton, MD, whose Philadelphia practice includes a number of physician-patients. "But it's not much of an issue anymore. There are people who can take their friends and family members and maintain the appropriate professional relationship ... ."

Still, there must be a professional courtesy policy set out in writing and approved in advance by the governing body of the practice, according to Alice G. Gosfield, Esq., of Alice G. Gosfield and Associates, P.C., a health law firm based in Philadelphia. 

Professional courtesy is defined under Stark II, Phase II regulations as the provision of discounted healthcare services to a physician or his immediate family members. The courtesy must be offered to all physicians on the entity's bona fide medical staff or in the local community without regard to volume or value of referrals.

(Additional information regarding professional courtesy, and how it applies to Stark law, can be found at 

 under the newsletter article "Stark II, Phase II: The Interim Final Story," May 2004.)

In the end, Fenton believes that, whether they are physicians or not, "there are always going to be people who are more willing to be partners in managing their healthcare. There are people who can be objective and appropriate ... and then there are people who feel that they don't want to be in that position of responsibility [for their own health]."

You may assume as your own physician that you are in good hands managing your own care. But the importance of having a primary-care doctor far outweighs the perks of being your own "second opinion." 

Erin Romanski, editorial assistant for Physicians Practice, can be reached at 

This article originally appeared in the November/December 2004 issue of 

Physicians may be among the most reluctant people to play the role of patient.