Homeless Healthcare ...

[woolie]

Anyone ever work with the homeless and their healthcare? I am spending a year in a free clinic and we work with the local homeless population. I really wanted to do it, and enjoy alot of what I do - plus I get to learn just TONS of cool stuff.

But, as much as I want to help these people it can be very hard when they yell at you, swear or tell you you're messing up their lives. I can easily spend days or many hours working on a free, specialist referral for a client and then sit with them for a while explaining where to go etc., plus give them a bus token to get there - only to have them throw the token back in our faces, yelling at us because we don't excatly what bus they should take to get there (or whatever). 😕

I know their lives are way stressful, but as much as I like helping them it's really hard to like people who are nasty, rude and hostile towards you.

Does anyone else know what I mean? Some people are really grateful which is great. But I guess I am really shocked at how ungrateful, angry and demanding alot of the others are.

Anyone else work with the 'underserved?'

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[doc05]

yeah, there lives are REAL stressful...I mean, deciding what park bench to sleep on, mooching off whatever taxpayers and/or philanthropists send there way.

if you want to avoid all this nonsense social work crap, I suggest radiology, or maybe plastics.

 

[nutmegs]

I recently started working with a clinic and needle exchange that serves inner-city IV drug users, many which are homeless or of unstable housing. While there's a million points you can aruge with this one, there are the two things I try to keep in mind

1- For the most part, people end up on the streets for a reason... whether it be circumstances that never really gave them a shot at the opportunities you and I have, or the fact that they are mentally ill or ******ed and not capable of fully caring for themselves. They may have immature and inappropriate reactions, including displacing their anger onto those trying to help them...

2- Think about all the things you look forward to, and all the hope you have for the future... makes it a lot easier to get through your day, right? If I had to constantly worry about being harassed, not having food to eat or a place to sleep, day in and day out again, I think I'd be pretty angry and bitter too.

The bottom line is, none of this is an excuse for acting rudely, it's just something I try to think about when I end up in a situation like that. Hopefully the good things outweigh the bad... good luck, and remember that your work is appreciated and valued by many, whether they show it or not.


doc... why you wanna be one, exactly? 🙄

 

[LukeWhite]

woolie,

Some time ago I was reading an article on Catholic doctors working full-time without salary in a Houston mission. The interviewer asked them if they got a feeling of satisfaction after a day of the work, and they said, "No, usually just a headache."

I worked with an inner-city missions church for awhile...some people definitely try to take advantage of you because they feel a sense of entitlement. But there was an incredible number of people who had gone through major problems and were now hugely productive and caring members of the community.

My impression (though I haven't had enough experience to say definitively) is that long-term work with the underserved is far more rewarding. There's a lot of damage, but by the same token as a physician in an underserved community you can play a crucial role in building up a whole community rather than going through the old routine of constant well-child visits and sports physicals. The details might be grinding, but looking back after a few years of it, I think those who go into underserved medicine tend to be gratified by the results they accomplish.

 

[Teufelhunden]

Yeah...it's funny...these people have had the same opportunities I've had...after barely graduating H.S., I joined the military and earned the Montgomery G.I. Bill, which paid for my undergraduate education....then paid for my medical education with a HPSP scholarship....funny how people in the same situation made poor choices and ended up on the streets w/o healthcare...but I made sacrifice after sacrifice...and now have the distinct privelege of paying for these losers' health care.

Thing is...I was in the same exact position as these waste-of-space losers that now suck the system dry... but instead of suckling of the government tit, I decided to take charge of my own future...and without any government aid (that I didn't earn)...paid my own way through college and medical school.

Let me ask you liberals this: Why is it that I....in the same dire circumstances...was able to earn my own way to a college education, through service to my country...why is it that I was able to make it on my own, with no help of taxpayer's hard-earned dollars...why is it that NOW I should have to pay the way for others who are too lazy to pay their own way through hard work and sacrifice as I had to...why...why is it that I had to pay my own way, as well as the way for others...why...why shouldn't they have to pay their own dues as I have?

Why?


Why?

 

[souljah1]

I don't think people are homeless because they are lazy. The vast majority of individuals who are homeless suffer from mental illnesses and substance abuse. Some of these posts make it seem like being homeless is absolutley their fault. If you took a family history on your homeless patients, it would soon become clearly evident that there were many environmental forces working to make homelessness an unfortunate possibility. Vietnam vets on the street, runaway kids who were sexually abused, etc...not exactly homeless because they are lazy. Kind of surprised that this sort of nearsightedness is on this forum.

