A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Purpose To understand the reasons why physicians volunteer their time to provide healthcare to the uninsured and to educate future physicians. Another goal is to define the barriers that prevent physicians from volunteering. Background Physician volunteers play an integral role in educating medical students and providing health care to the uninsured. Therefore, understanding the reasons why physicians volunteer their time can possibly improve recruitment procedures. It may help clinics and medical schools advertise to prospective volunteer physicians by emphasizing the positives and directly addressing the main concerns in volunteering. Materials and Methods A survey was distributed to physicians from multiple specialties who work at the University of Arizona College of Medicine – Phoenix and Banner University Medical Center – Phoenix. The survey consisted of questions regarding physicians’ background information, volunteer experience, barriers to volunteerism, and motivation behind their volunteerism. Motivation was evaluated utilizing a validated and widely used survey called the Volunteer Functions Inventory (VFI). Results A total of 100 physicians responded to the survey. 84% of physicians cited “lack of time” as being the primary barrier to volunteerism. 25% and 22% of the physicians cited “Financial Costs” and “Unaware of Opportunity” as barriers, respectively. With respect to VIF components, the “Values” category showed the highest score of 30.38 out of a possible 35 ,while “career factors” observed the lowest score of 14.09 Conclusions Medical schools and clinics could possibly improve their recruitment efforts by making it less time consuming for physicians to volunteer and by minimizing the financial costs to physicians. They could also benefit by advertising the altruistic and humanitarian nature of the volunteer activity.

In the U.S., the number of persons who cannot afford health care continues to rise. Providing a "safety net" for such persons is becoming increasingly important. Medical professional volunteerism provides access to health care for people who have little or no access to health care otherwise. At a not-for-profit free health clinic in Tampa, Florida, hundreds of physicians have volunteered their time in an attempt to reduce the health care gap in their community. The clinic sees thousands of persons who have very limited options in regards to their health care. This study investigates the reasons physicians volunteer and the barriers physicians face when providing free medical service. Through a survey, shadowing sessions, and focused in-depth videotaped interviews with volunteer physicians concerning the risks, rewards, experiences, and barriers of professional volunteering, a greater understanding of this important topic was obtained. This applied visual anthropological project was developed in collaboration with the free clinic in order to provide a product which would be of use to the organization at the end of the research process. This research led to an enhanced understanding of this population as well as recommendations in volunteer physician recruitment strategies.

Management of chronic disease requires a different service delivery model from that of acute illness. The uninsured population experience poorer health status and increased incidence of chronic disease than do the insured population. The purpose of this study was to identify the supports and barriers present in providing chronic disease management to patients at Ohio free clinics. Wagner's theory of chronic disease management served as the theoretical lens. The sequential, exploratory mixed methods study collected data from 13 free clinics belonging to the Ohio Association of Free Clinics (OAFC). Quantitative questions focused on processes in clinics with high and low fidelity to the chronic care model (CCM) determined by the Assessment of Chronic Illness Care (ACIC) survey. A backwards stepwise logistic regression was used. The quantitative analysis determined the 3 highest and lowest scoring clinics on the ACIC survey who then participated in a 2 tiered multi-case study series. Qualitative questions examined supports present in high fidelity clinics and barriers present in clinics with low fidelity. Qualitative findings identified 5 support areas that centered on progressive vision and patient-centered care themes that existed in high fidelity clinics. Four barriers were identified in low fidelity clinics that focused on the theme of capacity building. These findings provide evidence to guide the OAFC's work in improving adherence to the CCM constructs, thereby elevating the quality of care to the uninsured with chronic disease to the level of those providers governed by accrediting organizations. Changes in quality of care may result in an improvement to the health status of the individual and the communities in which they live.

Appalachia is characterized as being a place of health inequalities, including substandard health care access. Health disparities in access to health care persist in the region, and many Tennessee residents are unable to afford premiums, if they can afford insurance at all. Uninsured individuals rely on community based free clinics, which serve as health care safety nets and allowing people to obtain limited health care. This ethnographic investigation, involving semi-structured interviews and participant-observation of the Blackberry Spruce Free Clinic, provides insight into the continued need of health care safety net resources. This research provides a patient’s perspective on the barriers to care for the uninsured, the difficulties in managing chronic illnesses and other medical needs when relying on charity care, and the problems of clinic management in its role as a temporary solution for the uninsured population.

In 2001, The Institute of Medicine published its recommendations for bringing high quality care to all people of the United Sates. That solution involved fulfilling criteria expressed in the acronym, STEEEP. Care must be: Safe, Timely, Effective, Efficient, Equitable and Patient Centered (Institute of Medicine 2001). While improvements were made in terms of infant mortality, longevity, and deaths amenable to quality care, healthcare in the United States has remained fragmented with much work yet to be done. This leaves many uninsured individuals without access to affordable healthcare. Despite the implementation of policies such as the Affordable Care Act and the American Rescue Plan, which have expanded Medicaid and given access to many, it still falls short. Approximately 24.9 million people remain uninsured. The rising costs of healthcare in the U.S. have led to both insured and uninsured patients being exposed to medical debt, lower health status, and limited access to care. Safety net clinics, such as free clinics, have become essential for many uninsured individuals who rely on them to receive medical care. Free clinics are an example of safety nets that give medical access to the uninsured. These clinics have positive results on health outcomes and help to lower healthcare expenditures, particularly in emergency room visits. Studies have shown that uninsured individuals are more likely to use emergency services, which results in higher healthcare costs. Free clinics provide preventative care and early interventions that can help prevent costly emergency visits and hospitalizations. Moreover, free clinics serve as a place for volunteers to grow their skills and become better providers of medicine. Volunteers include physicians, nurses, medical students, and other healthcare professionals who dedicate their time and expertise to help those in need. Volunteers at free clinics are provided with a unique opportunity to enhance their skills by working with a diverse patient population that often has complex medical conditions. Free clinics are essential safety nets that provide medical access to the uninsured and underserved communities. Without these clinics, many uninsured individuals would be left without access to care, leading to poor health outcomes and higher healthcare costs. The importance of free clinics cannot be overstated, and unless there is a change in the current healthcare system, free clinics should be given the place they deserve, including more volunteer and funding support. As the U.S. healthcare system continues to evolve, it is critical to recognize the value of free clinics and the role they play in ensuring access to care for all individuals, regardless of their insurance status.

In 2008, the election of President Barack Obama brought health care to the forefront of national discussions and led to the passage of the Patient Protection and Affordable Care Act (ACA). The legislation changed the rules of health care delivery in the United States, but the ACA did not do one fundamental thing: It did not end the need for many of the nation's most needy patients to seek free medical care from groups such as Remote Area Medical (RAM). A mobile clinic, RAM brings together volunteer dentists, physicians, nurses, and other professionals as well as support staff for multi-day clinic events to provide free, on-site care to anyone presenting for treatment without qualification questions. This thesis looks at the ongoing need for RAM in central Appalachia after the passage of the ACA due to a continued lack of comprehensive health care coverage for all Americans.