Funding and Physician Assistants in an Underserved Clinic

Abstract

David Wood, PA-C Student Member at Large Stigler, Oklahoma Email: paeasmal@aol.com INTRODUCTION As the authors of a recent journal article put it: “Inequities in access to care mar the landscape of health care in the United States.”1 I recently saw the truth of this up close. Spending one month in a underserved clinic was an eye-opening experience. I learned that there is a much larger underserved population than I had realized, especially in Carson City, Nevada, where my clinic was located. I also saw what a clinic goes through in order to keep its doors open for the people who would not otherwise have health care. Spending this time in an underserved clinic, I experienced first-hand why physician assistants (PAs) are so important in rural and underserved clinics. Studies show that students who spend a clerkship in an underserved rotation will more likely work in an underserved area than those who are not exposed to these experiences.2 Having the opportunity to spend time in a rural/underserved clinic has greatly influenced my decision about where I want to work when I finish my training. I spent my underserved rotation at Sierra Family Health Center in Carson City, Nevada. This clinic is part of a larger organization called Nevada Health Centers, Inc. (NVHC) that serves many of Nevada’s rural and underserved populations and provides quality health care for all people. NVHC is considered a community health center, a not-forprofit organization whose revenue comes from four main sources: 49% from patient charges, 34% from federal grants (Section 330e of the Public Health Service Act), 9% from local/county contributions, 5% from private contributions and donations, and 3% from other sources.3 The patient charges are paid in various ways. If a patient comes in without insurance, he has the opportunity to fill out some paperwork to find out if he qualifies for a sliding scale. There are a couple of different sliding scales, and each patient’s payment is determined by the total income of his household. Many of the patients at the clinic have Nevada Medicaid and Medicare as their only source of health care coverage. Carson City is a small community, and many of the physicians in the area are not accepting new Medicaid/Medicare patients, so Sierra Family Health is the only option for many of these patients. The clinic will not turn anyone away. A small percentage of the patient population has other insurance that covers their visits to Sierra Family Health Center. Sliding scale patients are charged in a way that allows them to be able to afford treatment that they otherwise may not be able to afford. Patients may pay copays according to the sliding scale for which they qualify. Each procedure and visit has a copay that the patient is expected to meet at the time of her visit. The medical assistants are able to draw blood for patients who pay according to a sliding scale so that the laboratory fees are billed back to the clinic and the Feature Editor’s Note: