The Urban Underserved

[lowbudget]

So... does any know anything about Federally Qualified Health Centers treating predominantly Medicaid, SSI, and Self-Pays in the inner-city/urban environment?

What's the practice environment like?
How's the nursing/ancillary support?
How's the daily caseload ?
How's the case mix?
How's it like working with the patients?
How are the administrators?
How are you compensated and how is your performance measured?
How's the autonomy and the level of professional control over your environment?
How is malpractice handled?
What's the treatment capacity like (i.e. access to radiology, consultants, instruments for procedures)?

Just curious...

 

[nozzie]

So... does any know anything about Federally Qualified Health Centers treating predominantly Medicaid, SSI, and Self-Pays in the inner-city/urban environment?

What's the practice environment like?
How's the nursing/ancillary support?
How's the daily caseload ?
How's the case mix?
How's it like working with the patients?
How are the administrators?
How are you compensated and how is your performance measured?
How's the autonomy and the level of professional control over your environment?
How is malpractice handled?
What's the treatment capacity like (i.e. access to radiology, consultants, instruments for procedures)?

Just curious...

This is a good background paper on FQHCs (also known as community health centers): http://www.phsi.harvard.edu/quality/clinical_it_safety_net/NHPF_CHC_Fundamentals.pdf. It's a policy paper so it doesn't answer all of your questions, but I think it covers a couple of them.

 

[burlypie]

I used to be the Medical Director's admin at a FQHC (serving the latino population) in San Francisco, so here's my experience...

What's the practice environment like? -- SOme loved it and some couldn't handle it. It was mostly the people who were really dedicated to the population that handled it best. Busy-ness varied by the day.

How's the nursing/ancillary support? -- It was hard ot keep RN's because they can be so much better compensated elsewhere -- again, it was the people dedicated ot the population that stayed on longest. Ancillary support was good, but they were Union...I hate unions now. They completely destroy any work ethic any person might have.

How's the daily caseload ? -- each practitioner usually saw aout 20 patients per day. Administration was always trying to raise that number...

How's the case mix? -- pretty much all primary care. Adult medicine, women's clinic (including prenatal care) and peds. A lot of patients were from mexico and central america and they would go home and return with some aewsome diseases. Otherwise, TONS of diabetes, HTN, asthma, etc.

How's it like working with the patients? -- most patients are very appreciative, but their education level and literacy even in their native languages was usually questionable. Never kept lists of their meds, and weren't always adherent to medical advice due to their poverty and inability to buy glucose test strips or regular meds.


How are the administrators? -- Again, this will vary. I loved my boss. but in general at my clinic the feeling was that we needed new blood -- the same people had been runnng the place for 30 years and were very resistant to changes. THere was often a bit of a clash between administrators and practitioners, mostly b/c the administration was by and large not medical people. (except the medical director)


How are you compensated and how is your performance measured? -- COmpendation for a department head a couple years ago was about 105K. Dount it's gone up much, and remember this was in SF, one of the costliest citites to live in. Full time regular docs made about 85-90K, but many had some loan forgiveness mixed in there too. Performance is measured officially through peer chart reviews and by formal chart reviews for adherence to federal standards. Unofficially, performance review was: do we like you? Do you work hard? Do patients like you? Do you work quickly? Do you work well with the team?


How's the autonomy and the level of professional control over your environment? can't really speak to this...but I think a few people left because of a lack of autonomy.

How is malpractice handled? -- covered by the clinic and the feds

What's the treatment capacity like (i.e. access to radiology, consultants, instruments for procedures)? -- Had our own xray facility and lab. MOre complex stuff was referred out to SF General. We had a referral coordinator who tracked every patient who was sent over there. Unfortunately SFGH"s capacity was limited and the waits for colonoscopies, for example, could be 6 months or more.

Again, this was one clinic and I would go back to work there in a heartbeat if I spoke Spanish better! even with all the tribulations! It just felt like being part of a family there.

hope this helps...anyone with other experiences?