As Lisa Smolski walks through the cheerful yellow hallways of the Rhode Island Free Clinic’s new space on the third floor of 655 Broad St. in South Providence, she beams with pride.
The new space is 4,000 square feet larger than the space the clinic had occupied in the basement of the same building until seven months ago. It’s brighter too, being on the third floor with large windows on all the outside walls.
But more important, said Smolski, the clinic’s executive director, the space has increased the number of patients the clinic can handle.
The next challenge, she said, is finding more volunteers – including doctors, nurses, medical assistants, interpreters, psychologists, psychiatrists, social workers and non-medical volunteers – to make the most of the available space and serve as many patients as possible.
The clinic, which provides free primary care and mental health services to the uninsured, has about 1,600 patients on its active roster, and on the first Thursday of each month, it holds a lottery to accept a few more. Last month, it accepted a record 24 new patients.
“That’s more than twice the number we could have done in the old clinic,” Smolski said, adding that the old clinic averaged about eight to 10 new patients per month, depending on the number of volunteers available to provide care.
Yet the clinic is also turning away more patients than ever. Prior to the move, the clinic was turning away just over half – 10 to 12 – of the people at each month’s lottery. Now it’s up to 38 to 40 uninsureds per month, Smolski said, as more are seeking the clinic as a source of care.
Part of the increase in demand might be due to increased awareness of the clinic’s services because of publicity for the new space, said Jessica Knapp, a VISTA volunteer and communications coordinator for the clinic.
Smolski agreed, but said she thinks the jump in new patients seeking care also might be a byproduct of patients dropping off RIte Care since the state adopted strict federal citizenship and identity verification requirements at the beginning of the year. Smolski said other health care providers also have seen a spike in the number of uninsured patients in recent months.
Gov. Donald L. Carcieri’s budget for fiscal 2008 anticipates a 5,750-person reduction in the RIte Care rolls due to the new requirements. In January and February – the first two months under the new rules – the RIte Care rolls declined by 3,437 to 112,636, state figures show.
Lacking enough volunteers to meet the increased demand, the clinic is ramping up its recruitment efforts this month. Knapp and other clinic staff members are setting up information stations at busy lunchtime hours in hospital cafeterias across the state in hopes of raising awareness of the clinic’s need for practitioners to donate a few hours per month.
The recruitment efforts are something the clinic has never had to do before, she said. Before the move, the clinic had to turn away volunteers because it lacked the space to accommodate them. The clinic currently has more than 200 volunteers, but most come once a month for a block of three to five hours after work.
Getting primary care doctors to donate their free time is another challenge in the recruitment process because they are “the ones who are most squeezed right now because of what’s going on in health care,” Smolski said. Primary care doctors are paid far less than specialists, so they carry heavy patient loads to compensate and often have very little free time.
“We’re looking specifically for [health care] providers, but we can really put anyone to work,” Knapp said. “But of course providers, nurse practitioners and physicians, will allow us to increase our patient base immediately.”
The clinic has the space. It has seven exam rooms, as opposed to the three it had before. It also has five mental health counseling rooms, whereas before the counseling took place in a small alcove. The new space also has a small pharmacy area, a volunteer lounge and conference room, a patient and family waiting room, a community resource area equipped with computers, tables and chairs, and a small kitchen for cooking demonstrations.
And each of the exam rooms and counseling rooms is equipped with computers for the electronic medical record system the clinic is implementing. The software and the training were donated by eClinicalWorks with the help of the Rhode Island Quality Institute, which approached the software company on the clinic’s behalf.
The clinic also increased its staff by adding a full-time clinic manager in addition to its full-time medical assistant and part-time registered nurse, Smolski said. They are busy setting up policies and procedures to make the new clinic run more efficiently.
The clinic sees patients 12 nights a month – 10 for general primary care, plus a women’s clinic and a diabetes clinic. To make the most of each session, the volunteers are being organized into teams with a provider, a medical assistant and shared interpreters and nurses. Each team will have two rooms so that the medical assistant can take the patients’ vital signs and medical history while the doctor examines patients, as is done in most primary care offices.
The system will allow the clinic to see more patients, Smolski said. And it’s a better use of the volunteers’ time.
“Our goal is to have every clinic session … running full tilt with a full staff of volunteers,” she said. “And then look to add another night or add an afternoon.”
