Conclusions from "Barriers" Portion

Increasing demands at work


Conclusions: National Trend: Decline in Physician Volunteer Hours
Primary care physicians face increasing time pressures in a setting of relatively stagnant reimbursements and salaries.
-Declining numbers of medical graduates are going in to primary care.
-Chronic illness morbidity continues to rise while chronic illness management guidelines continue to expand; this combination increases the required per patient visit time in primary care.
-Reimbursement rates emphasize procedures over preventative medicine and health education.
In a nationwide tracking report, the percentage of US physicians that provide charity care has dropped from 76% in 1996-97 to 68% in 2004-05.

The Rhode Island Free Clinic is no exception to this trend.


Lack of information about free clinic volunteer opportunities


Conclusions: 67 physicians marked "lack of information" as a major or minor barrier to not volunteering at the Rhode Island Free Clinic. Almost half of the respondents to the RIMS survey marked "I have no idea where the free clinic is". Several write in comments had a similar tone: "never been asked.", "the free clinic has never approached me or any physician that I know.", "any need for specialists?", "Is there a pediatric need?", "I would like to volunteer who do I contact?", etc.

From these results the conclusion is that not enough primary care physicians know about volunteer opportunities at the Rhode Island Free Clinic.

The RIFC is working to improve its communication with the physician community. The clinic has a Vista volunteer now who works solely on public relations. The clinic also has a newly appointed communications director. With the new Vista volunteer coordinator beginning at the end of July also, I have recommended that the clinic host monthly open houses for potential volunteers. This way, individuals could learn more about how the clinic operates, and see that the staff do care about the volunteers and especially the patients.


Concern over malpractice issues


Conclusions: 42% of respondents listed "concern over malpractice issues" as a major or minor barrier.

The Federal Tort Claims Act covers all physicians in a free clinic setting. It is a fair bit of paperwork, but the Rhode Island Free Clinic staff and volunteers do the majority of the work. Even if the FTCA covers you at other clinics, the necessary paperwork can be done so it covers you at the RIFC as well.

This does not need to be a barrier.

Other write-in Barrier Conclusions:

"never been asked"

The RIFC is asking all interested physicians to volunteer a few hours each month if they are able. Specialists are also in high demand. In the past, there has been no pediatric need but this may be changing... therefore please contact if you are interested in starting a free pediatric clinic.

"the free clinic staff don't care about the volunteers or the patients"

Please, please, please stop by the free clinic to see how a clinic runs. Any preconceived notions may be turned around by a single visit and an open mind.

Volunteers at the RIFC get no recognition from Brown University

Several current physician volunteers teach students and residents during their volunteer hours. The clinic is hoping to build on relations with Brown in order to expand this. Ideas and innovations are very welcome.

Methods and Results from "Barriers" Portion

Barriers to volunteering at the Rhode Island Free Clinic according to past, current and never primary care physician volunteers

Methods: To assess the barriers to volunteering at the Rhode Island Free Clinic, I created two surveys. The Full Survey assessed 8 advantages and 16 barriers and was emailed to approximately 450 lifespan and brown email addresses and to current and former volunteers. The survey was intended for primary care physicians and to sort out which physicians were primary care, I googled each name. The RIMS survey assessed 8 barriers and contained a comments section. This survey was sent as a link to the Rhode Island Medical Society (RIMS) list serve. Respondents for both were asked to assess a barrier as either a "major barrier", "minor barrier", or "not a barrier".

Below are the results graphed using excel. Red bars equal data collected from just the full survey. And green bars equal data collected from the full survey and RIMS survey. Several barriers were combined for the green bars. For example, "Increasing demands at work" was a barrier question on the RIMS survey. The results below demonstrate those results in addition to the "increasing demands at work due to increased patient load and per visit patient time" barrier plus the "increasing demands at work due to increased income requirements or increased costs" barrier from the full survey. The green and orange bars of the second "the free clinic is too far of a drive or the timing of the clinic is inconvenient" represent data from only the RIMS survey because the answer choices were altered for this question.

Several write-in barriers are listed at the bottom of this section. Two are quotes, the others are paraphrased.

Results: 54 replied to the full survey and 58 responded to the RIMS survey. Therefore for certain barriers there were anywhere from 54 to 107 tallied responses.


I volunteer/work with a similar population elsewhere




I do not believe in the mission of the free clinic




Challenges presented by wait time for referrals




Challenges presented by lack of consistent medication samples




Challenges presented by patient language barrier




Challenges presented by rate of patient non-compliance




Challenges presented by electronic medical records




Concern over malpractice issues




Concern over degree of volunteer recognition by the RIFC




Challenges presented by turnover of staff at the RIFC




Increasing demands of family time




Increasing demands at work




Lack of information about free clinic volunteer opportunities




The free clinic is too far of a drive or the timing of the clinic is inconvenient




The free clinic is too far of a drive or the timing of the clinic is inconvenient




Other barriers written in:

"Never been asked."
"The free clinic has never approached me or any physicians that I know."
There is a lack of communication between the board and the volunteers.
The staff does not appreciate the volunteers.
Not interested in volunteering.
Volunteers at the RIFC get no recognition from Brown University.

Conclusions from "Advantages" Portion

Satisfaction in treating those with limited access to health care



Conclusion: Our current and former physician volunteers believe in the mission of the free clinic.

Opportunity to spend more time with patients than in your usual hospital/office setting

Conclusion: Our current and former physician volunteers would be open to ideas in limiting physician-patient time to diagnosis and management.

As discussed in the "Barriers" section, primary care physicians are becoming more and more overworked and under reimbursed. We need to think of new and creative ways to maximize the use of our primary care physician volunteers so that they can see more patients. One idea is the "teamlet model" outlined by Bodenheimer et al*. In this model, physician visits would be surrounded by a pre-visit and a post-visit from "health coaches" or "promotoras". Health coaches could spend the proper time discussing preventative medicine strategies, health education, medicine compliance, chronic illness management, and physician visit agenda setting. This allows the physician to spend the majority of visit time on diagnosis and management, and building a relationship with the patient. Health coaches would also follow up with the patients after the visit to make sure that the patient understood everything that was discussed with the physician.

Health coaches could be volunteers that are medical students, nursing students, pre-med students or pre-nursing students. This would give an opportunity for many more individuals to be involved in the health care of our patients and increasing the number of patients seen in a given clinic night.

*Bodenheimer T, Laing BY. “The Teamlet Model of Primary Care.” Annals of Family Medicine. 2007 September-October; 5(5): 457-61.

For the full training curriculum for health coaches, click here: HealthCoachTrainingCurriculum

This is just one idea. The RIFC is open to other ideas and hopeful that students and physicians will be involved in creating new models of primary care.

Methods and Results from "Advantages" portion

Advantages to volunteering at the Rhode Island Free Clinic according to current and former primary care physician volunteers

Methods: The "advantages" portion of the survey was included in the full survey e-mailed out to current and former volunteers. Respondents were asked to assess the following 8 features as either a "major advantage", "minor advantage", or "not an advantage".

Results: In total 19 individuals responded to the "advantages" portion of the survey. 9 were former volunteers and 10 were current volunteers.

Satisfaction in treating those with limited access to health care



Opportunity to teach medical students/nurse practitioner students




Opportunity to work with other volunteers with similar values




Opportunity to spend more time with patients than in your usual hospital/office setting



Opportunity to be involved in creating a new model of health care delivery



Opportunity to use skills/knowledge to treat patients




Opportunity to work on research projects




Opportunity to gain experience with the uninsured community