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American Academy of Family Physicians
Monday Oct 17, 2011

Practicing without a safety net

We had a partner leave the practice this summer.  We are looking for the right person to hire, and in the meantime, we're sucking it up, the way we all do when we're short-handed.  We're committed to great access, so this has meant adding in a bit of time here and there and using our e-mail and other team resources (pharmacist, RNs) to help deliver care without visits when appropriate.

We've maxed out our flow system of doing indirect care while also doing patient care (more about that in my next post).  But I can only imagine what it would be like if we didn't have a flow system at all, and if we didn't have such dedicated staff members – staff members who are cross-trained to do so many things. 

But I don't want to whine because despite the temporary strain, I still love going to work.

Something else weighs on me more:  the state of Americans' health coverage.  Yesterday, Saturday, I saw a middle-aged guy with asthma who hasn't been able to afford his steroid inhaler and who has no insurance. He doesn't qualify for low-income programs because somehow his unemployment benefits put him over the line.  So he's been suffering an asthma exacerbation for a month.

Next I saw a 30's something guy who had lacerated the tip of his finger cutting aluminum with a saw. As I finished up the sutures, lining up the cuticle and nail borders, he asked, "Any idea how much this is going to cost?"  He has a decent job but no health insurance coverage.

It's a kind of encounter I'm having two or three times a day, and I'm not in the inner city or a rural, underserved, economically depressed area. I can get many patients covered by our own organization's "charity care" plan for full coverage.  Some we can get on the Washington State Prescription plan for affordable medications. It takes me back to my residency in a clinic that served Hispanic and other underserved immigrant populations. I learned a lot about social work then, and we had a part time social worker, so doing this several times a day didn't faze me.  But that was 1990 at the SeaMar Clinic in Seattle. This is now.

We've been hard at work aligning tasks for all staff members and getting ever closer to the point where physicians do only physician work – as witness our ability to absorb the work of a departed colleague with minimal pain – and here I find myself needing to direct a bit of social work.  Thankfully we have a local nonprofit social work organization that helps immensely.

But really, back to the guy with asthma: how can it be that there are no generic steroid inhalers that a person with no insurance can afford when that alone could keep him out of the office and the ER?

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