Barriers and Motivating Factors Associated with Volunteering at Local Free Clinics: A Survey of UF Faculty Physicians

Brian McDanielUniversity of Florida Masters in Public Health Student

Internship Special Project PaperSummer 2014

Internship Preceptor:Dr. Robert Hatch, MD

Faculty Advisors:Dr. Nancy Hardt, MD

Dr. Mary Peoples-Sheps, DrPH

Contributors & Team Members:Martin Wegman

Adam GrippinRonak Gandhi

Vishal PatelGabby Tom

Donna Berezowski

Abstract:The Equal Access Clinic Network is a network of four weekly student-run free clinics that

provide about 1900 patient visits per year to the medically underserved populations of Gainesville. As the network has expanded there has been a growing shortage of volunteer physicians which has limited the quality and quantity of care provided. A survey of UF-Shands faculty physicians was performed to gain a better understanding of what factors motivate them to volunteer and what factors act as barriers to volunteering. The participants ranked “giving back to the community” and “providing care to the medically underserved” as the biggest motivating factors while “concerns about malpractice coverage” and “a lack of familiarity with local free clinics” were the highest rated barriers to volunteering. When asked if departmental incentives would increase their frequency of volunteering, about two thirds of the participants answered yes or maybe.

Equal Access Clinic Network Background:The Equal Access Clinic Network is a network of four weekly free clinics that operate

throughout Gainesville Florida. Each of the clinic sites is student-run under the supervision of faculty members. The mission of the Equal Access Clinic Network is to “improve the physical, mental and social well-being of all, by enhancing access to high quality, comprehensive, patient-centered care” [7]. Equal Access first opened its doors in 1992 and since then has steadily expanded from one weekly primary care clinic location to four.

Equal Access offers a variety of primary care services as well as laboratory work, prescription vouchers, and referrals to specialty medical services. All services are free of charge to patients. Over the last two decades Equal Access has also created various specialty clinics. Equal Access now has a weekly Physical Therapy Clinic, weekly Free Therapy (mental health) Night, weekly Occupational Therapy Clinic, monthly Women’s Health Night and Monthly Dental Clinic. The clinic network has an operating budget of about $30,000 per year which is collected through county funding, grants, donations, a yearly 5K race and various other fundraisers.

The network provides about 1900 primary care patient visits per year to the medically underserved populations of Alachua County. These clinic sites also provide over 10,000 hours of hands on clinical experience every year for medical, physician assistant, pharmacy, and pre-med students. A 2012 patient satisfaction survey conducted by Dr. Nancy Hardt MD, Brian McDaniel et al. shows the impact Equal Access has on local hospitals. 28% of patients reported that they would have been “Very Likely” to go to the Emergency Department if Equal Access did not exist [6]. This suggests that Equal Access prevents about 500 unnecessary ED visits per year.

Need for the Project: Over the last decade the Equal Access Clinic Network has steadily expanded from one

primary care clinic site to four. Unfortunately, as the network has expanded it has become increasingly difficult to staff the clinics with faculty volunteers. The advertising and recruitment efforts by medical student officers have not kept pace with the expanding number of available faculty volunteer positions. Additionally, in 2013 a UF-Shands after-hours primary care clinic was opened. This new requirement for nighttime hours limits the nighttime availability of many

physicians from Family Medicine, Emergency Medicine and Internal Medicine. As a result, the pool of faculty volunteers has not expanded substantially in recent years and many spots go unfilled. Equal Access is open nightly Monday through Thursday, but does close for certain national and academic holidays. This means that EACN has about 180 total clinic days per year. As each clinic would prefer to have at least 2 providers per night, there are about 400 faculty volunteer positions to be filled each year. Not having enough providers is important, because the number of physician volunteers is the limiting factor for providing care. There is almost always a surplus of interested patients, student volunteers, community resources and financial resources. This means that the number of providers available is the biggest determinant of the quality and quantity of care provided.

Having a shortage of providers significantly impacts the quality and quantity of care that can be provided. When no providers can be found, clinic must be closed and all patients are turned away. Being understaffed also inhibits the clinics from providing high quality care efficiently. All of the clinics would prefer to have at least 2 physicians, because it allows the clinic to take more patients and run more efficiently. However, clinics are frequently forced to hold clinic with a single provider. Having one provider means more patients must be turned away (a lower patient “cap” is set”) and wait times are much longer. Having patients wait two hours to be seen is not unheard of and patients have complained in the past. In a recent patient satisfaction survey 34% of patients rated the wait time as “poor” or “fair” [8]. Having a single provider also leads to clinic staying open later. This means that student and faculty volunteers are required to stay longer. Theoretically clinic should close no later than 9:00pm, but when the clinic is understaffed it is not uncommon for clinic to stretch to 10:00pm or 11:00pm. Therefore, a volunteer shortage may itself be a cause of future volunteer shortages as volunteers get burned out by longer hours. It is much easier to get providers to volunteer if it means a two hour time commitment instead of a 4 or 5 hour time commitment.

Needs Assessment:Although there has been growing awareness of the provider shortage among Equal

Access student officers and faculty volunteers, there has been no data collection on the topic. Therefore, this project began with a needs assessment related to faculty physician volunteers. This data was used to help better understand the scope of the issue and the “resources” available for solutions. Current recruitment, advertising & scheduling practices by Equal Access were also investigated.

The first step was determining how many physicians there are in Gainesville. According to the “Find A Doctor” feature on the Shands website, there are 936 faculty physicians affiliated with the UF-Shands Gainesville campus. In 2013, 56 of them volunteered at least once with Equal Access which translates to a relatively low participation rate of 5.7%. This suggests that there is a lot of room for improvement for the recruitment and advertising procedures. Additionally, Equal Access can recruit and legally protect physicians from outside of the UF-Shands network. Alachua County has over 1700 physicians and about 3 times as many doctors per 10,000 citizens as the statewide average [1]. In 2013, there were only 3 physician volunteers who were unaffiliated with the Shands-UF. This suggests that Equal Access has not

tapped into the pool of physicians in the community. A 2009 New England Journal of Medicine survey shows that 73% of physicians agree that “every physician is professionally obligated to care for the uninsured” [9]. Therefore, it is likely that a large percentage of the county’s physicians are at least open to the idea of volunteering. There are also mechanisms by which Equal Access can legally protect Physician Assistants and Nurse Practitioners. However, these types of providers have been recruited sparingly in the past and in 2013 there was only one PA volunteer and no NP volunteers. These results suggest that there is an abundance of potential providers in the area and that the provider shortage could be corrected if advertising, recruitment and scheduling procedures were expanded to reach providers that have not historically been associated with Equal Access.

Informal interviews of medical student officers and faculty volunteers were performed to collect information about how Equal Access currently advertises, recruits, and schedules provider volunteers. These informal interviews were performed in person and via email. The results suggest that very few resources are currently dedicated to the effort and that there has not been any coordinated effort between different clinic sites to address the physician shortage.

In theory, the recruitment of provider volunteers should be carried out by the medical student officers who run the individual Equal Access clinic sites. However, the advertising and recruitment effort of student volunteers has been largely non-existent and/or unsuccessful in recent years. In reality, most of the faculty volunteers are recruited via word of mouth by current physician volunteers. Relying solely on the efforts of a small number of current faculty volunteers to handle all of the recruitment is not a sustainable solution and puts an unneeded amount of stress on those volunteers. The students must take over the role of provider recruitment if the provider shortage is going to be addressed.

There is a wide variety in the frequency of volunteering among the providers. Some of the physician volunteers only once a year, while others volunteer multiple times each month. Physician volunteers do not receive any compensation for their volunteer efforts. There are also no formal incentives for faculty members to volunteer. However, the UF-Shands Emergency Department does informally incentivize volunteering by considering it during the end of year evaluations which determine qualifications for certain bonuses. No other department currently incentivizes volunteering, but some department chairs support the clinic network by encouraging volunteering.

Each of the four Equal Access clinic sites handles their own provider scheduling. There is no centralized physician schedule and each clinic keeps these records in a separate location without a standardized format. Each clinic does a little recruitment on its own but these efforts are not coordinated between clinics. This often results in clinics sending redundant recruitment emails to the same physicians. This has led to complaints in the past. Although all four of the clinic sites have successfully recruited some new physician volunteers in recent years, a majority of available volunteer spots are filled by a core of dedicated faculty volunteers who have been with Equal Access for many years. The clinics have not been unable to recruit new

volunteers at the same rate that they lose physicians from this volunteer pool. The problem has been further exacerbated by the addition of new clinic sites in recent years which have increased the demand for provider volunteers.

Historically physician recruitment and scheduling has been a secondary concern within Equal Access. For a majority of its existence, there has not been a student officer position dedicated solely to recruiting faculty volunteers. Equal Access attempted to remedy this situation over the last two years by creating a “Physician Recruiter” position. However, the efforts of the individuals which held this position were largely unsuccessful and over that two year period less than a half dozen new physician volunteers were recruited. These recruitment efforts were largely limited to listserv emails that were sent to dozens or hundreds of physicians at once. This type of email recruitment had an extremely low success rate. The students who held this position reported that the job was simply too big for a single person to handle and that the fragmented nature of the clinic network prevented a cohesive collaboration between different clinic sites. The communication between different clinic sites was limited and the students tasked with physician recruitment felt like they did not have enough resources available for the project. There was also a lack of data to guide these recruitment efforts. Additionally, there were no established procedures or protocols for these students to build on.

To better understand the scope of the physician shortage data on the number of physician volunteers was collected and analyzed. Data was collected as far back as September of 2012, which is when the fourth Equal Access Clinic Network site first opened. The “Nightly Email Reports” from each of the four clinics was identified by combing through the Equal Access listserv emails over the 18 month period (240 clinic days). These Excel sheets which are filled out by officers each night were collected, organized and labeled according to clinic site and date. This data was cross referenced with the separate Google Doc volunteer schedules each clinic utilizes to help fill in gaps where data was missing. For nights when no clinic was held it was determined why clinic was canceled by checking the schedules, looking through listserv emails from that week or asking clinic officers directly. This data was used to help differentiate between nights where clinic was closed because no provider could be found and nights where clinic was closed for some other reason (such as a school holiday). All of this data was then entered into an Excel sheet. The database included the number of providers, name of providers, type of provider (MD/DO, Resident, PA), facility the provider is from (UF-Shands, VA, Community, Retired) and medical specialty/department for each clinic night over the 18 month period. This data was then analyzed using Microsoft Excel to identify trends.

Table 1: Summary of Overall Clinic Data from 9/24/2012 through 3/9/2014Tower Road GCM Bartley Temple Main St. All Clinics

Number of Times Clinic Closed Because an Attending could not be found 10 4 3 0 17% of Dates Where Clinic Closed because a Provider Couldn’t be Found 15.15% 5.80% 4.76% 0.00% 6.54%Average Number of Providers Per Night 0.95 1.28 1.52 2.95 1.65% of Clinic Days that Have Less than 2Providers (AKA Understaffed) 89.39%

69.57% 42.86% 1.61% 49.71%

Number of Different Providers that have Volunteered at this Site 12 15 28 103 158* GCM = Gainesville Community Ministries

An overall summary of the data from this needs assessment is provided in Table 1. The most important figures listed above are the percentage of nights which had to be canceled because no provider could be found and the percentage of clinic nights which were understaffed (zero or one provider). During this time period about 7% of all clinic nights had to be canceled because no provider could be found and that number was as high as 15% at the Tower Road location. A total of 12 clinic nights had to be canceled for this reason in 2013. Additionally, about 50% of clinic nights were classified as being understaffed (<2 providers). This data clearly supports informal complaints from medical student officers that there is a severe provider shortage.

