Volunteer doctors blocked by red tape

Volunteer clinicians play a critical role in the current U.S. safety-net health care system and in many health care coverage expansion proposals. Yet, bureaucracy and red tape make it excruciatingly difficult for well-intentioned clinicians to donate their time.

This summer, the U.S. House of Representatives passed the Health Centers Renewal Act (H.R. 1343) to provide funding for more safety-net health care centers. But without policies that make it easier for doctors and nurses to volunteer, our shiny new clinics could become empty reminders of a failed effort to improve the public’s health. Also, Sen. Mike Enzi, R-Wyoming, introduced the Volunteer Health Care Program Act in July to  expand liability protection to volunteer doctors.

I live in Pennsylvania, but am doing a fellowship in Baltimore and want
to volunteer as a primary care doctor in one of they city’s many
clinics for the uninsured. After spending nearly $1,000 and numerous hours jumping through hoops trying to get a Maryland physician’s license, I can say confidently that these are needed reforms. With the time and money I’ve spent so far, I could have easily seen and
helped many patients.

Volunteer clinicians provide quality care while allowing the free clinics, referral networks, and federally qualified health centers that comprise our safety-net health care system to keep costs down. For example, the federally qualified health centers just renewed by H.R. 1343 saved billions of federal dollars in 2007 alone. This was in large part because preventive care provided by volunteer and paid clinicians reduced costly specialty care referrals, hospital admissions, and emergency room visits.

Attempts to expand coverage, such as the Healthy Howard Plan, rely on volunteer clinicians. And the demand for volunteer providers will continue growing as the number of uninsured Americans climbs above 47 million. Yet the percentage of physicians providing free care is declining, and multiple barriers between clinicians and volunteer care don’t help.

Dr. Stanley Tyler, a retired physician in Florida, summed up his battle through bureaucratic red tape in his op-ed “Get a medical license? It’s easier to get a gun.” Licensure is necessary to prevent unsafe clinical practice, but a prohibitively inefficient licensing system is not.  In addition to unwieldy paperwork, state medical boards require volunteer physicians to pay a license fee, which can approach $1,000 depending on the state, and often do not honor reciprocity with other states.

Not all barriers to clinical volunteering have gone unnoticed. The drafters of the Health Centers Renewal Act laudably took one step forward on the issue of liability insurance for clinical volunteers. Liability is necessary for safe clinical care, but clinicians may be discouraged from volunteering if liability insurance is unavailable.  Previously, physicians who were paid staff at a community health center were provided with liability insurance through the Federal Tort Claims Act (FTCA), but volunteers were not. The Family Health Care Accessibility Act (H.R. 1626) corrected this by expanding FTCA insurance to volunteers, and the provisions were adopted in the renewals act.

The Health Centers Renewal Act is a step in the right direction toward encouraging volunteer providers to participate in caring for underserved people. As the number of uninsured in our country grows, it is essential that the Senate show the same bipartisan support for the important legislation.

The successful expansion of our safety-net system or the implementation of expanded coverage or universal health care systems, however, may not be possible without further measures to encourage voluntary clinical work, such as simplifying the licensing process, reducing of license fees, and relaxing anti-reciprocity rules. Facilitating the partnership between qualified volunteer clinicians who want to improve the public’s health by serving populations in need of care should be a top priority.

June Spector is a physician trained in internal medicine and primary care. She is currently a postdoctoral fellow at the Johns Hopkins School of Medicine and a public health student at the Johns Hopkins Bloomberg School of Public Health.

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3 replies »

  1. Hello June,
    My name is Naomi Ackie and I’m a 2nd year student at central school of speech and drama in London, and I’m training to become a theatre maker. I’m currently creating a piece of thaetre based on interviews around the American Healthcare system, And am very interested to learn more about the free clinics and what doctors go through.
    I would love to interview you for my play. If you were interested and had the time, it would take no more than 45 minutes to ask a few question on your experiences and thoughts. This information would be shared with the cast and the audience members and I would be able to post you the show after I had performed it.
    If your interested please get back to me on Naomiackie@hotmail.co.uk

  2. If you are looking for a way to serve, but you hate leaving the computer, check out 10000strong.org. Its a place where you can go to get inspired, tell your story, and donate to the cause. Do your part this MLK day and visit 10000strong.org — There is no excuse for hunger, help to fight it!

  3. 2 thoughts:
    1. There are a lot of doctors volunteering or expressing the interest to volunteer (myself included). This is great. However, I know that some of these doctors are fighting for every dollar of their 200 K + incomes, even to the extent of doing procedures that they are not well trained in, fighting with colleagues about who is allowed to do certain tests/procedures (even though the colleagues may have the same or better background to that particular test/procedure) … how does that square? Is that a parallel to the millionaires and billionaires fighting taxation, but give large sums to charity for whatever motivation?
    2. I do not see one good reason in favor of maintaining state licensing for physicians, or can anyone tell me any? The board exams (both USMLE and specialty boards) are already nationwide affairs. There is already a great deal of control re. accreditation of foreign medical graduates by the ECFMG. There are, however, plenty stories of doctors disciplined in one state, who then simply start to practice in another. Why wouldn’t we develop a federal licensing board (which is supervising state/local agencies) for the entire US?

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