Economic downturn stresses medical community

As the economy is making nearly everyone tighten their purse strings, many may be putting off medical help because they feel they cannot afford visits or co-pay amounts. Others may be searching for cheaper alternatives than going to see a doctor, like exploring home treatments before seeking out a physician or going to a pharmacy clinic with a nurse practitioner instead of the emergency room.

Physicians also are in a tenuous position, as any small business owner; they have overhead to pay, and reimbursement rates are rarely equal to the full price charged for a procedure or visit.

Those who offer reduced rate or pro bono medical services are finding themselves more in demand as  people seek out affordable health care. Clinics and programs offering discounted rates are seeing an increased concern about finances from patients.

Dr. Bashir Ahmed, who runs the Al Shifa Clinic at the Muslim Community Center for Human Services, said part of the problem is that the number of uninsured Americans is increasing as more people fall into economic hardship or lose their jobs. People who may have been drawing a decent paycheck are now without jobs as many companies have announced layoffs or bankruptcy this year. Many of these people may currently be using COBRA, or temporary government-backed health insurance, to extend their health care coverage, but Ahmed said he worries about what will happen when those people can no longer draw COBRA benefits.

“I think we are expecting more pressure in the coming few months,” Ahmed said.

The Al Shifa Clinic, which treats people of any faith, relies on volunteering physicians to donate their time and efforts to treat the uninsured, and it has expanded its services recently; it is open two days a week now and has an eye clinic. A dental clinic is anticipated to start in 2009. Despite the broadening of services, Ahmed said the clinic will need more physicians to support the anticipated patient growth. Not only has the patient caseload increased, but the social workers at the Muslim Community Center also are increasingly busy as problems like domestic violence have increased.

“We have some increase in our caseload but I am more concerned in the next coming few months we will  have more,” he said.

The increased volume is something anticipated by health care professionals at Moncrief Cancer Resources. Dr. Keith Argenbright, medical director at the UT Southwestern Medical Center-affiliated center, said for many of the organizations that offer reduced rate or pro bono work, support is essential to provide services.

“Funding is always an issue,” Argenbright said. “Funding is an issue for us in good times and in bad times.”

Niki Barr is a psychotherapist who sees cancer patients and those affiliated with them who seek help from Moncrief. She had a private practice for nine years and said she always had a percentage of patients she would take on pro bono, and at Moncrief it costs $25 an hour to see her, compared to $100 or more some therapists may charge in private practice. MoncriefÂ’s mission is to help the underserved cancer patients, and so some patients with financial hardship may be eligible to get up to eight free sessions with Barr.

Therapy often is essential for cancer patients who face life-and-death issues, Barr said. Unfortunately, itÂ’s also a facet of care that is ignored when times get bad.

“With the economy the way it is, therapy is the first thing to go,” Barr said.

Cancer patients deal with a wide range of emotional and behavioral challenges due to their illness, but Barr said “finances always come up.” Patients are more worried than ever about their personal finances, and she said she is privileged to be in a position to still help them, regardless of the economy. She has only been seeing patients since January, and so she can’t accurately gauge if the economy is driving more people to her or if more knowledge about the service is bring patients, but she said general practice therapists she knows and has heard of appear to be losing patients rapidly because many don’t accept insurance.

“They’re tanking,” she said. “If people don’t have cash to pay you, then you don’t have a practice.”

Bashir said he has hopes with more support, his clinic will be better equipped to deal with the underserved patients no matter what the economy does.

“There’s always something to keep us busy,” he said.

Argenbright said he has heard area physicians vocally rededicate themselves to serving patients, whether they are able to pay or not. He said heÂ’s been a part of the Fort Worth medical landscape for about 25 years and has always been impressed by the communityÂ’s ability to rally for patients.

“I think this is a very benevolent medical community,” he said.