Bringing RAM to Pennsylvania!

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Free clinics were first developed in the 1960s to aide in basic health care needs for those without access to care.  Despite significant changes in health care policy over the past five decades, the need for free clinics in the United States still exists. Non-for profit organizations such as Remote Area Medical (RAM) and Mission of Mercy (MOM) help to provide health care access to millions of uninsured or underinsured people in the United States through free mobile health clinics.  Currently, in states such as Virginia and Tennessee, RAM provides health, dental, and eye care through multiday health clinics.  RAM relies heavily on volunteers, particularly licensed health care professionals from around the country, to staff these massive clinics.

RAM-clinic

In 2012, eleven percent of Pennsylvanians were uninsured. Even today with the institution of the Affordable Care Act, there are many that “fall between the gaps” of coverage.  Hospitals such as Reading Health System are advocating for institution of alternatives to their emergency rooms to provide basic health care needs to the population.  Charitable free clinics such as RAM may be a part of the solution.

Currently in Pennsylvania, under the Volunteer Health Services Act (VHSA), only previously board licensed retirees from Pennsylvania are allowed to volunteer in mobile clinics. Out of state volunteers that would like to participate in these clinics are not currently granted temporary licenses in the state.  Because of this, groups like RAM are unable to host clinics in Pennsylvania as their clinics require thousands of volunteers to staff appropriately.  States such as Arizona have been blocked by similar policy issues. Legislative change was opposed by the Arizona State Licensing Board due to concerns about legal repercussions secondary to lack of liability coverage for out of state practitioners.  Pennsylvania’s State Licensing Board has similar concerns with additional apprehensions due to drastic variations among licensing standards across states.

To improve health care access for Pennsylvania residents, legislation must change.  Mimicking bills of states such as Tennessee and Illinois, a new draft of the VHSA needs to be developed to include a clear law that allows mobile clinics like RAM and MOM to recruit providers from other states under temporary three day licenses.  Support of this amendment through RAM’s Facebook page and personal letters to local legislator can assist in the success of this policy change.

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2 Responses to “Bringing RAM to Pennsylvania!”

  1. jdricken Says:

    First and foremost, I am a 100% supporter of programs such as the one that is spoken of in the post. It does seem as though the state is hindering the cause, more than it is helping it, by severely limiting the amount of physicians/former physicians who qualify to volunteer.

    In order to address some of the licensing issues, and liability coverage, it seems that there would be significant benefit from creating a national organization of volunteer physicians. There could be a central part of the organization that assists in obtaining licenses for the given states, or liability coverage. Would it even be unreasonable to establish some sort of policy where, after providing the adequate documentation, there is a special license for volunteer physicians that is valid is all states?

    Maybe it would be a good idea to partner with medical schools and residency programs in order to staff the mobile units. Not only does this provide manpower, but the primary care provider volunteers would then have access to a rich network of specialists, and subspecialists. This might help to increase funding as well.

    Many of the obstacles in global surgery seem as though they would be quite similar to those in the scenario spoken of in the post. The opposition might counter by saying that such free clinics do not provide care that is equal in quality to that of an insured person. They might go on to say that this disparity is not acceptable.

    Another issue that people might have is that there is probably very little continuity of care, which might be an especially important issue for a population that might possibly be plagued by a greater amount of morbidities, or more severe morbidities.

    Then there is the issue of sustainability. In order to improve access to health care, clinics and hospitals need to be built in the communities, and they need to be staffed by people who are regular, full-time workers.

    This is an enormous issue, so for now, free mobile health clinics seem to be a good band-aid for the bigger issues.

  2. jnwadiuko Says:

    Thanks for the post. You might have seen Jon Stewart’s recent segment profiling this group last week. Needless to say, I think it’s mindblowing that we need to have medical missions to people in the United States. It just goes to show that even as our country (and the world) is becoming increasingly urbanized, there remain rural pockets from sea to shining sea.

    There have been an increasing amount of discussion revolving around the idea of “reverse innovation”, that projects that were started in LMIC due to resource (or other) constraints might actually be quite effective in the United States. Community Health Workers has been a reverse innovation that has taken hold in various segments of the country. I wonder if there are other methods and approaches to providing care that can help communities like the rural places that you suggest.

    E health and telemedicine is another innovation that can prove to be effective in these settings. My home medical school has been developing and using software that allows neurologists to assess patients for stroke while they are hundreds of miles away. You can’t conduct a physical exam that way (yet), but there’s plenty that you can do, and it’s a great step in the right direction.

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