'For me, it's a win-win situation.'
Over the course of nearly five decades practicing medicine, Dr. Ken Martin often found himself frustrated by limitations of healthcare in the United States.
Patients had trouble paying for insurance if they weren't covered by their employers. And on the other side, rather than focusing solely on the wellbeing of the patient, doctors like Martin had to factor in other concerns: what kind of insurance — if any — did the patient have? Did the insurance cover the specific treatment the person needed? Who would pay for the CT scan or MRI that Martin deemed necessary?
Even at his private practice in King City, where he spent 25 years working primarily with older patients, Martin was handcuffed by the insurance industry.
"That's actually why I joined Legacy (Health) 16 years ago — I was in danger of going belly-up," Martin said. "The way Medicare reimburses a lot of private practice physicians, you can't afford to take more than 5-10% Medicare patients because the reimbursement doesn't cover your overhead."
That wasn't how Martin, a 42-year Lake Oswego resident who specializes in internal medicine, wanted to practice — not in his early years working in Juno, Alaska, not at his private practice and not in his final 16 years of full-time work at the Legacy Health Bridgeport clinic. So when he retired from Legacy two years ago, Martin searched for a way to help those who fell through the cracks.
And that was when he found the Clackamas Volunteers in Medicine (CVIM) clinic in Oregon City.
"I wanted to cut back, but still do some things," Martin said. "I was looking at various clinics around here, and which ones have been around a long time and were set up well and doing a good job — (a place where) I didn't have to reinvent the wheel, basically, and could just do my thing."
CVIM, which was opened in 2012, is a free clinic that's part of the national Volunteers in Medicine America organization founded by Dr. Jack McConnell in the early 1990s. Along with physicians like Martin, the clinic relies on volunteers for nursing, translating, administrative tasks, scribe work, IT support and more.
"CVIM serves adults who are low-income, uninsured (or underinsured) and living in Clackamas County," CVIM Executive Director Martha Spiers said in an email. "Typically our patients are working, heads of households (supporting families), one missed shift away from unemployment and one paycheck away from homelessness. They make too much to qualify for OHP (the Oregon Health Plan), and too little to afford health insurance premiums or copays."
The clinic, which is open Tuesday-Thursday (with eye care available on Mondays) relies on volunteers like Martin to serve its patients. It offers everything from primary care to pre-diabetic education, eye care and physical therapy.
"(We have) a lot of hypertensive (and) diabetic patients," Martin said. "It's usually a little younger population, but these are hardworking folks who can't afford health insurance, and (the clinic does) a good job vetting who really needs it, and
who is just working the system — which you have to be a little careful of."
Specific to those with diabetes, the clinic works on preventative measures to help keep patients healthy and their costs down.
"Insulin nowadays is a big issue," Martin said. "You can give them free supplies of that, because a lot of people are choosing between medicine and food. Usually, they choose food, so they cut down their insulin and end up in a hospital, (or) emergency room, where it gets expensive."
The experience harkens back to some of Martin's earliest days in medicine when he worked at a public health service clinic in Juno, Alaska.
"I really enjoyed medicine up there, because you didn't have to worry about who had health insurance, and everything was covered," he said. "We didn't make a whole lot of money — we only made $12,500 a year working 80 hours a week — but it still was enjoyable medicine to me because you didn't have to worry about all the extraneous (insurance-related) things from a physician standpoint.
"That's kind of influenced me throughout the years."
A typical shift at the clinic for Martin runs from 12:30-5 p.m., and he's there about two days each month.
"I sleep in, go work out at the gym in the morning, take a shower, spend time with my wife ... then head over here," Martin said. "So for me, it's a win-win situation."
Indeed, Spiers noted that physicians can derive mental health benefits from working at the clinic.
"I met with the new executive director of the national VIMA ... and he was emphasizing the mental health benefits of VIM for physicians," Spiers said, noting that across the country physicians have one of the highest rates of suicide among professions. "He described the VIM clinic alliances as not only providing care for people living on the edge of poverty and unable to afford healthcare, but also as a life-sustaining opportunity for retired and working physicians to reconnect with their original life's purpose."
Further, the clinics provide opportunities for physicians to mentor younger pre-med students, who often take care of transcribing and other data entry.
"That's what I got tired of in practice, too, is doing all the typing and data entry," Martin said. "4-6 hours a day you're spending dictating notes, answering emails, answering phone calls and (doing) drug refills ... So the scribes do all of the data entry for us, plus they're pre-med students (or) pre-physician's assistant students so it gives me a chance to do some teaching."
In the end, of course, it's the patients who are at the center of CVIM's efforts. Spiers noted that aside from diabetes and hypertension, conditions like anxiety and depression are also common among patients at the clinic.
"A critical tenant of the VIM clinics is that we serve our patients within the 'VIM Culture of Caring' that seeks not only to provide quality medical care but to address the hurt often caused by stigma," Spiers said.
Looking to donate or get involved with the clinic? One of the biggest fundraisers of the year is coming up on Giving Tuesday, which is Dec. 3. Learn more at https://app.etapestry.com/onlineforms/ClackamasVolunteersinMedicine/on-linegiving.html.
You can learn more about volunteering for CVIM clackamasvim.org/medical-volunteers.
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