Free Clinics Come in All Sizes

The thousand or so free clinics around the United States run the gamut of sophistication from tiny outposts open one or two days a month to multimillion-dollar operations in the nation's largest cities, according to Gayle Goldin, M.A., director of community partnerships at Volunteers in Health Care, a Rhode Island–based resource organization for free clinics. The unmet need for psychiatrists and mental health professionals is a current topic of discussion among clinic officials around the country.

The biggest problems are obtaining malpractice coverage for volunteer health care professionals and having to raise funds continuously to maintain services, Goldin said in an interview. “As we see Medicaid squeezed, we will see more pressure on free services and a greater need for free medications.”

While the St. Joseph's Neighborhood Center in Rochester, N.Y., has an annual budget of under $500,000, a staff of seven, and 140 volunteers (see story at left), the Venice Family Clinic on the west side of Los Angeles has an annual operating budget of more than $16 million, 245 staff members, and 1,580 volunteers. Each year almost 20,000 patients make nearly 100,000 visits to the Venice clinic, the largest free clinic in the United States.

Among the 462 volunteer physicians at the Venice clinic is Regina Pally, M.D., a psychoanalytically oriented psychiatrist in private practice in an affluent area of Los Angeles. Why does she do it?

“I went to medical school as an idealistic person and had been thinking about some sort of volunteer work, but September 11 clinched it,” she said in an interview.

She started volunteering at the clinic one morning a week in October 2001 to do psychiatric evaluations and follow patients on medications. She finds that her clinic patients, mostly diagnosed with depression or anxiety, are more disabled by the same symptoms than her private patients, yet she feels she can be more open and down to earth with the clinic patients. Her Spanish language skills helped, too, since 64 percent of the patients are Hispanic. She still meets regularly with a Mexican psychologist to fine-tune her psychiatric Spanish.

“I love the clinic,” she said. “The people are kind, caring, and devoted, and I've found it very rewarding personally.”