In order to put the physician shortage in perspective, we tried to quantify the impact it has on patients. Some basic calculations were done to project how many patients would have been seen if Equal Access had an ideal number of physician volunteers (2 every single Monday through Thursday). Since Equal Access averages about 9 patients per clinic nights, it is projected that there would have been about 100 more patient visits in 2013 if clinic had not been closed 12 times. Clinic officers from each site also report setting the patient “cap” (maximum number of patients that are taken before patients are turned away) much lower when there is only a single provider. For these calculations we estimated each clinic night that was understaffed would have seen about 3 more patients if it were properly staffed. This is a very conservative estimate as most providers feel comfortable seeing 6-8 patients per night and we almost always turn more than 3 patients away. There were 84 clinic nights that were understaffed in 2013 which amount to 250 more patient visits. These calculations suggest that Equal Access would have provided at least 350 more patient visits in 2013 if there had been an adequate number of provider volunteers. That would have been an 18% increase in the total number of patient visits provided in 2013. The quantity of care provider by Equal Access is particularly important because many patients are turned away each night and many of these patients have nowhere else to receive medical care.

The data also shows a striking difference between clinic sites. The Main St. clinic location averages about 3 providers per night while the other 3 clinics collectively average about 1.5 providers per nights. The Tower Road location averaged less than 1 provider per night (had 1 provider most nights it was open and had to close often because no provider could be found). These results suggest that one way to address the physician shortage would be to redistribute some of the provider volunteers from the Main St. location to other clinic sites. This idea was brought to the Main St. clinic officers, but these officers were very resistant to the idea for fear of slowing their own clinic operations. The clinic site at Main St. has fewer problems scheduling providers because it is the oldest clinic location and has formal agreements with multiple departments within Shands. These departments agree to provide a predetermined number of volunteers each month. In effect, the Main St. location does not have to do any recruiting as the departments take care of it for them. The other 3 clinic sites have been unable to arrange similar partnership and therefore have to recruit individual physicians one at a time. Numerous conversations with leaders from various departments within UF-Shands suggest that creating arrangements like Main St. has with anymore clinics is not feasible as they are already stretched thin trying to cover a single clinic.

Table 2: Hospital Affiliation of Provider Volunteers, 9/24/2012 to 3/9/2014

* This data presents the hospital affiliation for all 430 of the provider volunteer spots that were filled from 9/24/2012 to 3/9/2014. This means that individuals who volunteered more than once in the study period were counted multiple times. * “Community” represents providers who are not affiliated with UF-Shands or the VA hospital

The data presented in Table 2 shows that about 93% of provider volunteer spots are filled by UF-Shands faculty. This may means that the adjacent VA hospital and other community clinics/hospitals are untapped resources that are currently not being recruited. One way to address the physician shortage may be to expand the geographical “footprint” of the recruitment effort. If additional steps are taken in advance, Equal Access can provide malpractice coverage for any physician.

Table 3: Percentage of Total Volunteer Spots Filled by Each Specialty/Department from 9/24/2012 to 3/9/2014

* The above calculations count the specialty/department of each of the 148 providers who volunteered at least once between 9/24/2012 and 3/9/2014. The specialty for each volunteer was only counted once regardless of how many times they volunteered during the study period.

The data in Table 3 shows that about 75% of all Equal Access provider volunteer spots are filled by physician from only 3 departments. This is intuitive as Equal Access is a primary care clinic and these 3 specialties are considered the primary care specialties. Equal Access would prefer to have physicians from these departments because they are most qualified to see the types of patients that frequent clinic. However, these results also suggest that other specialties and departments are not being recruited adequately. Physicians from many other specialties feel comfortable seeing primary care patients, especially if they are paired with a primary care physician at clinic. In this way physicians from non-primary care specialties can hand off any cases they don’t feel comfortable taking themselves. There are about 400 volunteer spots a year for Equal Access to fill and relying solely on 3 departments to fill all of those spots is unrealistic. The only way for the physician shortage to be addressed is to reach out to departments that have not historically been associated with the Equal Access Clinic Network.

Table 4: Level of Training for Provider Volunteers, 9/24/2012 to 3/9/2014

* The above calculations count the specialty/department of each of the 148 providers who volunteered at least once between 9/24/2012 and 3/9/2014. The specialty for each volunteer was only counted once regardless of how many times they volunteered during the study period.

The data presented in Table 4 shows that nearly all of the providers for Equal Access are MDs or residents (have MD degree but have not yet finished their residency training). Equal Access can have Physician Assistant and Nurse Practitioner volunteers legally covered for malpractice, but this option is currently not being utilized. This suggests that reaching out to

these disciplines in the future could be one mechanism for addressing the provider shortage. The numbers presented above suggest that Equal Access is doing an adequate job of recruiting and scheduling resident physicians. However, 98% of all resident volunteers volunteer at a single clinic site (Equal Access at Main St.). The other three clinic sites essentially have no resident volunteers. Therefore, these three clinic sites could improve their resident recruitment substantially.

After the initial needs assessment was performed a system was devised to allow for continued data collection. This data will allow for continued monitoring of the physician shortage and give the student officers a way to determine if new recruitment techniques are correcting the shortage. An undergraduate volunteer was recruited, selected and trained to carry out this project. This data set has already been updated through June 2014 and the student carrying out the project plans to continue working on it and make the results available to the Equal Access board of directors for 2 more years. This is one of the first steps in finding sustainable long term solutions to the physician shortage.

Mobile Outreach Clinic Background:This paper focuses primarily on the Equal Access Clinic Network. However, other safety

net clinics in the area are experiencing similar problems. Specifically, the Mobile Outreach Clinic works very closely with Equal Access and even allows Equal Access to hold clinic on the “bus” two nights a week. The Mobile Outreach Clinic is currently encountering increasing difficulty in recruiting volunteer physicians. Therefore, the below survey was conducted using terms that are not clinic-specific. General terms such as “local free clinic” were used in hopes of making the results generalizable to the Mobile Outreach Clinic and other local free clinics.

Gainesville’s Mobile Outreach Clinic began when the University of Florida donated a bus that had previously been used for the MOMobile program. The MOMobile bus operated from 1992 until 1999 and had the mission to reduce low birth weights and infant mortality in Putnam and Hamilton Counties. The 1992 Blue Bird 37-foot bus has two examination rooms, one bathroom and a work-up station. Upon receiving the bus, the medical student run free clinic Equal Access expanded and began holding weekly clinic on the bus in January 2010. UF medical students recruited volunteer physicians, nurses, and social workers to supplement the student volunteers. By February 2010, the local safety net taxing district (Choices) and the University of Florida College of Medicine began aiding the mobile clinic financially. With their support, daytime clinic locations were added to the weekly schedule. These clinic locations continue to utilize 2-3 student volunteers, but the daytime clinic hours are organized by the Mobile Outreach Clinic staff instead of the students. Medical students continue to run two weekly night time clinic locations on the bus, while the paid staff organizes the four daytime locations.

The Mobile Outreach Clinic locations where selected specifically to address “hot spots” that were identified on GIS maps for births to teenagers, Medicaid births, low birth weight births, domestic violence and child maltreatment in Alachua county. Some trial and error was used to determine the best locations for the bus within these “Hot Spots.” Numerous locations were attempted until Mobile Outreach Clinic Sites were identified that would place the clinic at

maximum patient capacity. Most of the current clinic sites are located at Apartment Complexes and local libraries.

By bringing the clinic directly to the neighborhoods being served the barrier of obtaining transportation is greatly diminished. Analysis of intake data conducted in 2012 by Dr. Nancy Hardt MD & Brian McDaniel shows how important this is to the Mobile Outreach Clinic. This data showed that 33.9% of Mobile Outreach Clinic patients walked to the clinic and 2.1% rode a bike to clinic. Some of the clinics are located in rural areas were walking is not an option, but other locations have up to 75% of the patients walk to clinic. This is particularly important because the area of highest need identified by the GIS mapping is located in Southwest Gainesville. This area is three separate bus rides away from the Health Department. If it were not for the Mobile Clinic, uninsured patients in this area without transportation of their own would be effectively isolated from healthcare access.

According to the 2012 patient intake data, 73.8% of patients that visit the Mobile Clinic do not have medical insurance. About 18% of patients seen have Medicaid coverage, 1.2% have Medicare coverage and 7% have some other type of medical insurance. Because a large majority of patients do not have insurance, services provided by the Mobile Clinic are free to the patients. The Mobile Clinic offers primary care services, health screenings, family medical services, well women check-ups, contraception and some on site lab services. The Mobile Clinic also provides referrals for services such as smoking cessation, legal services, X-rays and domestic violence services.

Literature Review:The Functional Approach to Volunteerism assumes that individuals volunteer for

purposeful, goal-directed reasons [4]. In other words individuals chose to participate in a planned behavior, such as volunteering, in order to satisfy specific personal desires. Successful volunteer recruitment and retention relies on matching the goals of the volunteers with the opportunities offered by the organization. Therefore, understanding what goals potential volunteers have is very important to the success of an organization that relies on a volunteer workforce. Clary et al broke down motivational factors for volunteering into 6 distinct groups [4]. People choose to volunteer due to their values, understanding (or learning experiences), social aspects, career advancement, enhancement (personal development/growth), and/or protective feelings for the population served. From these 6 factors a 30 question survey called the Volunteer Function Inventory was developed to help organizations better understand why their volunteers chose to volunteer.

There is a small amount of literature on the topic of physician volunteering that was used to guide the development of this survey. Previous surveys and interviews of physicians who volunteer at free clinics have identified a common set of motivating factors and barriers to volunteering. Peer influence, giving back to the community, providing care to the medically underserved, and career advancement have been identified as key motivating factors [2, 6]. A lack of time, concerns about legal coverage, lack of awareness, and concerns about continuity of care have been identified as barriers to volunteering [2, 6]. Another study of physicians who

volunteered to teach medical students rated personal satisfaction and enjoyment related to teaching as being a stronger motivating factor than reimbursement or other incentives [3]. Since volunteering at Equal Access involves also working with students we will also want to include these teaching opportunities in our list of potential motivating factors.

Purpose & Objectives:The purpose of this survey is to better understand the faculty physician’s perspectives

on volunteering with the Equal Access Clinic Network and other local free clinics such as the Mobile Outreach Clinic. It is particularly important to understand what factors motivate physicians to volunteer so those things can be emphasized during the recruitment process. We also want to understand what barriers inhibit physicians from volunteering so that these factors can be addressed. We hope that this knowledge will help improve future recruitment efforts and decrease the physician volunteer shortage.

