Dermatologists and free care

Dermatologists and free care

Denny L. Tuffanelli

I’ve practiced dermatology for 40 years in San Francisco. Our city is, in some ways, unique. It has been called the People’s Republic of San Francisco, the Capital of the Left Coast, and the Home of the Latte Liberals.

We have a five-physician office. We belong to all the local IPAs and HMOs. We also see MediCal patients, Medicare patients, and San Francisco Free Clinic patients.

We do not have a lot of extra time. All dermatologists are busy in San Francisco. Most have long waiting lists, and, economically, we’re doing better than we ever have. I believe the starting salary for a dermatologist at Kaiser Permanente in San Francisco is over $200,000. Keep in mind, of course, that it costs $600,000 to buy a house here.

Nonetheless, there are many reasons that we see patients who cannot pay at all or whose insurance pays poorly.

The San Francisco Free Clinic, which refers us patients, is an organization set up by many of the socially prominent movers and shakers in town. It’s funded by donations. We receive no payment. Through our association with the clinic, we have been invited to social events with people who are very involved in health care politics, providing us an opportunity to talk to them and present our viewpoint as dermatologists. At the last luncheon for the neighborhood free clinic, I got a chance to hear Sen. Dianne Feinstein’s (D-Calif.) ideas about medical care.

We see MediCal and Medicaid patients for various reasons. We certainly see stimulating cases, patients with very complicated problems. It’s a challenge. It keeps the practice interesting.

It also builds relationships with referring physicians. At a medical meeting recently, a physician who practices in an area of predominantly poor African American and Hispanic patients came up to me and said, “I really want to thank you for seeing my patients. You’re the only private dermatologist in San Francisco who sees these patients.”

Our practice reflects the very diverse population in San Francisco, which includes South and Central Americans, Hispanics, Filipinos, Hmong, Mien, and a very large and special Chinese American population. Our office has 14 excellent employees, and 12 are Filipino. One is a Laotian Mien. Our newest physician associate speaks fluent Mandarin and Cantonese.

You keep a pulse on your community when your staff and your patients reflect the place in which you live. We might see a Chinese American MediCal patient who comes in with a young child. Ten or 15 years later he or she may come in as a patient and you ask the child, who is now a young man or young woman, “Where are you going to school?” The answer may well be Harvard, Yale, or Stanford. This generational leap in our San Francisco population is quite spectacular.

We belong to the Chinese Community Health Plan, which is an HMO, and On Loc, a patient service for the elderly indigent. Needless to say, our Asian American physician friends, who often have practices in Chinatown as well as at California Pacific Medical Center, one of our best hospitals, tend to send us their higher-income patients because they appreciate the fact that we also see their lower-income patients.

I’m from the Midwest originally, and I realize that every place is not like San Francisco and every practice cannot provide unreimbursed care in exactly the same ways we do. But I will say that providing free care has benefitted us in innumerable and unexpected ways.

The rewards are many, and I would hope that all dermatologists, in some way or another, will give some thought to providing free care for needy patients.

Further, I urge the American Academy of Dermatology to administer a program of free care for the medically indigent. Every participating dermatologist would care for a reasonable number of free patients. The program would benefit patients and the specialty.

DR. DENNY L. TUFFANELLI is a dermatologist in a private practice in San Francisco.

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