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HL20: Ellen Beck, MD—Giving Life to Hope in the Desert of the Underserved

 |  By cclark@healthleadersmedia.com  
   December 13, 2012

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Ellen Beck, MD.

This profile was published in the December, 2012 issue of HealthLeaders magazine.

 

 "Our students come in to medicine with passion and compassion. And programs like this keep those emotions alive."

Ellen Beck, MD, has long held the funny notion that healthcare should be a right, not a privilege just for those who can afford it. "I'm from Canada," the clinical professor in family medicine at UC San Diego Medical Center says with a laugh.

Years after participating in a Southern California conference on "humanizing medical education," she was offered a job as director of Medical Student Education for the Division of Family Medicine in the Department of Family and Preventive Medicine at UC San Diego, where she also would treat patients.

But once she arrived, she recalls, "I saw a desert of access to care for the underserved, and it was very troubling to me."

The area's safety-net program income thresholds left many uninsured patients falling through the cracks. Many of them had jobs, but made just a bit too much—the cutoff was 133% of the federal poverty level—to be eligible for government health programs, she says.

Many of her medical students saw the same thing. They came to her asking if they could provide free care to these underserved patients, arguing they both would benefit from the experience.

For the students and Beck and of course the patients, those goals came together in 1997. What started as a classic grassroots effort became the UCSD Student-Run Free Clinic Project for the underserved in a beach area church, at first using money from student bake sales, along with university support.

"Everyone was baking muffins for the free clinic," she laughs. "And if we ran out of supplies, we'd hold another bake sale."

Fifteen years later, the clinic has expanded to four sites within San Diego, two of which run during off hours out of community churches and two in public elementary school buildings.

"Our students come in to medicine with passion and compassion," Beck says. "And programs like this keep those emotions alive. It gives them a sense of ownership and reminds them why they wanted to become doctors. They learn how to build relationships with their patients."

The clinics operate once or twice a week at each site, helping some 2,000 regular clients a year, 1,000 of whom receive medical care for chronic illnesses. Another 1,000 access the clinic's legal, social work, dental care, and acupuncture services provided by health professionals and students in the area. That's key to the program, Beck says.

Many of the patients receiving medical services also benefit from other types of assistance because, Beck says, providers need to treat the "whole" patient.

Beck emphasizes what she calls "a humanistic empowerment" approach, which she says helps these future doctors understand the social determinants of disease, such as issues in patients' living situations, their levels of stress, and even their job situations.

The clinics' patients have an array of common or chronic illnesses, from high blood pressure to diabetes, heart disease, asthma, and depression. 

Foot and eye exams for patients with diabetes, renal function status checks, wound care, "all our services are completely free to the patient," Beck says. "With students' passion and commitment, we've been able to help patients with cancer deal with challenges to securing surgery and care, and have had some success that led to patient cures," she adds.

The entire medical portion of the operation is funded with about $1.5 million a year from foundations, private donations, and the medical school. But millions more come from in-kind contributions such as discounted lab testing and volunteering doctors.

By filling this gap, the clinics not only lift a costly burden from acute care hospitals and clinics in the area, but also spawned a federally funded training program, through which Beck teaches like-minded physicians how to start similar clinics in their cities. At least 10 successful free clinics have been created, many by former students.

Getting the clinics started was tough at first. UCSD officials had questions.  "They were appropriately wary of the level of quality we would provide in the basement of a church," Beck says. "And, of course, they wanted to be sure that every medical student would absolutely be supervised as they provided care to these patients," she says.

But from the start, Beck was committed to tight supervision, and she kept that promise. A diverse and expanding array of doctors and other practitioners, many of whom are former students who have returned as volunteer faculty, help oversee the students regularly.

While medical student participation is elective, the clinics are a popular choice. Of the 460 future doctors in UCSD's combined four-year program, at least 250 make the clinic part of their credit experience. In their fourth year, the clinic fulfills requirements for a family and underserved medicine clerkship.

"We are very grateful for the support of our community- and health professional-partners, as well as the core support of the university," she says.

If it weren't for the free clinics, Beck says, "patients with no resources would have almost nowhere to turn. It makes me sad that a nation as wealthy as ours has not matured sufficiently to realize that healthcare is a right. Until then, we will do whatever we can to create environments where individual patients take charge of their health and achieve well-being, while we do our best to inspire the next generation of health professionals."

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