MethodsSurvey Design & Content

The survey includes four multiple choice questions, two free response questions and two questions where the physician is asked to rank a list of items in order of importance. There is 2 open-ended question and 5 closed-ended questions. The survey (Appendix C) is derived from the Volunteer Function Inventory (VFI), but substantial changes were made to make it more applicable to the free clinic setting. Past surveys dispersed through the faculty council have had very low response rates if they were more than a half dozen questions. Faculty physicians are extremely busy and would be unlikely to fill out a 30 question survey. Therefore, the 30 question VFI had to be condensed considerably. Additionally, the VFI is meant to be given to current volunteers and focuses on the factors that motivate them to volunteer. The survey we created was sent to current volunteers as well as physicians who have never volunteered before. This means that some alterations had to be made. While the VFI focuses mainly on the motivating factors for volunteering, we also hope to identify the barriers to volunteering. Therefore, we added a question about the barriers to volunteering. The different motivating factors also had to be modified to better represent the medical field and an academic activity. Finally, there are some specific questions which are unique to the Equal Access Clinic Network which were asked on the survey such as the physician’s familiarity with Equal Access.

In question number 1, the physicians were asked to assess the level of familiarity with Equal Access in their department. We knew that individuals who have volunteered in the past were more likely to participate in the survey and that is why we worded the question like this. Rather than asking about the participants personal familiarity with Equal Access (which could be skewed by the fact that more current volunteers were expected to participate in the survey), we asked the survey participants to estimate the level of knowledge within their entire department. The results of this question will be used to assess the advertising efforts of Equal Access. In question 2, they were asked to rank 5 factors that motivate them to volunteer. These 5 motivating factors were chosen by selecting key topics from the Volunteer Function Inventory and factors identified as being important to physician volunteers in the literature [2, 3, 6].

Question number 3 asked the physicians to rank 5 barriers to volunteering from most important to least important. The list of 5 barriers was created by referencing the identified barriers in other similar studies [2, 6].

Question number 4 asked participants to report if the presence of departmental incentives would increase their frequency of volunteering. This information will be used to assess the impact of potentially including volunteerism in the end of year evaluation process. One department (Emergency Medicine) has already implemented an informal incentive for volunteering, and the results of this question will help us determine if expanding this practice to other departments would increase the rate of volunteering. Question number 5 is a free response question where physicians will have an opportunity to give suggestions of their own. This question may offer novel ideas for addressing the provider shortage, and give us a new perspective on the problem. Question number 6 asked participants if they have daytime availability. We will use this information to determine what percentage of UF-Shands physicians could volunteer during the daytime Mobile Outreach Clinic even if they had a desire to. Question 7 is a free response question that asked the participant which department/specialty they are in. We asked this question so that we can spot trends between different departments. Since Equal Access has historically been most closely associated with the primary care specialties, we expect there to be some difference in answers between those departments and non-primary care departments.

PopulationParticipants must be licensed MD or DO faculty physicians at the University of Florida. In

the future we would like to expand recruitment to PA & NP providers, but some issues related to malpractice coverage must be ironed out before we can begin recruitment of these providers. We also plan to eventually expand recruitment outside of the UF-Shands network, but logistical factors made limiting the survey population to UF-Shands more feasible. It is easy to send a single email through a UF-Shands listserv and reach hundreds of physicians at once. Reaching out to providers affiliated with many different hospitals would be much more difficult. Physicians could participate in the survey whether or not they have volunteered with Equal Access in the past. We wanted to receive a mix of opinions from those who have and have not volunteered with us in the past. Physicians from all departments were encouraged to participate.

Data CollectionThe survey took approximately 5 minutes to complete. It was opened on 6/19/2014 and

closed on 7/2/2014. The survey (see Appendix C) was administered through the online UF Qualtrics survey system. A link to the survey was distributed to every UF-Shands Gainesville clinical faculty physician via email using the Clinical Faculty Listserv on 6/19/2014. The template used for the email can be seen in Appendix A. The message was endorsed by the Faculty Council and the President of the Faculty Council, Dr. Nancy Hardt, to encourage participation. A reminder email was sent on 6/26/2014. The email template used for the email reminder can be seen at Appendix B.

Participation in the survey was completely voluntary and those who choose not to volunteer did not face any penalties. There was no compensation for participating in the survey. This survey was anonymous and did not collect any identifying information. The participant’s answers were added to the answers of others before analysis was performed to protect their anonymity. The survey received University of Florida IRB-02 approval on 6/4/2014 (IRB # U-631-2014). The first page of the survey included the informed consent. Participants were required to click “I accept” in order to participate in the project.

Data AnalysisThe multiple choice and ranking results from the survey were exported from Qualtics to

Microsoft Excel for further data analysis. A raw count of the number of responses will be recorded as well as percentages and measurements of central tendency. This data was later reformatted into tables for easier consumption. Free response answers will be exported to a Microsoft Word Document. The data analysis was performed by a pre-medical student who was not involved with the design of project. Subgroup analysis was performed on the results for question 1. This analysis broke the responses down into primary care & non-primary care responses, because there was expected to be a large difference between the two groups. Specialties considered primary care for these purposes were general internal medicine, family medicine, general pediatrics & emergency medicine. There were 6 participants who opened the survey but either left the entire thing blank or answered only a single question. These blank responses were discarded before analysis was performed and were not recorded as responses. Some individuals filled out most of the questions, but choose to leave 1 or 2 questions blank (for example, filling out all of the multiple choice questions and skipping the free response). These individual’s responses were counted, but the sample size for individual questions reflects that these individuals did not answer particular questions.

Results:Number of Responses = 101Estimated Total Number of UF-Shands Physicians at the Gainesville Campus = 900Approximate Response Rate = 11.22%* The number of responses for individual departments/specialties is presented in the results section for Question number 7

Question #1: How many of the physicians in your department do you think know about the Equal Access Clinic Network?

Count PercentAlmost all of the physicians in my department 19 19.00%Most of the physicians in my department 19 19.00%Some of the physicians in my department 31 31.00%Few of the physicians in my department 18 18.00%Almost none of the physicians in my department 13 13.00%

* n=100 (1 participant left the question blank)

Question #1 – Subgroup Analysis (Primary Care Physicians Only): How many of the physicians in your department do you think know about the Equal Access Clinic Network?

