Rough and rural medicine: More medical professionals volunteering to help the poor

TRAVERSE CITY – Traverse City is a regional medical care hub for residents of northwest Michigan. It's also a region where many local physicians balance their private practices with caring for patients who can't afford medical care, both in this corner of the state and beyond our borders.

Africa, India, South America and Central America are recent destinations for local doctors, nurses and other medical professionals who volunteer for a week to several weeks at a time providing care ranging from cardiac, eye and dental to specialties like hand surgery and pediatric rehabilitation. A retired emergency medicine physician, Robert Baker, spent over a month caring for victims of Hurricane Katrina in Louisiana.

For the past five years Traverse City nurse anesthetist Bill Hermann has helped organize medical missions to the Dominican Republic. Surgical and dental care were the focus of his latest trip, on which he was accompanied by practitioners and support teams from Traverse City and Cadillac, as well as other Michigan communities.

"It's rough and rural medicine," Hermann says. "It's without the safety nets and back-ups you have here in the states. We were working in an operating room without air conditioning and with the power going out. We'd have five people standing over the O.R. table with flashlights in a room that had a hole in the wall large enough for critters to crawl through."

Munson donated $800 in supplies for the Dominican Republic trip and the volunteers used their airline luggage allotment toting it. Toys and candy for the local children were also tucked into their bags.

Hermann says that even though volunteers use vacation time and pay their own expenses, he has no trouble recruiting.

"We come home physically exhausted but really energized. You know the work you're doing for these people is going to impact them for the rest of their lives."

A recent Michigan State Medical Society survey found that volunteer hours for physicians has increased from an average 5.1 hours a month in 1999 to 5.6 in 2005. Overall, the total of free care provided to low-income patients increased from an average of three hours a week in 1999 to 3.7 in 2005, says public relations director David Fox.

Mission work at home

Perhaps less obvious than overseas medical missions is the ongoing volunteer care for low-income patients through the Traverse City-based community clinic as well as directly through physicians' offices.

Last year 21 doctors and nurse practitioners donated 1,196 hours on site for 4,000 patient visits to the Community Health Clinic, according to administrator Meg Lancucki.

"But the need is great. New patients are waiting at least six weeks to be booked for an appointment."

The clinic that was founded 30 years ago to serve the five-county area saw a dramatic increase in services when Dr. Carl Benner, a retired surgeon, took over in 2000. The patient load has almost quadrupled. Benner has been honored by both the Grand Traverse-Leelanau-Benzie Medical Society and the Traverse City Area Chamber of Commerce for his work.

Thanks to a new state law, retired physicians can get a special practitioner license and that has made it easier for retirees to volunteer at the clinic, Lancucki says.

A larger volunteer program-in terms of participating doctors-is the Coalition Health Access Program (CHAP) founded two years ago to match uninsured low income residents in northwest Michigan with health care providers willing to see needy patients without charge in their offices.

Currently 1,300 people are enrolled. Of those, 450 receive free primary care through local doctors' offices and 850 through the free clinic. CHAP coordinates basic health services for enrollees and also arranges referrals to specialists, says executive director Arlene Brennan.

Physician participation is a remarkable 70 percent of general parishioners and 75 percent of specialists, all who volunteer their services.

Even with a majority of local physicians volunteering, the need is increasing with an estimated 4,000 to 5,000 eligible residents in the three-county area.

In April, CHAP and the Community Clinic officially merged to become the Traverse Health Clinic and Coalition. Pharmaceutical, vision and dental programs staffed by volunteer care providers are also under their umbrella.

In addition to supporting overseas volunteer projects, Munson Medical Center has donated "millions of dollars in uncompensated services," Brennan says.

While the number of volunteer hours has increased in Michigan, the proportion of U.S. physicians providing charity care has dropped from 76 percent in 1997 to 68 percent in 2005, according to a study by the Washington, DC-based Center for Studying Health System Change. The shift is across medical specialties, physician income levels and geographic regions.

Locally, barriers and benefits to volunteering seem to reflect national trends.

Increased pressure in the business aspects of practicing medicine-record keeping and paperwork associated with filing claims-is often cited as an obstacle.

While doctors in our area are generous with their time, it's not unusual for local practices to have 50 to 60 percent of their paying patients Medicare and Medicaid recipients, with huge paperwork requirements and declining reimbursement, Brennan says.

"The need is increasing and volunteering is starting to plateau. People can do a certain amount and then max out and we understand that. You just can't keep doing everything without getting any compensation.

"We've had great support, but the need is huge." BN