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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
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.
ACP Council of Student Members (Osteopathic representative)
Philadelphia College of Osteopathic Medicine, Class of 2013
August 2012 Issue of IMpact
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