Oh, and if you want to talk about people sucking up our tax dollars..I think you should be pointing your finger at people who spend billions of dollars to send to stupid spaceship around Mars or to build newer weapons of mass destruction so that we can sell our old (out of date) weapons of mass destruction to other countries. Gotta love those tax dollars at work.

Oh yeah - i'm not a liberal, nor am i a republican.

Teuf, congrats for working your way up the ladder. Self-efficacy was certainly in your favor. Perhaps you have a deeper level of inner-fortitude to climb your way out of situations in which other individuals would feel helpless.

 

[....]

Originally posted by Teufelhunden
Let me ask you liberals this: Why is it that I....in the same dire circumstances...was able to earn my own way to a college education, through service to my country...why is it that I was able to make it on my own, with no help of taxpayer's hard-earned dollars...why is it that NOW I should have to pay the way for others who are too lazy to pay their own way through hard work and sacrifice as I had to...why...why is it that I had to pay my own way, as well as the way for others...why...why shouldn't they have to pay their own dues as I have?

Why?


Why?

Maybe beacue that is what humanity is about. Being emotionaly moved by others sufering regardless of whether they brought it on themselves or not. Wanting to do somthing about it.

I agree with you, but the above should bother you a bit.

 

[klgsatx]

Well said HIGHTRUMP and SOULJAH1

 

[nutmegs]

Originally posted by Teufelhunden
Yeah...it's funny...these people have had the same opportunities I've had...after barely graduating H.S., I joined the military and earned the Montgomery G.I. Bill, which paid for my undergraduate education....then paid for my medical education with a HPSP scholarship....funny how people in the same situation made poor choices and ended up on the streets w/o healthcare...but I made sacrifice after sacrifice...and now have the distinct privelege of paying for these losers' health care.

Thing is...I was in the same exact position as these waste-of-space losers that now suck the system dry... but instead of suckling of the government tit, I decided to take charge of my own future...and without any government aid (that I didn't earn)...paid my own way through college and medical school.

Let me ask you liberals this: Why is it that I....in the same dire circumstances...was able to earn my own way to a college education, through service to my country...why is it that I was able to make it on my own, with no help of taxpayer's hard-earned dollars...why is it that NOW I should have to pay the way for others who are too lazy to pay their own way through hard work and sacrifice as I had to...why...why is it that I had to pay my own way, as well as the way for others...why...why shouldn't they have to pay their own dues as I have?

Why?


Why?

Good job. You have a great story there. Now, why don't you go volunteer with some outreach/recruitment programs to help people get on the same track you were on?

Why not?

Why not?

 

[Doctor Octopus]

Originally posted by Teufelhunden
Yeah...it's funny...these people have had the same opportunities I've had...after barely graduating H.S., I joined the military and earned the Montgomery G.I. Bill, which paid for my undergraduate education....then paid for my medical education with a HPSP scholarship....funny how people in the same situation made poor choices and ended up on the streets w/o healthcare...but I made sacrifice after sacrifice...and now have the distinct privelege of paying for these losers' health care.

Thing is...I was in the same exact position as these waste-of-space losers that now suck the system dry... but instead of suckling of the government tit, I decided to take charge of my own future...and without any government aid (that I didn't earn)...paid my own way through college and medical school.

Let me ask you liberals this: Why is it that I....in the same dire circumstances...was able to earn my own way to a college education, through service to my country...why is it that I was able to make it on my own, with no help of taxpayer's hard-earned dollars...why is it that NOW I should have to pay the way for others who are too lazy to pay their own way through hard work and sacrifice as I had to...why...why is it that I had to pay my own way, as well as the way for others...why...why shouldn't they have to pay their own dues as I have?

Why?


Why?

Wow. I'm impressed that despite your mental illness, history of physical and sexual abuse, and mental ******ation that you were able to do all of these things.

 

[Teufelhunden]

Originally posted by nutmegs
Good job. You have a great story there. Now, why don't you go volunteer with some outreach/recruitment programs to help people get on the same track you were on?

Well actually....I did. The name of the outreach program I was involved with was "Marine Corps Recruiting."

 

[Teufelhunden]

Originally posted by Doctor Octopus
Wow. I'm impressed that despite your mental illness, history of physical and sexual abuse, and mental ******ation that you were able to do all of these things.

