After “getting burned out” during his career as a radiologist in San Diego, Charles Lee, MD, was looking for something different.
“I went on and got my law and MBA degrees and I said: Hey, I want to do something that I could combine all of my education,” said Dr. Lee, an AMA member.
The right practice setting to employ all that training and talent?
“Going to jail is where I could do that.”
Dr. Lee spent a decade working as a correctional physician. Currently president of the American College of Correctional Physicians, Dr. Lee now audits correctional facilities to optimize care.
During an education session at the 2023 AMA Annual Meeting, Dr. Lee offered insight on what a career in correctional medicine involves. Here’s a look at some key takeaways.
Many inmates at correctional facilities are from populations that are underserved with limited access to health care and have been experiencing subpar health care services well in advance of their incarceration, Dr. Lee said.
“Many people who end up incarcerated had not had appropriate or adequate medical care out on the street,” he noted. “They'll walk in and we do screening, we do a finger stick, and say, ‘Well, wait a minute, your blood sugar is 200-and-something. You may have diabetes.’ They won’t know about it.
“Same thing with dental. Many of them have never had dental care. They come in, you check their mouth out, they got a lot of cavities, misaligned teeth, impacted teeth. So the primary care, when they come in, many times it's the first care that they get. That's rewarding—that is very rewarding.”
Correctional officers and correctional physicians have to be on the same page in every patient interaction, Dr. Lee said.
“Every time you talk to a correctional officer in a correctional facility and you ask them, ‘What's the main issue here?’ The answer would be “safety and security,” Dr. Lee explained. “If you don't have safety and security, you're dead in the water. Medical must work with custody.”
Even with the emphasis on safety, Dr. Lee said he has always felt protected.
“People always say, ‘Aren't you scared working in a jail or prison?’ I say, ‘No,’ for a couple of reasons,” he said. “No. 1, there are always correctional officers around. And No. 2, the people who we are working with need our medical help. So you don't bite the hand that's feeding you.”
Although your days can be intense, Dr. Lee highlighted that when working in correctional medicine, you can leave work at work.
“One thing you don't have to worry about: billing,” Dr. Lee said. “In private practice, you got to make sure the bills go in. Not that there's anything wrong with it. I did it for 20 years. But that's one thing, you don't have to worry about as a correctional physician.
“You may take call periodically. Let's say there are five people who work in that facility; you may take call every fifth week. And when you are not on call, when you leave that gate, you are finished for the day.”
Most of the duties of correctional physicians fall under primary care, but what a physician does varies widely.
“What is a correctional physician?” Dr. Lee said. “It runs the whole gamut of primary care. And depending on the person, they may do some minor procedures” such as suturing or splinting. The nature of the work “depends on that person's individual skills. Mental health management and addiction management are also a large component.”
Treating patients with chronic conditions such as diabetes and hypertension is also a major part of practicing in a correctional facility, Dr. Lee added.
A 1976 Supreme Court ruling in Estelle v. Gamble established that failure to provide prisoners with adequate care was a violation of the Eighth Amendment forbidding cruel and unusual punishment. Since that ruling, standards of care for correctional facilities were established and are consistently evolving, Dr. Lee said.
“Generally speaking—there's always exceptions—but the care should be equal to community care,” Dr. Lee said. “And if it's above and beyond the capability of the facility, the appropriate response is to send them out. Every place I go to, we always find out: Do you have a hospital that you can refer patients to?”
At some correctional facilities, there may not be a hospital within 100 miles.
“That's challenging,” Dr. Lee said. “I've been to other places in the middle of the city. And many of them have relationships with university hospitals” to which the physicians send the incarcerated patient in need of care.
The message for correctional physicians in such situations is “don't mess around, send them out, whether it's to the ER or to general surgery or cardiac surgery, send them out. Don't worry about the payment. Forget about who's going to pay the bill. Care comes first.”
It is important to appreciate the scope of correctional medicine, Dr. Lee said.
“People don't understand what it's about. It's not about just walking in and handing out a few pills,” he said. “You got to give the people incarcerated the same quality of medical care that the community gets.