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It is important to acknowledge that many physicians volunteer their clinical expertise by evaluating and treating patients in their practice who are unable to pay for professional services. For colleagues who feel volunteering exemplifies the calling of medicine and find it particularly rewarding, there are a multitude of domestic and international opportunities to do additional volunteer work. In addition to the gratitude that a volunteer encounters, volunteering in an underserved and low-tech environment often is a great way to sharpen basic clinical skills. Mindful of the current liability climate, be sure you have adequate professional liability coverage before accepting a volunteer assignment.
— John A. Fromson, MD*
By Bonnie Darves, a Seattle-based freelance health care writer
One of the main reasons physicians choose to go into the medical profession is because of a desire to improve the health and well-being of others. This impetus also figures as a primary motivator for physicians who decide to pursue volunteer work. In fact, volunteering one’s medical expertise can be both personally gratifying and professionally enriching, as many physician volunteers have discovered.
For Russell W. Steele, M.D., a New Orleans pediatrician and vice chair of Pediatrics at Louisiana State University School of Medicine, three decades of volunteer work, in settings ranging from a leper colony in Hawaii and a Ghana medical school to an inner-city clinic for homeless teens, have provided him with a perspective on medicine and humanity he might not have developed otherwise. “The feedback is rewarding because people are very appreciative. But one of the big things is that volunteer work, especially abroad, can help you recapture your basic skills in medicine,” Dr. Steele says. “You don’t have elaborate laboratories or CT scans. You go in with your hands, your stethoscope, and your clinical skills.”
Like many physicians, Dr. Steele also believes it is his professional responsibility to volunteer his services to help the underserved, whether they are in Third World countries or on the streets of New Orleans. In recent years, he has devoted much of his volunteer time to the New Orleans Covenant House, one of a dozen facilities in large U.S. cities that take care of the health and psychosocial needs of homeless teens. Dr. Steele not only provides his own services, he also set up and now helps operate a program at the Covenant House that enables medical students and residents to work in the clinic.
A desire to care for the homeless also emerged as a calling for Roseanna Means, M.D., a Boston internist and associate professor of medicine at Harvard University Medical School. Dr. Means, who began her volunteer work during her residency at a refugee clinic on the Thailand-Cambodia border, later developed an interest in helping homeless women she encountered daily during her travels to and from Massachusetts General Hospital. After serving for several years as medical director of Health Care for the Homeless in Boston, Dr. Means decided to reach out to the many homeless women she knew weren’t receiving care. She started the Women of Means program, in which volunteer physicians rotate among shelters to provide care in makeshift clinics.
“I started with myself in one shelter, schlepping my clipboard and stethoscope, and carrying medical supplies in an Ace Hardware toolbox,” Dr. Means recalls. Five years later, Women of Means has 16 volunteer physicians and a part-time nurse who travel to nine shelters throughout Boston. Dr. Means, who is in private practice, devotes approximately two days a week to her volunteer work. Much of her personal reward has come from gaining an understanding of the myriad social factors and circumstances that conspire in the lives of women who become homeless. It’s a reality check that Dr. Means thinks would benefit all young physicians, which is why she encourages rotations through her clinics.
“In academic medicine, students and residents can be very much in an ivory tower, and they don’t often have the opportunity to see the real world,” she says. “So what they gain from this experience and other volunteer work helping underserved populations is a sense of another reality and of how they can actually be agents of change. It’s very empowering.”
Jonathan Spector, M.D., knows well that volunteer work can be life-changing. He had done rotations abroad during medical school, in Brazil, Israel, and South Africa. But after completing his pediatrics training at UMass Memorial Medical Center in Worcester last year, Dr. Spector joined Doctors Without Borders for a four-month volunteer position in war-ravaged Angola, where many areas had been essentially closed to outsiders for three decades until last year.