Your sarcasm aside...I concede your point. Those who are mentally ill, MRDD, etc. should receive goverment assistance. I have no problem with my tax dollars going to help those people.

Again, my comments above are directed at those people who, given the same opportunities as I've had, have chosen to leech off the system instead of earning their own way.

Obviously, the mentally ill and ******ed do not have those opportunities, so it would be wrong to condemn them for their status.

 

[Teufelhunden]

Originally posted by souljah1
I don't think people are homeless because they are lazy. The vast majority of individuals who are homeless suffer from mental illnesses and substance abuse.

Let's make an important distinction here between mental illness and substance abuse. Now, there are some people who began abusing substances due to their mental illness...I'll concede that.

But, the rest of the substance abusers made a CHOICE to become crack-heads, alcoholics, pot-heads, etc. I have no sympathy for those people. Again, if their substance abuse was the direct result of mental illness, then okay...not their fault. But for the rest of them...no one put a gun to their heads and made them take that first hit of crack...no one forced them to start downing pints of gin.

So, as I said before...I have complete sympathy for those in society who are mentally ill or mentally ******ed...and we as a society have an obligation to help these people as their predicaments are of no fault of their own.

But if you make a conscious choice to start shooting heroin in your arm, or start smoking crack....then all I can say to those people is "good luck with all that." I can not and will not be responsible for other peoples' poor choices.

If I decide tomorrow to become a heroin fiend, does that now translate into a societal failure that needs to be corrected through taxpayer dollars? Are you all willing to fork over more tax dollars for my rehab because I made a poor choice? All you bleeding-hearts who want to fund rehab programs with hard-earned taxpayers? money?.why should we have to pay for their poor choices?

God forbid we hold people accountable for their own actions?.geez! What's wrong with you people?

 

[woolie]

This is really great feedback to my original post. I was hoping people would offer their expereinces and ideas because I was really having a hard time understanding the people I am supposed to be helping. To be honest, I was asking myself: why the heck am I here?

This is an AmeriCorps placement too, so this means I am not earning much money at all, so I find myself working my butt off for very little money, and for people who are angry and abusive towards me. Maybe you begin to see where I am coming from. No one is giving me free bus tokens and I have to walk to work sometimes because I don't have the bus fare.

I definitely agree about the mental health of alot of the people I see. My feeling is that there is massive trauma of some kind in their backgrounds, and that this is unresolved and being acted out in front of us all.

I too, worked my way through school and have done my best to make my way in the world without rich parents, etc. Just me. Still, I have also made enormous sacrifices to get somewhere and it makes me upset as well, to see people who despite all our efforts to get them into respite care, and all sorts of healthcare, would rather walk away with their meds and go back out onto the streets where they can shoot up again. Oh, and did I mention they were physically completely messed up? It's hard to comprehend that this was someone's choice, but there it is.

This is an excellent dialogue, I am glad to hear everone's opinions. I also posted on the Emergency forum and whoa! those guys really know what it's like -

 

[nutmegs]

Originally posted by Teufelhunden
If I decide tomorrow to become a heroin fiend, does that now translate into a societal failure that needs to be corrected through taxpayer dollars?

here's the thing: tomorrow, you are NOT going to become a "heroin fiend". you have something that these people don't in that regard- something that means you aren't about to leave your job, school, life, and wind up on the streets. what is it that makes them different from you? dunno, if I did I can imagine I'd be a rich person. one of my close childhood friends- was raised much the same as me, same opportunities, extremely smart kid- is still fighting a 7 year heroin career. I think of it all the time, why him and not me? he wants to stop and hasn't been able to. he also has a psychiatric diagnosis. i'm glad you can see the point about mentally ill and mentally ******ed homeless persons. now that you're recongized that, go look up a few studies that list the % of homeless who have one of these conditions- it's either 60 or 80, I believe, which means there are really few people who are what you call "lazy" and we can argue about them later.

 

[emedCleo]

I've volunteered with homeless & formerly homeless people & here are a few random musings. Sorry this is long, but this issue is close to my heart.

1) #1 cause of homelessness is lack of housing. Ppl don't know that because they don't realize that most of the homelessness problem is hidden. Ppl live tripled up, in substandard housing, or in shelters mostly. People on the streets are a small fraction of the poor. The myth of the lazy druggie homeless person is pervasive, but irrational. Some ppl may be addicts, but they are homeless b/c they are poor. If drug addiction was the primary cause of homelessness instead of poverty, Robert Downey Jr., Hunter Thompson, Rush Limbaugh, Betty Ford, Aerosmith, Keith Richards, your drunk Aunt Louise, your coked up sister Kara etc., etc, etc. (ad nauseum) would have done stints at the local shelter.

