The fine art of giving away your talents for free

Volunteering ophthalmic services to those in need can be therapeutic for surgeons feeling burned out.

John B. Pinto

Giving up. Relinquishing. Surrendering to hard times. These are passive words. So un-ophthalmologic. And yet, as you will read, these words are in finest tradition of the best health care professionals in America.

In small-town South Carolina, R. Malcolm Edwards, MD, and colleagues are giving away the store, or rather at least part of the store. It is a program they call “Kindness to Prevent Blindness,” which is taking their local community by storm and re-energizing everyone who works in the practice.

Every week, the doctors and staff open their hearts and their already busy clinic to treat some patients for free — or almost free. Here is how it works.

• Every doctor in the practice has committed to seeing at least three “kindness” patients a week, although they can see more, time permitting (there is now a 3-month backlog).
• Patients are not clustered for an “indigent” clinic but dispersed throughout the week’s scheduling template to avoid any sense of embarrassment.
• The program is conducted strictly on the honor system, with no checking of patient finances.
• Kindness patients pay what they can afford, with a minimum $1 payment. All the money goes to a local charity, so program patients have a sense of pride, rather than shame.
• The Kindness program was launched largely through posters placed in storefronts, but local media interest and word-of-mouth has created a sustained buzz.
• Many people showing up are past patients. Most are ashamed to ask for help.
• About one-quarter of the patients showing up for the Kindness program turn out to have insurance, and such patients are treated in the customary manner at customary fees.
• Community support for Dr. Edwards’ practice, always high, is on the rise. Early indications are that the practice is sailing through the recession, even though it is located in one of the most disadvantaged counties in America. As it turns out, most uninsured and financially disadvantaged patients have lots of friends and family members who have the means to pay for care.

Frances L. Story, MD, practices with Dr. Edwards. “Our service area is now running double-digit unemployment, and the local job prospects are pretty grim,” Dr. Story said. “Our program is reaching our intended target: people who need a hand and not a handout. I have seen young people who are looking for work and need proper glasses to qualify, a widow trying to get back into the job market after taking care of her husband who had cancer for 3 years, diabetics who haven’t been checked in several years, and others who really need our help but don’t quite qualify for government assistance.”

Stories of need

Another provider in the practice, Kevin J. Nusz, MD, put it this way: “It was the end of the day. I was eager to get home, but we were out of milk, so I was rushing trying to get my milk and get home to my family. An older woman came up to me in the store and, speaking very loudly, said, ‘You’re one of the doctors that looks at people’s eyes who don’t have any money. You gave my daughter some drops and glasses. Now she can see good. You are so nice helping people like that,’” Dr. Nusz said.

“Then she put her hand on my forearm and continued (in an even louder voice), ‘Thank you, Jesus, thank you. We need help like that. There just aren’t any jobs. Bless you. Jesus, bless you.’

“By that time, there was a crowd gathered around us. I was thoroughly embarrassed. Embarrassed by the crowd, embarrassed that I had been rushing to get away from her and get on home, but mostly embarrassed by the fact that I had no recollection who her daughter was, despite the obvious impact I had had on her. It put things into perspective,” Dr. Nusz said.

Help at home and abroad

“In the past, I went overseas to help the needy because that’s the only place I thought they lived,” Dr. Edwards said. “I always assumed that health care was available to anyone in our country who really needed it. I was wrong.

“We’re seeing all kinds here. The middle-aged myope who can’t pass his driving test, doesn’t have a job and needs glasses. Or the 45-year-old woman I saw recently with a 22-year history of diabetes. … She’s had no eye exam in 10 years; works but has zero insurance. She had severe diabetic retinopathy and no clue that in a few years she would be blind.

“When I told her she would need laser treatments, she said, ‘I can’t pay you.’ I had the pleasure of treating her for $1.”

Dr. Edwards’ experience and comments suggest something I have recommended to client surgeons experiencing career burnout. It is common for me to send such doctors on a foreign surgical mission trip. Usually — despite the grueling hours, crude conditions and jet lag — they return energized, their depression somewhat lifted. They no longer complain about the indignities and irritations of modern American practice.

It is well-recognized that service given freely to others is wonderfully therapeutic in restoring surgeons in a career funk. Dr. Edwards’ hometown eye mission project demonstrates that you do not have to take a transcontinental flight to get high on volunteering.

Patients with serious disease

For all the good feelings, however, the toughest part of the program is trying to help patients with truly serious disease and no means to get help once you have opened the tap. Their stories can be heartbreaking.

As Dr. Nusz describes, “I saw an unemployed young mother whose husband was a laid-off military veteran. She had a history of shingles, lupus and 6 months of gradual vision loss in both eyes. She now is [best corrected visual acuity] 20/80 and 20/400 and has severe uveitic [cystoid macular edema] in both eyes from an unknown cause. She needs to see multiple specialists. A retina specialist friend of mine agreed to see her without charge. But she needs major laboratory work to identify the underlying cause of her problems. We are doing all we can to work with local organizations to get these tests done. We’re just looking at the tip of an iceberg of needed care.”

After reading this, I hope you are moved to do a bit more surrendering of your own profits, even in the face of softer practice. On the way to greater happiness in a decidedly dour economic climate, you may even find a bit of a lift in your practice’s paying business as well.

Please make a commitment this year to touch the growing ranks of the underserved. And let me know how it turns out.

Getting started

• Discuss this program internally among your staff and colleagues. Even if you are excited about it personally, make sure that everyone is on board.
• Make an initial, written commitment, spelling out all of the details. “For the next 6 months, each of our providers will see three uncompensated eye exams per week and provide any needed follow-up care that is within their scope of practice.”
• Incorporate Dr. Edwards’ key success factors:

• Patients are not shamed by being put into one block time for a “charity clinic.” They are appointed throughout the day to avoid feeling marginalized. The financial status of such patients is protected as diligently as you preserve a patient’s medical status.
• Patients pay whatever they can afford for each visit, but not less than $1. The money they pay is turned over to a local named cause (such as the local food bank), so that rather than receiving charity, they are indeed giving to charity. Patients are told where their money goes.

• Get the commitment of others. Ask your medical supply and implant vendors to provide materials at or less than cost. Network your patients with drug company programs to subsidize the cost of glaucoma medications. Get a commitment from your hospital outpatient department or freestanding ASC to provide free facility time. Ask subspecialists you refer to actively to support your new project.
• Get the word out. In small communities, word gets out fast through word-of-mouth alone. In larger communities, you may need formal advertising and outreach to community service organizations.
• Remember that the best kind of giving is when you give without any expectation of recompense or secondary gain. All the same, it is great to “do well by doing good,” and in these challenging times, keep up every effort to promote your practice to paying patients. Therefore, to whatever extent you feel comfortable, make your efforts and results known to the local press, referral sources and general patient base.

• John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. Mr. Pinto is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice, The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees, The Women of Ophthalmology and the new book, Legal Issues in Ophthalmology: A Review for Surgeons and Administrators. He can be reached at 619-223-2233; e-mail: pintoinc@aol.com; Web site: www.pintoinc.com.
• R. Malcolm Edwards, MD, Frances L. Story, MD, and Kevin J. Nusz, MD, can be reached at The Eye & Laser Center, 1240 Colonial Commons Drive, Lancaster, SC 29720; 803-285-4333; e-mail: macmdeye@aol.com.