Count PercentAlmost all of the physicians in my department 13 28.89%Most of the physicians in my department 12 26.67%Some of the physicians in my department 11 24.44%Few of the physicians in my department 2 4.44%Almost none of the physicians in my department 1 2.22%* n = 39

* General Internal Medicine, Family Medicine, General Pediatrics & Emergency Medicine were classified as Primary Care Specialties.

Question #1 – Subgroup Analysis (Non-Primary Care Physicians Only): How many of the physicians in your department do you think know about the Equal Access Clinic Network?

Count PercentAlmost all of the physicians in my department 1 2.22%Most of the physicians in my department 5 11.11%Some of the physicians in my department 16 35.56%Few of the physicians in my department 14 31.11%Almost none of the physicians in my department 9 20.00%

* n = 45* Any specialty other than General Internal Medicine, Family Medicine, General Pediatrics & Emergency Medicine were classified as Non-Primary Care Specialties.

Question #2: What motivates you to volunteer (or consider volunteering) at local free clinics?Most Important -----> Least Important Average

Ranking1 2 3 4 5I want to give back to the community 35 42 0 12 2 1.95I want to provide healthcare to the medically underserved 36 28 2 24 1 2.19My friends and colleagues volunteer 20 14 10 42 5 2.98I enjoy working with students 0 6 45 10 30 3.70My department encourages volunteering 0 1 34 3 53 4.19

* n = 91 (10 participants left this question blank)

Question #3: What factors prevent you from volunteering at local free clinics more often?Most Important -----> Least Important Average

Ranking1 2 3 4 5I am not familiar with the free clinics in the area 42 17 3 8 23 2.49I am concerned about malpractice coverage 5 22 56 4 6 2.83I don’t have enough time 17 15 12 31 18 3.19I have concerns about continuity/quality of care 22 15 5 24 27 3.20I don’t feel comfortable seeing adult outpatient primary care cases 7 24 17 26 19 3.28

* n = 93 (8 participants left this question blank)

Question #4: If your department incentivized volunteering by considering it during the end of year evaluations, would you volunteer at local free clinics more often?

Count PercentYes 25 24.75%Maybe 40 39.60%No 36 35.64%

* n = 101

Question #5: What do you think local free clinics can do to encourage more / physicians to volunteer?

Responses are listed in Appendix D

Question #6: The Mobile Outreach Clinic is a partner organization of Equal Access that operates from 11am to 4 pm Monday through Thursday. Would your work schedule ever allow you the flexibility to volunteer during these hours?

Count PercentYes, occasionally I am free during standard business hours 20 20.00%No, I am rarely free during standard business hours 80 80.00%

* n = 100 (1 left blank)

Question #7: Which department/specialty are you in? [Free Response]Department/Specialty CountAnesthesiology 5Cardiology 3Emergency Medicine 3Endocrinology 1Family Medicine 9Gastroenterology 2Geriatrics 1Hematology/Oncology 1Infectious Disease 1Informatics 1General Internal Medicine 16Neurology 4OB/GYN 4Ophthalmology 4Orthopedics 1Pathology 4Pediatrics 9Psychiatry 6Pulmonary 2Radiation Oncology 2Radiology 3Surgery 4* n = 86 (15 participants chose to leave this question blank)

Strengths & Limitations: Offers insight into a topic with very little available literature. The project offers information very specific to the population of interest and

“actionable” results that should improve recruitment in the near future. Surveys have inherent limitations such as recall bias. No residents, Physician Assistants or Nurse Practitioners participated in the survey.

These providers make up a large group of potential volunteers, but their perspectives were not taken into consideration.

No physician from outside of the UF-Shands network participated in the survey. These physicians offer a huge pool of potential volunteers to be recruited, but their perspectives were not taken into consideration.

While the response rate was higher than similar faculty survey dispersed through the listserv, a response rate of 11.22% is not ideal. It is possible those that chose to participate are different in some way than the individuals who chose not to volunteer. It is likely that those who have volunteered with Equal Access in the past are more likely to have participated in the study.

The survey did not differentiate between those who have volunteered in the past and those who have not volunteered with Equal Access in the past. It is possible these two groups answered questions very differently. We chose not to include a question about the survey participants past volunteering, because we were trying to limit the number of questions to increase the response rate as much as possible. We know there was likely a good mix of current volunteers and non-volunteers. Current volunteers are more likely to participate in the survey, but there were 101 responses and only 58 UF-Shands physicians who volunteered last year. Therefore, we know at least half of the participants are not current volunteers.

Suggestions for Future Equal Access Recruitment Efforts: Work with department chairs to support the Equal Access Clinic Network and

incentive volunteering by considering it in the end of year evaluation process. The Emergency Department is already doing this in an informal manner and has one of the highest rates of volunteering in the hospital. In the free response question numerous physicians suggested things like receiving credit for patients seen at Equal Access or lowering requirements by a small amount to free the physicians up to dedicate more time to the local free clinics. Another physician recommended that at least a small amount of volunteering be required to gain tenure or other promotions. Even a very small incentive or reward would likely get the attention of many physicians. Even if these suggestions are not feasible, there are other ways department leadership can help Equal Access. Some survey participants suggested that getting departmental chairs to recognize Equal Access and volunteer themselves would go a long way towards establishing a culture of volunteerism.

Expand recruitment and advertising efforts into non-primary care specialties. The primary care specialties fill a majority of the volunteer spots currently and rate a much higher level of familiarity with Equal Access. However, the non-primary care physicians rate a much lower level of familiarity with Equal Access and have been recruited extensively in the past. One physician from a non-primary care specialty noted in the free response question that they had been with Shands for 4 years and never even heard of Equal Access. Many of these subspecialists will feel comfortable seeing primary care patients if they can be paired with a primary care doctor and have access to the 4th year pharmacy students that are at clinic each night.