2) When I started doing my volunteer work I underwent 2 weeks of intensive training. I learned assertiveness training, burnout prevention, unlearning the isms (racism, classism, sexism), education about the US economic system, social services, etc. There was a lot more, but as you can see I received a lot of preparation. Volunteer work may be unpaid, but it is work. No one would ever throw a 3rd year med student on a hospital floor w/o training on the rationale that he or she isn't getting paid and thus isn't really responsible for anything important. Training & education is a must to protect the volunteer from burnout & the helpee from being harmed by misguided help.

3) Humility is key in doing "helping" work. History teaches lessons about do-gooding that ended up pretty malignant. You as a volunteer is simply a person with 2 hands and a brain. As soon as you get notions that you can change people you are destined for a big let down.

4) Once you spend enough time with the homeless you will develop less tolerance for your affluent peers. Poor ppl are often more generous than rich folks (there's even peer reviewed research to back that claim up). I have been sheltered and fed by the formerly homeless. They tend to be grateful for the roof over their heads & practice the principles of AA/NA which are strongly geared toward service. I can't tell you how many rich folks think they are entitled to not just to their fancy education, cushy jobs, & shiny toys, but also to their snot-nosed attitudes. It makes me nuts how somebody can throw a tantrum in a restaurant b/c their soup is lukewarm & then say the "homeless" are so behaviorally offensive. 😡

As a trust-fund baby, I am SOOOOOO grateful that I was given the gift of affluence & I know that I have a choice to either use my privledge to benefit only myself or to benefit myself in the context of a larger community.

I know y'all heard of the serenity prayer, but let me pass on another prayer used at recovery meetings:

I am responsible
For anyone anywhere
Who reaches out for help
I want the hand of (AA/NA/etc.) to be there
And for that I am responsible

You may discover you have more in common with a person who is temporarily unsheltered than you expected.

Peace.

Cleo

 

[Nanon]

woolie - I also work at a needle exchange, and I work in public health looking at HIV in the homeless.

The first thing I have to say is: Stop taking it personally. The outbursts, tantrums and offensive language have nothing to do with you, or what you've said, or what you've done or not done. It more likely has to do with a mental illness, or that they haven't gotten a fix, or that they're getting kicked out of their place, or they haven't gotten enough to eat for the last several days... any number of things that have nothing at all to do with you.

The second thing is: Understand that helping another person is often a series of very small steps. Sometimes it's really hard to see the good that you're doing for a person - it's the forest for the trees thing. Sometimes it takes more than a few visits to earn enough trust for a person to listen to you. Your position of authority isn't going to do it for a person who lives on the streets.

The last thing is: If it's really starting to get to you (and it seems like it is), and you're starting to burn out, talk to your co-workers or a staff psychologist about it. It's called de-briefing, and many sites have a system set up to counter-act the inevitable low-level depression that occurs with people who work in this area of healthcare. It's hard work, and you see a lot more in a single day than most people see in a month (or even a year). I've found that I have to take care of myself first before I can handle anyone else's problems.

I think working with this population is so incredibly rewarding that I plan to do it for the rest of my life, even knowing full well what the downsides are. Although, I really hope that one day, there won't be a need for people who work with the homeless...

Nanon

 

[8744]

Originally posted by Teufelhunden
Well actually....I did. The name of the outreach program I was involved with was "Marine Corps Recruiting."

Har Har. You tell 'em, Devil Dog!

 

[Teufelhunden]

Originally posted by emedCleo
I can't tell you how many rich folks think they are entitled to not just to their fancy education, cushy jobs, & shiny toys, but also to their snot-nosed attitudes. It makes me nuts how somebody can throw a tantrum in a restaurant b/c their soup is lukewarm & then say the "homeless" are so behaviorally offensive. 😡

Yeah, but for some reason most normal people (read: not you) still find urinating on the streets more offensive than complaining about cold soup. And, BTW, if I'm paying $10 for a bowl of soup, it had better be God damed served hot!!!

BTW, your assumption that all rich folk feel entitled to their educations, fancy jobs, and shiney toys is quite a generalization. Most financially successful people I know didn't get that way through sense of entitlement, but rather through hard work and sacrifice.