One of the most pressing situations Dr. Spector and his fellow volunteers encountered was severe malnutrition among the children. The physicians built and set up therapeutic feeding centers for the very young children — initially treating those in the immediate areas and later traveling to outlying villages to bring back the most severely malnourished children. “In a lot of volunteer opportunities abroad, people talk about making a difference on a day-to-day basis in a way that we sometimes don’t feel here,” says Dr. Spector, who works at Harvard University Health Services. “Here, if I don’t show up for work one day, there are other doctors to take care of those patients. There, I was one doctor for 500 kids and you do feel as if you’re saving lives daily.”
The Angola work also provided Dr. Spector with an opportunity to learn about and treat tropical infectious diseases, such as malaria and sleeping sickness, and challenge his clinical skills in a bare-bones environment. “Each time I go abroad, I find that I experience a lot of professional and personal growth. When you come back, you find that you have a different perspective on everything it makes one’s life richer in some ways,” he says.
Volunteer Opportunities Abound — Locally and Abroad
Volunteer work abroad can offer physicians an unparalleled opportunity to challenge themselves, but there are many ways to pursue rewarding volunteer work without leaving home. David Norton, M.D., a Ware, Massachusetts pediatrician, finds his local volunteer work as gratifying as his longtime work with Interplast, an organization that provides free reconstructive surgery in developing nations. Through the Massachusetts Medical Society (MMS), Dr. Norton works on the Public Health Executive Council. He also serves on the state immunization advisory board and is actively involved in American Academy of Pediatrics legislative initiatives targeting underserved children.
“There is plenty of opportunity out there. I see part of my role as a physician, as being a patient advocate — especially for children, who are unable to advocate for themselves,” he says. “Medical societies and professional organizations welcome help from doctors at whatever level of time and commitment they can afford.” Dr. Norton says that his volunteer work not only enriches his own life, it also gives him an opportunity to improve his skills in non-medical arenas, such as the legislative realm.
Although volunteer opportunities abound — with commitments ranging from a few hours a month to several weeks a year — many young physicians aren’t quite sure where or how to start looking for volunteer work. Drs. Norton and Means suggest the local medical society or state professional organization as good starting points. The Massachusetts Medical Society, for example, annually hosts a volunteer opportunity fair, and many professional organizations provide listings of opportunities on their websites. For physicians who wish to pursue work abroad, organizations such as the MMS’s Global Medicine Network, Health Volunteers Overseas, and Doctors Without Borders (see sidebar) are excellent resources. The Global Medicine Network, for instance, was created to allow health providers throughout the world to establish personal and professional contacts, for pursuits ranging from international medical service to research, education, and visitor exchange.
In general, it’s best to let personal interests drive your quest for opportunities, Dr. Norton says. “If you have an underlying interest in a certain specialty or population, your local medical society can be a good resource for helping you find people with similar interests who may know of opportunities.” He adds that a demanding work schedule, or professional or family commitments that preclude travel, needn’t be deterrents to physicians who want to volunteer. Physicians can help with overseas efforts by volunteering to collect and ship needed medical supplies, for example, or by serving as occasional consultants to physicians in developing nations through a growing number of telemedicine networks including one recently launched by Harvard Medical School.
“Even if you only have a few hours a month to give, there are many rewarding volunteer opportunities you can pursue,” Dr. Norton says.
On a business note, physicians who intend to volunteer should ensure their professional liability policy will cover them in the clinical setting where they provide services. In general, physicians in active practice who volunteer in their own state are usually covered by the policy in force in that state. If they go to another state to volunteer, they should research the matter to ensure that they will be fully covered. For the record, liability coverage generally isn’t an issue for physicians who volunteer overseas and would only come into question in the highly unlikely event the physician volunteering abroad was later sued in the United States. In some states, including Massachusetts, insurance carriers have made arrangements to provide limited-liability policies to retired physician volunteers who do not receive reimbursement for their services.
*Dr. Fromson serves as the editor for Career Resources and is Vice Chair for Community Psychiatry, Brigham and Women’s Hospital; Chief of Psychiatry, Brigham and Women’s Faulkner Hospital; Associate Professor of Psychiatry, Harvard Medical School.