Correct misconceptions about malpractice coverage. The Equal Access Clinic Network receives malpractice coverage through UF-Shands. Therefore, concerns about malpractice coverage should not be a deterrent to volunteering. However, the results from question number 3 show that one of the biggest barriers to volunteering is concerns about malpractice coverage. Students need to do a better job of explaining what legal protections are in place for volunteers.

Future recruitment efforts should emphasize the impact the clinics have on the community, rather than the academic impact. This is because the answers to question number 2 suggest giving back to the community and working with the medically underserved are far greater motivating factors than teaching students.

Expand recruitment and advertising efforts to Nurse Practitioners and Physicians Assistants. There has only been a single PA volunteer and no NP volunteer during the study period. Therefore, these types of providers are a large untapped resource or potential volunteers.

Expand recruitment to physicians in Gainesville who are not affiliated with UF-Shands. Only about 7% of volunteers during the study period had hospital affiliations other than UF-Shands. There are approximately 800 physicians in Alachua County that are not affiliated with UF-Shands. These community providers offer a large untapped resource or potential volunteers. If additional steps are taken ahead of time these physicians can receive malpractice coverage at no cost to then.

The free response answers offered some novel ideas that may be worth exploring further. One physician suggested having an orientation session to help get new volunteers acclimated to Equal Access so that they can be less intimidated by the situation. Multiple physicians suggested having new volunteers shadow or be mentored by current physician volunteer until they learn how things operate. Others mentioned that we need to do a better job of recognizing those who serve often. One participant thought an Equal Access newsletter would be a good way to spread awareness about Equal Access and easily distribute the list of dates that are in need of more physician volunteers. One participant believed that sharing the stories of current volunteers would be a good way to encourage volunteering. Another provider thought Equal Access should hold clinic on the weekend when most physicians have more availability. Multiple participants said that cutting down the amount of paperwork for physician volunteers by having scribes would be a good way to make volunteering more enjoyable.

Generalizability:The wording of most of the survey questions was left intentionally vague. Instead of

mentioning Equal Access specifically, we used the term “local free clinic.” This was so the results would be useful to more than just the Equal Access Clinic Network. The Mobile Outreach Clinic and numerous other free clinics based in Alachua county recruit UF-Shands physicians. Therefore, these results will likely be useful to these clinics which recruit the same pool of doctors. The results from some of the survey questions are likely applicable to free clinics outside of Alachua as well. The motivating factors and barriers to volunteering are likely not very different from city to city. Until a similar survey can be repeated in different locations, the results of this survey could be used to guide recruitment efforts elsewhere. UF MPH Core Competencies that Applied to this Project: • Mobilizing community partnerships and action to identify and solve health problems (Mobilizing and partnering with the UF-Shands Physician Community)• Linking people to needed personal health services and assure the provision of health care when otherwise unavailable (Addressing the physician shortage will increase the quantity of care provided to the medically underserved of Gainesville)

• Evaluating effectiveness, accessibility, and quality of personal and population-based health services (Evaluating the effectiveness of physician recruitment/scheduling and the impact the shortage has on the quality/quantity of care provided) • Conducting research for new insights and innovative solutions to health problems• Communicating effectively with public health constituencies in oral and written forms (This paper and the public health day presentation offer opportunities to hone communication skills)

Appendix A: Initial Email Message (sent 6/19/2014):

FROM BRIAN MCDANIEL, MD/MPH STUDENT ON BEHALF OF NANCY HARDT MD, PRESIDENT OF FACULTY COUNCIL

Faculty Physicians,

Equal Access is a network of student run free clinics that operates evenings Monday through Thursday at four sites in Gainesville. The network provides almost 2000 patient visits per year and over 10,000 hours of hands on clinical experience for medical, PA, pharmacy, and pre-professional undergraduate students. 50% of clinic nights in 2013 were understaffed or had no faculty volunteer. Having one provider instead of the ideal two means that fewer patients are served and wait times are longer. The Mobile Outreach Clinic is a free clinic on wheels that serves 4500 patient visits a year. The clinic bus is brought to "hot spot" neighborhoods demonstrating poor health and social outcomes from 11am to 4pm four days a week. The MOC also has challenges recruiting licensed health professional volunteers. We have created this survey to help better understand the factors that encourage OR prevent faculty involvement at local free clinics. We want to learn ways to improve our recruitment to expand our pool of volunteers to include individuals and departments who have not been involved with our clinics in the past. This anonymous 7 question survey takes approximately 5 minutes to complete. Faculty members from ALL DEPARTMENTS are encouraged to participate WHETHER OR NOT THEY HAVE VOLUNTEERED WITH EQUAL ACCESS OR THE MOBILE OUTREACH CLINIC IN THE PAST. Please click on this to participatehttps://ufl.qualtrics.com/SE/?SID=SV_b7MpTRAKd9NIIrH

Thank you very much for your time Sincerely,

Brian McDanielMD-MPH student class of 2016Outgoing Equal Access Co-Director

Nancy S. Hardt, MDProfessor, Department of Pathology and Ob-GynDirector, Health Equity and Service Learning ProgramsUniversity of Florida College of MedicineGainesville, FLCell phone 352-514-3991

Appendix B: Reminder Email (Sent on 6/26/2014):

FROM BRIAN MCDANIEL, MD/MPH STUDENT ON BEHALF OF NANCY HARDT MD, PRESIDENT OF FACULTY COUNCIL

Faculty Physicians,

This is a reminder about the survey to help the Equal Access Clinic Network and the Mobile Outreach Clinic better understand the factors that encourage or prevent faculty involvement. This anonymous 7 question survey takes approximately 5 minutes to complete. Faculty members from ALL DEPARTMENTS are encouraged to participate WHETHER OR NOT THEY HAVE VOLUNTEERED WITH EQUAL ACCESS OR THE MOBILE OUTREACH CLINIC IN THE PAST.

