PROFESSIONAMA survey: More doctors volunteeringThe new study found that general surgeons, psychiatrists and subspecialists in internal medicine were more likely to provide charity care than other physicians.By Damon Adams, amednews staff. May 13, 2002. Nearly two out of three doctors provided charity care in 1999, up slightly from 1988, according to a new AMA report. The number of charity hours per doctor a week rose from 6.6 to 8.8 hours between 1988 and 1999, figures show. The report said physician commitment to charity care is strong, despite the financial pressures managed care may have imposed on practices. "[Charity care] has always been important, because there have always been those in need," said AMA President-elect Yank D. Coble Jr., MD. The information on charity care was taken from the AMA's Socioeconomic Monitoring System, a national survey of nonfederal physicians who have completed their graduate medical education. Charity care is defined as care provided for free or for a reduced fee because of the patients' financial needs. Doctors were asked how many hours of free or reduced-fee care they performed in their most recent complete week of practice. The report did not analyze the reasons behind most of the findings in the survey. Survey years were 1988, 1994 and 1999; information was not available for 2000 and 2001. The AMA report differs from a study done last year by the Center for Studying Health System Change, which said the number of doctors doing charity care had dropped 4% from 1997 to 1999. That study said the decline might be linked to changes in the medical marketplace during the 1990s, including a shift from physician ownership of practices and an increase in managed care. Why the difference in the reports? The AMA report said "data on charity care are not perfectly comparable between the two surveys because the questions about that subject are asked with regard to time periods of different length." The AMA report looks at a longer time frame, AMA officials said. The AMA report, released in April, found that 65% of doctors provided charity care in 1999, up from 62% in 1988. The 8.8 hours of weekly charity care accounts for 14.4% of total patient care hours. While charity care was higher in 1999 than in 1988, doctors were less likely to give free care in 1999 than in 1994, a decrease fueled by drops in four categories: general internal medicine, ob-gyn, surgical specialties and "other specialties." The most dramatic increase -- 13% -- was for emergency medicine physicians. The report said much of this increase was likely due to emergency departments complying with the Emergency Medical Treatment and Active Labor Act, which was designed to make sure emergency department patients are not turned away despite their inability to pay. So part of the motivation was to comply with government regulations.
65% of doctors provided charity care in 1999.
However, for Larry Alexander, MD, an emergency physician, doing charity care is his choice, not because of regulation. Twice a year, he and others at Central Florida Regional Hospital in Sanford, Fla., give free physicals to students from area schools. Typically, doctors in the area charge $40 to $70 per exam. More than 200 children showed up for the last batch of the free exams, which allow the students to play school sports. "This shows that the hospital is willing to meet the community's needs regardless of what they are," said Dr. Alexander, who serves as medical director of the hospital's emergency department. Charity care also increased among pediatricians, psychiatrists and subspecialists in internal medicine. In 1999, non-primary care physicians were more likely than primary care doctors to do charity care (67% to 62%). Other findings in the recent AMA report:
Otolaryngologist G. Paul Doxey, MD, sees the commitment to charity firsthand at the Doctors' Free Clinic of St. George in St. George, Utah. Nine internists and family doctors provide care to the uninsured, working poor and homeless. In three years, the clinic, located at a homeless shelter, has treated over 6,000 patients. When a specialist is needed, they call ones in the area to see if they will provide free care. "They will usually do it," said Dr. Doxey, president and chair of the clinic, which will move into a new building May 18. "We're just trying to make a difference." ADDITIONAL INFORMATION:Time sharingPhysician commitment to charity care is strong and is up slightly from 1988. Charity care is defined as care provided for free or for a reduced fee because of the patients' financial needs.
Percent* of Hours care
Physicians per week
----------- ------------
1988 1999 1988 1999
All physicians 62% 65% 6.6 8.8
General/family 65% 67% 5.3 8.1
Practice
General internal 57% 60% 5.8 8.1
Medicine
Pediatrics 54% 62% 6.4 8.4
Ob-gyn 61% 56% 6.0 7.9
Internal medicine 62% 71% 5.8 8.4
Subspecialties
General surgery 69% 73% 7.4 8.4
Psychiatry 65% 73% 8.8 10.0
Emergency medicine 48% 61% 11.9 12.3
* Percentages are rounded Source: AMA report, Physician Provision of Charity Care, 1988-1999. WeblinkAMA report, "Physician Provision of Charity Care, 1988-1999" (no longer available) Copyright 2002 American Medical Association. All rights reserved.
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