Well, we’re cheaper than the alternatives. Some of our patients might go to the emergency room, which can cost thousands, just for a simple cold. Some may stay home and let their problems get worse.
But most would try to make an appointment at a clinic that’s part of the system called the Federally Qualified Health Centers. This is a nationwide network of safety-net clinics that receive twice as much government funding per visit than private doctors like me. Not only they get more money, but by law, there can only be one in each area.
That means they have a monopoly on special funding for the poor. And like any monopoly, there’s a tendency for cost to go up and quality to go down. I’m not a government entity; I’m not a nonprofit. I’m a private practice. I have a capitalist drive to innovate. I have to be fast and friendly. I have to be cost-effective and culturally sensitive.
I have to be tall, dark and handsome. And if I’m not, I’m going out of business. I can innovate faster than a nonprofit, because I don’t need a meeting to move a stapler. Really, none of our innovations are new or unique — we just put them together in a unique way to help low-income folks while making money.
And then, instead of taking that money home, I put it back into the refugee community as a business expense. This is Mango House. My version of a medical home. In it, we have programs to feed and clothe the poor, an after-school program, English classes, churches, dentist, legal help, mental health and the scout groups. These programs are run by tenant organizations and amazing staff, but all receive some amount of funding form profits from my clinic. Some call this social entrepreneurship.
I call it social-service arbitrage. Exploiting inefficiencies in our health care system to serve the poor. We’re serving 15,000 refugees a year at less cost than where else they would be going. Of course, there’s downsides to doing this as a private business, rather than as a nonprofit or a government entity. There’s taxes and legal exposures.
There’s changing Medicaid rates and specialists who don’t take Medicaid. And there’s bomb threats. Notice there’s no apostrophes, it’s like, “We were going to blow up all you refugees!” “We were going to blow up all you refugees, but then we went to your English class, instead.”
Now, you might be thinking, “This guy’s a bit different.” Uncommon. A communal narcissist? A unicorn, maybe, because if this was so easy, then other doctors would be doing it.
Well, based on Medicaid rates, you can do this in most of the country. You can be your own boss, help the poor and make good money doing it. Medical folks, you wrote on your school application essays that you wanted to help those less fortunate. But then you had your idealism beaten out of you in training.
Your creativity bred out of you. It doesn’t have to be that way. You can choose underserved medicine as a lifestyle specialty. Or you can be a specialist who cuts cost in order to see low-income folks. And for the rest of you, who don’t work in health care, what did you write on your applications? Most of us wanted to save the world, to make a difference.
Maybe you’ve been successful in your career but are now looking for that meaning? How can you get there? I don’t just mean giving a few dollars or a few hours; I mean how can you use your expertise to innovate new ways of serving others. It might be easier than you think.
The only way we’re going to bridge the underserved medicine gap is by seeing it as a business opportunity. The only way we’re going to bridge the inequality gap is by recognizing our privileges and using them to help others.