And for the love of God...if we're going to be giving free sh|t to homeless people, will someone PLEASE GIVE THEM SOME SOAP!

 

[Street Philosopher]

Originally posted by emedCleo
1) #1 cause of homelessness is lack of housing.

LOL hard to argue with that.

It makes me nuts how somebody can throw a tantrum in a restaurant b/c their soup is lukewarm & then say the "homeless" are so behaviorally offensive. 😡

For one thing, people at restaurants pay for people to cook them stuff and serve it to them.

 

[Street Philosopher]

Originally posted by Teufelhunden
PLEASE GIVE THEM SOME SOAP!

experience tells me that soap is pretty useless when they aren't willing to spend 50 cents to do the laundry. instead they'll use it to buy two sticks of cigarettes. the sense of priorities among many homeless people is baffling.

another example... i used to hand out a lot of socks, and what do they do? they don't even wash their feet first. they take the socks and put it on right over their sweaty feet, then toss it after like a day. yeah, that's real smart. meanwhile i wear the same pair of socks for years.

another example, they would score some cool **** like a backpack or sleeping bag, but then ditch it to go around the corner and shoot up. then they'd come back surprised to find their **** stolen. and of course they were smart enough to keep all the identification in there, so that they would basically be locked out of getting jobs.

another example, people would pick up stray pets and take care of them even when they didn't even have money to take care of themselves. we're talking vaccinations, rabies shots, the whole 9. meanwhile they're using dirty syringes and getting knocked up because they won't use protection.

what the ****?

there are some that finally see the light and eventually do get out of their rut. most of the times they have a lot of support. these kinds of things make helping the homeless somewhat worth it, but it's very discouraging working with a lot of people who lack basic priorities.

 

[Teufelhunden]

Originally posted by Street Philosopher
experience tells me that soap is pretty useless when they aren't willing to spend 50 cents to do the laundry. instead they'll use it to buy two sticks of cigarettes. the sense of priorities among many homeless people is baffling.

Well damn it! Then let's give them laundry-machine vouchers! The homeless problem wouldn't bother me so much if they didn't STINK so damn bad!

 

[Teufelhunden]

Originally posted by Street Philosopher
another example... i used to hand out a lot of socks, and what do they do? they don't even wash their feet first. they take the socks and put it on right over their sweaty feet, then toss it after like a day. yeah, that's real smart. meanwhile i wear the same pair of socks for years.

another example, they would score some cool **** like a backpack or sleeping bag, but then ditch it to go around the corner and shoot up. then they'd come back surprised to find their **** stolen. and of course they were smart enough to keep all the identification in there, so that they would basically be locked out of getting jobs.

another example, people would pick up stray pets and take care of them even when they didn't even have money to take care of themselves. we're talking vaccinations, rabies shots, the whole 9. meanwhile they're using dirty syringes and getting knocked up because they won't use protection.

what the ****?

OMG! See...you can't protect stupid people from themselves...that's why the majority of social programs are abysmal failures.

 

[LukeWhite]

There's something to be said for doing the work for its own sake, regardless of the worthiness of those you're working for.

 

[Street Philosopher]

and what is to be said about it?

 

[woolie]

I wish that we had good training for this work, but I seem to have been just 'thrown' into the situation. I definitely do feel the need for de-briefing and lots of co-worker support. It doesn't make sense that I should have any more ability than the next person and I have needs and feelings, too.

While I have had expereince working in an urban ER, this daily work is hard and I am still trying to learn and do my best. I think it will take some time and I am trying to not burn out, as was described above. I know that I can't focus on the details and should just turn it over and do the best with what I can.

I think the heavy training the poster above described, sounds like just the ticket for me. I am definitely trying to not burnout. (I just repreated myself !) That's one of the reasons I posted here, I was hoping to hear from other people. These comments are excellent and are helping me understand the issues better.

 

[Kimya]

I've had some experience working with this population as well...

Some things to remember-- A sizeable portion of the homeless ARE suffering from mental illness. Some estimates lean it towards the majority. So these people don't need to pull themselves up by their bootstraps- they need adequate mental health care.

Mental illnesses like schizophrenia, often have the most tricky time with negative symptoms- which often involve inability to take care of oneself (read: hygiene problems) and a strong apathy about what is going to happen. These can be problems even with meds, which usually target positive symptoms. Most mentally ill people on the streets are not taking meds.

