Dr. Greg Litvinoff has worn many hats at the Indian Free Clinic in Compton--handyman, trash man and receptionist among them--but he never thought he would add plumbing to his repertoire of talents.
Nevertheless, on a recent Friday morning the 39-year-old dentist sat among an assortment of tools and surveyed a steady stream of water spouting from a broken pipe.
"We make do with what we have around here," Litvinoff said. "I've become as handy with a screwdriver as I am with a (dentist's) drill."
Despite the extra duties required of him by the clinic's shoestring budget, Litvinoff says he has one of the best jobs in dentistry.
Litvinoff is one of 30 full-time dentists working at 33 federally funded American Indian health clinics in California.
With an estimated 80,000 to 100,000 American Indians, Los Angeles County has the largest population of urban Indians in the country, according to Tom Sellars, executive director of the Los Angeles City-County Native-American Indian Commission.
While Litvinoff jokes that some of his colleagues call his place of employment a Third World clinic, he expresses real concern about the future of the 17-year-old clinic in the wake of recent cuts in the federal budget for American Indian programs. The clinic is funded by the Indian Health Service, a bureau of the United States Public Health Service.
"The funding for urban clinics (for Indians) is precarious at (best)," Litvinoff said. "That is the most frustrating thing about trying to help these people."
The clinic, staffed by 65 full- and part-time employees, offers free health services, counseling, nutrition programs, family planning and alcohol rehabilitation programs to American Indians.
The budget crunch seems to be affecting everyone at the clinic.
"We all have to wear several different hats," said Mary Cleghorn, health administrator. "Our front office people are not only receptionists, they are data operators, switchboard operators and billers."
Last year about 30,000 people--many of them Latinos who make up 30% of the clinic's clientele--went there for help, said Cleghorn, who is an Otoe Indian from Oklahoma. Non-Indians are charged a fee according to their ability to pay, she said.
Litvinoff, who is the clinic's dental director, supervises a staff of one other dentist and four assistants.
Although he earns considerably less than his colleagues in private practice and is often frustrated by the outdated equipment at the clinic, Litvinoff said he would never give up his job for an office on Wilshire Boulevard.
"I've already had my own practice and it wasn't for me," said Litvinoff, a Lakewood resident who has worked at the clinic full time since 1979. "I may not be making a hundred grand, but I am probably one of the few people who really feel fulfilled by what they do."
Dentists in the Indian Health Service earn an average of about $34,000 a year, while the average annual salary for a private practitioner is $77,000, according to American Dental Assn. figures.
Like many dentists fresh out of school and eager for experience, Litvinoff first worked at the clinic for a year and a half after graduating from the UCLA School of Dentistry in 1975. He then opened his own practice in 1978, but quickly became disillusioned.
"Dentistry in a private practice is a high-stress operation because you have to do dentistry and run your own business," Litvinoff said. "People aren't as appreciative either. Here they are grateful just to have someone to take care of their teeth."
Litvinoff said he was drawn to the Compton clinic by fond memories of a summer spent working on the Hopi reservation in Arizona while he was still in dental school. It gave him the opportunity to practice what Litvinoff calls "pure dentistry."
"I saw a life there that was almost stone-age," he recalled. "People living in clay buildings with the bare necessities. These people had no idea of proper health care or dental hygiene. Some of them have never had any dental care at all."
The warmth of the Indian people was another thing Litvinoff said he missed when he went into his own practice. That summer on the reservation was the only time, Litvinoff said, that his patients thanked him.
He has once again found that warmth at the clinic.
"There is a radical difference not only in the amount of services needed here but also in the people," Litvinoff said. "Indian people are very introverted. Many are afraid to see a dentist. When you take a little extra time with them, they are really grateful."
But the qualities that Litvinoff finds so endearing can pose special problems for dentists treating American Indians, he said.
"Time is money in a private practice," he said. "Dentists don't have a lot of time to spend talking to their patients. It is even worse at huge clinics where it's the clean 'em, drill 'em, fill 'em philosophy. That just wouldn't work with the Indians."