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Treating the Neediest: Community Clinics' Expanding Role in Primary, Vision Care
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When you think of the first place a patient in need of eye care might get help, what settings come to mind? If your short list didn’t include a community health center, you might be surprised, but these clinics are becoming an increasingly important practice setting for not just general practitioners but also ophthalmologists – and not just for seasoned ophthalmologists, but those new to practice or even still in residency.

What is a Community Health Center??
According to the Department of Health and Human Services (HHS), 19 million people relied on a community health center to receive medical attention in 2009 … 19 million. And this was not for emergency treatment, but for basic health screenings, dental checks, vision checks, etc.

The government has recognized this huge health need in our country and, thanks to the American Recovery and Reinvestment Act, provided $2 billion to be invested in community health centers. Then, in October 2010, HHS gave this effort an additional boost, by awarding community health centers an additional $335 million.

This federal funding couldn’t come at a better time. According to HHS, one out of every 19 people in the United States (a third of whom are children) relies on a community health center for their basic medical needs.

These health centers are public, non-profit, tax-exempt primary care facilities supported by the community. They are usually located in and/or serve a high-need community, such as a low-income area, community with English language barrier or migrant population and so on.

Centers provide services on a sliding pay scale, adjusting fees based on the patient’s ability to pay. With only 60 percent of patients seen having insurance, many centers rely on government funds, grants, donations, private funding and/or faith-based support.

The one thing they all have in common is a reliance on volunteer physicians. And that’s where ophthalmologists come in. According to Cathy Cohen, the Academy’s vice president of governmental affairs, 96 percent of community health centers provide vision screenings as part of their basic health services and try to identify problems. And many centers will be looking to expand those services.

“With this new influx of funding, many centers are looking at buying remote retinal imaging to screen diabetics and provide even greater care,” says Cohen.

“Community health centers are flush with spending right now, as the government gives them money to build and refurbish facilities so they will be more state of the art and more respectable entities,” says Cohen, though she notes “this money is for equipment and facilities but not staffing.”

An Opportunity for Residents
There are several ways for ophthalmologists to get involved in a community health center. For residents in the Yale School of Medicine’s department of ophthalmology and visual science, work in a center is part of their training. Since 2003, residents have helped staff the Cornell Scott-Hill Health Center in New Haven, Conn. It’s a win-win for the YOs and the community: patients get the treatment they need and residents have an opportunity to practice outpatient care.

One of those YOs was Anita Hwang, MD, who did a three-month rotation at the clinic as part of her residency at Yale. “Most of our patients were there for general ophthalmology,” she said, “but once a week we would have a pediatrics clinic and a couple of times a month we’d have glaucoma clinics.”

According to Susan Hill Forster, medical director of the eye department at the Cornell Scott-Hill Health Center and associate clinical professor and director of medical studies at the Yale School of Medicine, pediatrics and glaucoma are the community’s “particularly pressing subspecialty needs.”

During her rotation, Dr. Hwang worked in the clinic five days a week. “Essentially, there were two technicians, one front desk personnel, an attending physician, and me,” she said.

Though she only spent three months in the clinic, the rotation has had a lasting impact on Dr. Hwang. “It was life-changing. I cannot stress enough what a worthwhile experience it was,” she said. And it’s one she hopes to build on. “Whether I go into private practice or academics, I know that serving the underprivileged will definitely be a part of my practice,” Dr. Hwang said.

A Way to Give Back at Any Stage
For physicians who are already in practice, community health centers can also provide an opportunity to help those in the community who might never come into their office for care. A traditional way is to set a Saturday schedule at a clinic or center, which can be for a few hours every other Saturday, one Saturday a month, etc.

If volunteer time is simply not realistic, some physicians may buy or provide equipment for use in the center. They may even see patients as their schedule allows, without having set days and/or times.

Ophthalmologists may also choose to work with a faith-based center. Thomas Cannon, MD, an associate clinical professor in the University of Arkansas department of ophthalmology, says a volunteer at a faith-based center may have different reasons for giving time there versus a traditional center, but they all have the same mission: to reach those who cannot afford care. For Dr. Cannon, that happens at River City Ministry in Little Rock, Ark.

“While River City is a faith-based center, there are no requirements to be member of the ministry,” Dr. Cannon said. “In fact, I don’t know of any faith-based center that demands you be a member of that church or even that faith to receive care there, or even to volunteer there. No one is evangelizing or trying to convert you. They are simply treating your health care needs.”

For him, one of the benefits of a faith-based center is that the health care services are likely just one among many being provided for the underserved. “This makes it more comfortable for the patient,” says Dr. Cannon. “A patient is more likely to go somewhere that is familiar to them, rather than to another clinic or the ER.”

A Great Opportunity for YOs
Whatever your stage in practice, if you haven’t considered working in a community health center — whether on a volunteer or full-time basis — it’s an option to consider.

“Health centers are a good way for YOs to help serve the community while also helping to build a practice,” says Cohen, noting that the previously uninsured will soon have insurance. This translates to referrals from paying clients. “It’s also a great opportunity to show leadership by helping their community health center make good decisions with the new funding.”

Plus, community health centers give ophthalmologists an opportunity to treat patients in areas not normally served by the profession. For patients, this means that they can receive the type of eye care they need and deserve.

And, as Dr. Cannon points out, volunteering is often overlooked in school and during residency. “Whether you work with CHC or a faith-based clinic, it’s important to give back,” he says. “Most ophthalmologists are at the top of their class and are more fortunate than most Americans. It gives us a responsibility to give back. … If every ophthalmologist gave two days a year, think how many people we could serve. It would help a lot.”

If you would like to volunteer your time, no matter how often that may be, you can start by asking your medical school, residency or fellowship program, or current employer if they know of a community health center in your area. Dr. Hwang also suggests checking online for regional community health centers, getting involved with free vision screenings, or asking practices in your area where they refer patients who don’t have insurance or other financial means. Check the HHS website for the closest health center in your area.

“You may need to be proactive,” says Hwang. “There is always a need for health care, especially for a specialty such as ophthalmology. If you make yourself available, there is definitely a way to get involved.”

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About the author: Kimberly Day is a freelance health writer and medical editor and a frequent contributor to YO Info. She is the co-author of Hormone Revolution and ghost writer of Eat Papayas Naked.

 
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