Woolie the best advice I can give you is keep on reaching out- talk about it whenever you can. Don't expect miracles with this population- sometimes the gains are so small that you won't see them while you are there- doesn't mean that they are not happening.

 

[nutmegs]

Originally posted by Street Philosopher
the sense of priorities among many homeless people is baffling.

let me give you one word to clear that up: addiction.

 

[nutmegs]

Originally posted by Teufelhunden
The homeless problem wouldn't bother me so much if they didn't STINK so damn bad!

well by all means! whatever makes your life more pleasant! are you for real?!?!

 

[dl2dp2]

Because you are smarter. Are you aware of the fact that intelligence is 60-80% genetic? I point you to read "The Bell Curve"

Also, even if everything you say is right, your response is simply an emotional one, not a rational one. Ok fine, let's say we all agree with you and decide to get rid of all the social programs. What are you going to do with the lazy people? Let them die of starvation? Let them roam on the streets? It's a public safty issue. And, who says tomorrow you won't be lazy for some reason? Maybe you get depressed. Maybe your son's lazy. Would you want the government help your son to get him back on track (or simply give him some food stamps for a while) or would you let him rot to (or out of) his own misery? The welfare system is there for a reason--there is always, albeit small possibility that anybody could sink so low that the only one he could turn to is the government. Some ex-wall street investment bankers of the 90s are now on food stamps 'cause their stocks tanked, and don't tell me they don't work hard, because they worked 6-10 for the bloodsucking executives who you've claimed deserved the money because they made the right "CHOICES"...and don't even get me started on Enron. Please i'm sure all the millionaire crooks deserved their money. (and mind ya, they probably didn't do anything illegal--and even if they did, they'd get away with it with their army of lawyers, but hell they are still crooks)

Boy do I digress. But I think, honestly, sincerely, with all my humility, that you should consider the possibility that you were ideologically duped by a right wing propaganda machine that is so prevalent. The seriously rich and power people (do you know these people? I happen to know a few...they never went to the marines, or took scholarships...they had rich dads like Geroge Bush Sr.) want you to think that they deserved the money...they want you to think that tax cuts are good things--you get your $300 back and what do they get? Hundreds of millions--and wait till you get laid off...my tell me about making the right "CHOICES"...

Plus, who says you didn't have the help of tax payers dollars? You had your GI Bill, and HPSP both of which are funed by the tax dollars. The question you are raising is that you made the judgement that homeless people who go to free clinics didn't work hard enough to earn whatever they are getting. Are you that confident that your judgement is indeed correct?

Originally posted by Teufelhunden
Yeah...it's funny...these people have had the same opportunities I've had...after barely graduating H.S., I joined the military and earned the Montgomery G.I. Bill, which paid for my undergraduate education....then paid for my medical education with a HPSP scholarship....funny how people in the same situation made poor choices and ended up on the streets w/o healthcare...but I made sacrifice after sacrifice...and now have the distinct privelege of paying for these losers' health care.

Thing is...I was in the same exact position as these waste-of-space losers that now suck the system dry... but instead of suckling of the government tit, I decided to take charge of my own future...and without any government aid (that I didn't earn)...paid my own way through college and medical school.

Let me ask you liberals this: Why is it that I....in the same dire circumstances...was able to earn my own way to a college education, through service to my country...why is it that I was able to make it on my own, with no help of taxpayer's hard-earned dollars...why is it that NOW I should have to pay the way for others who are too lazy to pay their own way through hard work and sacrifice as I had to...why...why is it that I had to pay my own way, as well as the way for others...why...why shouldn't they have to pay their own dues as I have?

Why?


Why?

 

[LukeWhite]

Originally posted by sluox
Plus, who says you didn't have the help of tax payers dollars? You had your GI Bill, and HPSP both of which are funed by the tax dollars.

Not to mention the massive government funding that even many private schools get, as well as a residency system that works precisely because the government funds it with the expectation that hospitals, and their residents, will in turn provide care for those who are unable to afford it. There would be far fewer 500,000 a year heart surgeons if it weren't for the commitment of the medical community as a whole to care of the underserved.

There are all sorts of little ways it works. Want hospital privileges? Gotta do some free care. Don't accept medicare? Much tougher to get by. Some people simply choose to take more of the commitment upon themselves. Even if I were the type of doctor who chose to avoid working with the needy, deserving or not, I'd be awfully grateful to the ones who did, thereby enabling me to pursue my lucrative dermatology practice, etc.