Advocacy Update: From the Capitol to the Clinic: Taking Lessons from Leadership Day Back Home
I expected ACP Leadership Day to be inspiring, empowering, and a way for me to share my thoughts on health reform with our lawmakers. However, the meeting with my Congressman this past June exceeded all of my expectations. Not only was I able to advocate for patients and physicians, but I also discovered an incredible opportunity in my hometown of Bensalem, Pennsylvania.
As a constituent of the 8th district of Pennsylvania, I am represented by Congressman Michael Fitzpatrick. On Leadership Day, other members of the Pennsylvania delegation and I were able to speak to the Congressman directly about key ACP issues. Currently, I am a fourth-year medical student at Philadelphia College of Osteopathic Medicine and am planning to pursue a career in primary care. I told Congressman Fitzpatrick about my passion for public health, community health, and working in underserved communities, and how important it was to expand federal health programs and GME funding for primary care programs. The Congressman was thoughtful and listened-and then asked if I knew about the BCHIP clinic. BCHIP, or the Bucks County Health Improvement Partnership, is the largest free clinic serving uninsured, low-income adults in Bucks County, PA. Founded in 1993 and located in Bensalem, PA, it is locally driven and provides care to over 2,000 adults every year. I was immediately interested in learning more. And then, Congressman Fitzpatrick suggested that we visit the clinic together so I could get a closer look at community health in my own community.
Over the next few weeks, I arranged with the Congressman's district scheduler to tour the clinic with him and the Executive Director, Sally Fabian, later in July. As I drove to the clinic that day, I couldn't believe how close to my home it was; I must have passed it dozens of times. A modest, four-room clinic, BCHIP is located near a major shopping center and operates out of space donated by the adjacent St. Mary's health system. I was eager to understand how a non-federally funded clinic provides care.
Congressman Fitzpatrick arrived by himself and remembered me and my story. We chatted for a few minutes before Ms. Fabian greeted us and led us to the back. First, we met the staff-the social workers, nurse practitioner, and medical assistants. A social worker described how a thorough intake interview is performed first to ensure a patient qualifies. In order to be seen at BCHIP, the patient must have an income below 200% of the poverty level, but not so low as to qualify for Medicaid. Thus, the average income for a BCHIP patient is approximately $12,000-$22,000 annually. If the patient does not speak English, which is common because BCHIP serves a large immigrant population, interviews can be conducted via translator phone. I couldn't help notice the shelves stuffed with manila folders behind the reception area. BCHIP still uses paper charts, but has been trying to transition to an electronic system. Lack of funding and IT infrastructure have made this a difficult process.
We took time listening to the staff discuss the many challenges they face at the clinic, especially with funding, staffing, and care coordination. To fund BCHIP, Ms. Fabian depends primarily on grants and donations-a funding stream that is not always the most reliable, and usually, not enough. In the past year, the clinic saw 2,200 individual patients. The demand is greater; however, staffing and space limit the prospect of seeing more patients. The one full-time nurse practitioner expressed regret in not being able to do more, but she is limited by her scope of practice. She relies on the help of volunteers and the few part-time physicians who can offer their services. I wondered how provisions of the Affordable Care Act might impact the clinic, but most of the staff expressed uncertainty about what the future holds.
Another major challenge the clinic faces is care coordination. Often, people with chronic diseases or other health problems wait too long before coming into the clinic. At that point, the nurse practitioner described it as "constantly trying to put out fires," and she struggles with getting patients the care they need versus the care that they can afford. Referrals can also be an issue. The clinic can refer them to a specialist, but the patient would likely have to pay out-of-pocket for other services. For example, that morning a Hispanic man with a hand fracture was following up at BCHIP after being discharged from a nearby emergency room. If he needed to be referred to an orthopedic surgeon or physical therapy, he might not be able to afford it. If his hand does not recover properly, he might develop more significant problems and lose productivity down the road.
Despite these challenges, BCHIP is able to care for many individuals in the community. The clinic routinely provides preventive care, annual check-ups, and basic laboratory services for free. The clinic also has a Tobacco Control Program and connects patients to many other services, such as mental health care and other community support. I connected with the clinic to volunteer later in the year, and perhaps help them develop a greater web presence.
Congressman Fitzpatrick and I spent nearly two hours at the BCHIP clinic together as a direct result of my participation in ACP Leadership Day. As a physician or physician-in-training, I firmly believe that advocacy is powerful and necessary. We are on the front lines on healthcare delivery. We have experienced firsthand the challenges of a fragmented healthcare system and know the struggles of our patients. It is up to us to share these stories with our lawmakers and be involved in the process of creating solutions. As a medical student, one can feel that his or her voice does not matter. Rather, I have found the opposite to be true. Students are the future of medicine, and people are interested in what we have to say. Getting involved as a student offers unique opportunities to potentially shape the system that we will be practicing in, and allows us to make a difference for our patients at another level.
Preyanka Makadia
ACP Council of Student Members (Osteopathic representative)
Philadelphia College of Osteopathic Medicine, Class of 2013
E-mail: preyankama@pcom.edu