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Mandating pro bono work could help fix healthcare system

Why not make a week or two of community service a condition of medical licensing? If you want to practice medicine in California, let's say, you would need to volunteer every year.

August 16, 2009|DAVID LAZARUS

Thousands of people lined up last week for free medical treatment at the Forum in Inglewood. The arena floor resembled a vast healthcare assembly line as hundreds of patients at a time were seen by dozens of doctors, dentists and optometrists.

But many others had to be turned away because of a shortage of medical professionals willing to volunteer their time and expertise.

Stan Brock, founder of Remote Area Medical, the nonprofit group that organized the Forum mega-clinic, was clearly frustrated by being unable to match the overwhelming demand for healthcare with a sufficient supply of caregivers.

If local doctors aren't willing to donate their time -- a big enough problem on its own -- why can't physicians from other states come here to do pro bono work?

"The greatest impediment that we face in giving this type of care -- free care -- is that for some extraordinary reason that I've never been able to understand, a doctor, dentist or nurse licensed and trained in one state is not allowed to take that license and cross into other states to provide free care for needy and underserved Americans," he said.

Lisa Robin, senior vice president of the Federation of State Medical Boards, which represents licensing agencies nationwide, said the reason for this is simple: States need to ensure that certain standards of medical competence are met.

"You want to be sure people have the qualifications necessary to protect patients," she said. "You don't want different standards of care."

Candis Cohen, a spokeswoman for the Medical Board of California, was even more emphatic.

"We don't know how well someone may have been trained in Texas or Alaska or somewhere else," she said. "We have our own standards. They're quite high."

She said California does issue temporary licenses to "eminent physicians" from other states or countries who may be spending time at a teaching hospital or have a similar reason to practice medicine here.

But this is a formal bureaucratic process and wouldn't apply to doctors who simply want to show up for a week or two and volunteer their time.

So if it's difficult if not impossible for out-of-state medical professionals to parachute in for events such as the one at the Forum, what can be done to get more local healthcare providers to participate?

I have two ideas.

First, passage of a good Samaritan law at the state or federal level shielding caregivers from legal liability for any volunteer activities.

The possibility of a malpractice lawsuit is undoubtedly sufficient to deter many medical professionals from offering their time and abilities.

Let's eliminate that possibility from the equation -- as long as people seeking help at free clinics are made aware of the good Samaritan law and willingly sign waivers acknowledging their acceptance of the condition.

Second, why not make a week or two of community service a condition of licensing? If you want to practice medicine in California (or elsewhere), you'll agree to do some pro bono work every year.

I bounced this suggestion off Dr. Brian Johnston, an emergency physician at White Memorial Medical Center in Boyle Heights. He wasn't thrilled.

Johnston said he already devotes about a third of his time in the E.R. to treating people without insurance who may never be able to pay their medical bills. He also said he loses money on just about every Medi-Cal patient he treats because of low reimbursement rates.

"A week of free service wouldn't be fair," Johnston said. "I'm already contributing."

Fair point. On the other hand, I suspect there are more than a few doctors, dentists and others who aren't quite as charitably inclined.

So let's try this instead: As a condition of licensing, a medical professional would be required to demonstrate that he or she treats at least a tenth of patients on a pro bono basis annually.

That is, for every 10 patients that a healthcare provider sees, one would receive the same level of care as all the others but at no cost.

Such patients would obviously have no medical coverage or face some other economic hardship.

If that condition can't be met, the healthcare provider would have to volunteer for a week at a local free clinic or at an event similar to the one at the Forum.

Many high schools require that students perform community service as part of their graduation requirements. This is good for the students and good for the community.

I don't see why this same standard can't apply to people whose profession is all about helping people (or at least should be).

Brock at Remote Area Medical said that with about 47 million people lacking medical coverage in the United States, groups such as his that provide free healthcare aren't going to solve the problem.

But if more medical professionals could make their time and skills available to those in need, he said, "it would be a quantum leap in the right direction."

And it could probably be achieved faster than other healthcare reform proposals on the table.

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David Lazarus' column runs Wednesdays and Sundays.

Send your tips or feedback to david.lazarus@latimes.com.

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latimes.com/lazarus/healthcare

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