Establishing and Maintaining a Volunteer Charity Rheumatology Clinic: One Clinic’s Experience

Background/Purpose: In 2015, about 16% of adults under age 65 in Tennessee were uninsured. While there are options available for patients to receive primary care (health departments and faith-based benevolent clinics), there were limited options for rheumatology care, creating serious health risks for these patients. We set out to establish volunteer charity clinic to provide consultation and management for adult rheumatology patients who are uninsured.

Methods: The St. Sampson medical clinic was established as a 501c3 nonprofit organization, operating one Saturday per month since 2012. It’s yearly budget of $15,000, mostly for malpractice coverage, and clinic space was donated by the Lupus Foundation of America Mid-South Chapter, Tennessee Rheumatology Society, and Holy Trinity Greek Orthodox Church. The clinic has three Vanderbilt providers, two rheumatologists and a nurse practitioner, and other volunteers for intake. It uses an encrypted, password-protected electronic medical record designed for the clinic and HIPPA-compliant efax to communicate with referring providers. Clinic flow is shown in figure 1.

Results: As of May 2017, we have provided 1538 visits to 560 patients from 33 counties in Tennessee, Kentucky and Mississippi. The majority of diseases treated include rheumatoid arthritis/ other inflammatory arthritis (46%), lupus/ other connective tissue diseases (15%), fibromyalgia syndrome (11%), and psoriatic arthritis (7%). We have secured over $500,000 in free medications, largely for biologic agents through patient assistance programs. We estimate we have donated $186,703 in professional fees (consultations: $94,080; return visits: $92,623) to our patients.

Conclusion: We have been able to establish and maintain a successful volunteer charity rheumatology clinic with limited resources which has provided much needed care for rheumatology patients. Rheumatology is unique as a specialty as clinical history and physical examination play a majority role in diagnosis which was an important factor in being able to establish and sustain a volunteer charity clinic.