AmericanHealthcare:DoestheSystemAllowHealthcareProvidersEnoughTimeto
CareforTheirPatients?
Countlesshealthcareprovidersentertheirpre‐professionaleducationsbright‐eyed
andbushy‐tailed,eagertostartlearninghowtheycanbesthelpothersintheir
communities–throughmedicine.Theyexperienceclinicalrotations,writtenexams,and
otherarduouscompetencyteststogaintheknowledgeandabilitytoproperlycarefor
others.Somethingnottaughttothesefutureproviders,however,arethemanyconstraints
placedonthem,preventingoptimalcarefortheirpatients–forexample,thedetailsof
insurancepoliciesandbriefappointmenttimesasanecessityforseeingasmanypatients
aspossibletomaximize(arguablymeager)reimbursement.Thesearesomeofthemany
barrierssetupbyourhealthcaresystemthatworkagainstproviderstryingtogivetheir
patientsthebestpossibletreatmentoptions.Thiscausesproblemsinclinicsnationwide,
andfindingaproviderwhowillnotonlytreatbuthasthetimetolistentoallofone’s
symptomsandthoroughlyexplaintreatmentoptionsandtreatmentplansisnearly
impossible.However,thisisnotthecaseatNeighborhoodHealthcareClinics(NHC)in
Escondido,CA,whereproviderscontinuetheefforttoputthe“care”backin“healthcare”.
OnagivendayatNHC,oneprovidermayseeasmanyas22patientsinthespanof
sevenhours–aboutonepatientevery20minutes(includingtheextensivechartingthat
needstobecompletedforeachpatient).However,thisdoesn’tseemtobeanissueforNHC
providersandpatients:providerscometoworkreadytomovecarefullyyetefficiently,and
patientsfeelgenuinecompassionfromtheirproviders.Afterleavinghisappointmentthe
otherday,onepatienttoldme:“Ihavebeenseeingmyproviderhereforfiveyears.Ithink
shereallycaresaboutmeandgivesmethebestcareshepossiblycan,unlikeother
providersIhaveseeninthepast.IreallythinkthisisatestamenttoNHCbecauseallof
theirprovidersandspecialists,oratleasttheonesI’veinteractedwith,seemtoreallywant
tomakemebetter,andIlikethataboutthisplace.”
Itoohaveseenthisgenuinecompassionandexcellentcarefirsthandwhile
shadowingaprimarycarehealthcareprovideratNHC.Iobtainedthisinternshipthrougha
recommendationbyanursepractitionerwhohasworkedwiththeorganizationsince
2000,andwhoisafriendofmyparents.InSeptemberof2014,shementionedtomethat
shewouldlovetohavemeshadowher;shegavemecontactinformationforherclinicand
others,shouldIchoosetoshadowelsewhere.Networkingwithherandspeakingwith
providersatotherclinicsreallyhighlightedtheimportanceofnetworkingforme.HadInot
mentionedlookingforaninternship,Iwouldnothavereceivedthesupportand
connectionsthatIobtainedthroughher.TheinternshipatNHCreallycaughtmyattention
becauseoftheideaofhelpinganunderservedcommunity:manyofthepatientsseenat
NHCareunderprivileged,livingonfoodstampsandsocialsecurityordisability,someare
homeless,manydonotspeakEnglish,andevenmoredon’thavehealthinsuranceatall.As
someonewhodesirestopracticemedicinewithinanunderservedcommunity,Ithinkthis
internshipwillallowmetolearnmoreabouthowtobestcareforthisspecificpatient
demographic.
BeforeIobtainedtheinternship,however,Ihadtogothroughaninterviewand
orientationprocess.Iwasincrediblynervousbeforehand,hopingtheinterviewerwouldbe
nice,hopingmypalmsweren’ttoosweaty,andhopingIwouldcomeoutvictorious.I
remembertheDirectorofVolunteerandInternshipServicesaskingme,“Sowhydoyou
wanttointernherespecifically?Whydon’tyoustayinMassachusetts?Whatdoweeven
havetoofferyou?You’renotevenaNursePractitionerstudent.”Iansweredherquestion
withstrengthinmyvoice,thoughIwashighlyunpreparedforthisquestionandwasn’t
quitesurewhattosay.ItoldherhowIwashighlyinterestedinservingaclinicthathas
suchagreatreputationinEscondidoandwantedtoservetheunderprivilegedcommunity
inawayI’mnotentirelysureIwouldbeabletoinMassachusetts.Iexplainedmypassion
forNHC’smissionstatement,andhowIsharethedesiretohelpeverymemberofa
community,regardlessofprivilege.Shestoicallyshookmyhand,toldmethatshewasmore
thansatisfiedwithmyanswer,andtoldmetowaitoutsidefororientation.Ifeltsorelieved
afterwardsandcouldn'twaittotellmyfriendsandfamilyaboutmynewopportunityat
NHC.
OnceIstartedshadowingatNHC,Ifellinlovewiththeorganization.Iidentifyso
stronglywiththemissionandvisionoftheorganizationbecauseItoowanttohelptheless
fortunatemembersofmycommunity.Ihavealwaysbeenawareofmyprivileged
backgroundandIamadamantaboutleveragingthattohelpotherswhoaren’tsofortunate.
EventuallyIwanttobeaphysicianforunderprivilegedcommunities,andIthinkNHCisa
perfectplaceformetoseehowmedicineinanunderservedcommunityisputintopractice
aswellastolearnmoreaboutmanyofthecombinedhealthandsocialproblemsthese
peopleface.Additionally,Iameagertoobservehowthemissionstatementisputinto
practiceatNHCandhowNHC’sproviders’collaborationcorrespondstoexcellentpatient
care.
Thehealthcareprovidersareincrediblycaringandhelpfulandarealwaysputting
thepatientsfirst,evenwhenthatmeanslosingtimeforlunchorstayinglateattheclinicto
finishsendingprescriptionsorreferralstospecialists.Additionally,theprimarycare
providersareincrediblyknowledgeableaboutindividualinsurancecompaniesandknow
howtogetwhatpatientsneedwhilestillcomplyingwithinsurancecompanies’
labyrinthinereimbursementrules.Thedetailsofvariousinsurances,especiallyMedi‐Cal,is
atopicthatgreatlyinterestsmeasIpreferto“readtherulesbeforeIplaythegame”and
wanttoonedaybethebestproviderIcanthroughlearningtheinsandoutsofallaspects
ofthehealthcaresystem.Ican’twaittolearnmoreaboutitasIcontinuewithme
internshipatNHC.
ThreespecificexpectationsIhaveforthisinternshipareto:
1)Learnhowtoeffectivelytreatapatientinalow‐costmanner(sixtypercentof
patientsatNHCareeitheronMedicaidorareuninsured,seepage16),
2)Learnhowtoeffectivelyprovideforapatientwithstronglanguagebarriers,and
3)Learnhowhealthcareprovidersworktogethertoprovidethebestpatientcare
possible.
IbelieveHSSPmajorsarethemissinglinksbetweenthecitizensofourcommunities
andtheconfusinganddauntingworldofhealthcare.Wehelpourconstituentsunderstand
andgetpastthechaosandstressofhealthcareandhelpprovidethemwiththebest
availablehealthcare.Whenourhealthcaresystemfailstohelpourpatients,weworkto
makethenecessarychanges.GiventhatthisphilosophyisthebedrockofNHC’sapproach,I
thinkmytimeherewillallowmetobecomeastrongerandmoreskilledHSSPmajor.