The survey can be found at the below link and will remain open until Wednesday, July 2nd at 5:00pmhttps://ufl.qualtrics.com/SE/?SID=SV_b7MpTRAKd9NIIrH

Please make sure you click the "Next" button (arrows) on the last page so that your entry will be recorded

Thank you very much for your time

Sincerely,

Brian McDanielMD-MPH student class of 2016Outgoing Equal Access Co-Director

Nancy S. Hardt, MDProfessor, Department of Pathology and Ob-GynDirector, Health Equity and Service Learning ProgramsUniversity of Florida College of MedicineGainesville, FLCell phone 352-514-3991

Appendix C: Survey (Posted on Qualtrics Online System):

Informed ConsentThis survey is for gathering the perspectives of the faculty physicians on volunteering at the Equal Access student run free clinic and the Mobile Outreach Clinic. The medical student volunteers of these clinics hope to use this information to improve future recruitment and scheduling of volunteer faculty members. Faculty members from ALL DEPARTMENTS are encouraged to participate WHETHER OR NOT THEY HAVE VOLUNTEERED at these clinics in the past.

The survey is 7 questions long and should take about 5 minutes to complete. This survey is anonymous and does not collect any identifying information. Your answers will be added to the answers of others to protect your privacy. Participation is completely voluntary and there is no penalty for choosing not to participate. There is no compensation for participating. If you would like to participate with this study, please click I accept below.

I Accept

1. How many of the physicians in your department do you think know about the Equal Access Clinic Network?

Almost all of the physicians in my department Most of the physicians in my department Some of the physicians in my department Few of the physicians in my department Almost none of the physicians in my department

2. What motivates you to volunteer (or consider volunteering) at local free clinics? Please drag and rank 1 for the most important motivating factor through 5 as the least important motivating factor.

I want to give back to the community I want to provide healthcare to the medically underserved My friends and colleagues volunteer I enjoy working with students My department encourages volunteering

3. What factors prevent you from volunteering at local free clinics more often? Please drag and rank 1 for the biggest barrier to volunteering through 5 for the smallest barrier to volunteering.

I am concerned about malpractice coverage I don’t feel comfortable seeing adult outpatient primary care cases I don’t have enough time I have concerns about continuity/quality of care I am not familiar with the free clinics in the area

4. If your department incentivized volunteering by considering it during the end of year evaluations, would you volunteer at local free clinics more often?

Yes Maybe No

5. What do you think local free clinics can do to encourage more physicians to volunteer? [Free response]

6. The Mobile Outreach Clinic is a partner organization of Equal Access that operates from 11am to 4 pm Monday through Thursday. Would your work schedule ever allow you the flexibility to volunteer during these hours?

Yes, occasionally I am free during standard business hours No, I am rarely free during standard business hours

7. Which department/specialty are you in? [Free Response]

If you are interested in volunteering or would you like to learn more about Equal Access please email us at EqualAccessRecruiter@gmail.com. We currently have physician shortages at the following sites:

Equal Access at Tower Road (Monday night at 6pm) Equal Access at Gainesville Community Ministries (Tuesday night at 5pm) Equal Access at Bartley Temple United Methodist Church (Wednesday 6pm)

The Mobile Outreach Clinic is also experiencing a physician shortage. If you are interested in volunteering at one of these clinic sites please email us at EqualAccessRecruiter@gmail.com.

Majestic Oaks Apartments (Monday 11am to 4pm) Library Partnership (Tuesday 11am to 4pm) Downtown Library (Wednesday 11am to 4pm) Cone Park Library (Thursday 11am to 4pm)

Your survey is now complete. Thank you very much for participating!

Appendix D: Responses for Question Number 6 - What do you think local free clinics can do to encourage more / physicians to volunteer?

Advertise and highlight doctors that serveAdvertise opportunities with faculty. Educate about malpractice. Educate about educational or medical resources available to help with taking care of problems one is not familiar with in primary care.aforementioned incentivesAfter hours are tough, compete with family time, and often run long. Many of us have competing administrative or organized medicine work we complete during after hours time. Were it to be incentivized, best to do so during the work day -but that would probably conflict with budgets, RVUs, etc. again, if the dept helped sponsor or free folks from other clinical duty occasionally, in return for a defined commitment. I believe you'd see more folks volunteer. It's fun and worthwhile - but most of us clinical faculty are booked throughout the day.As a pediatrician I have not seen an adult patient in many many years. I do not know how to care for simple adult issues (hypertension, diabetes, etc). Thus while I would like to volunteer I am not comfortable seeing adults and supervising learners in seeing adults. I don't ever foresee being comfortable seeing adults and thus do not foresee volunteering at equal access. It's too great of a risk and potential to do harm.Ask MD to arrive at 7 and be ready right away to present patients. Noboby presents a patient for the first 45 minutes. I work until 6:30 each day.assure subspecialists that they are capablebetter exposure. discuss long term building of bonds with students. Site examples of cases that have improved or saved lives. Start a real expsure campaignbetter hours (daytime weekdays) and good incentive-hard for physician with kids who are already pulled in different directions, even if they want to. Unless kids activities combined thereClarify medical/legal implicationsContact personallycount it as valuable academic servicecreate some sort of system that identifies persons who contribute above a certain threshhold. Help providers to work in clnics that are closer to where they live (for example, Equal Access is far from my home. Finally, coordinate all the clinics together - I am typically asekd avbout equall access separaely from teh other free clincis.currently the work load is too great at UF to have time to volunteer for anythingDifficult problem. Physicians already have a lot of demands on their time and EPIC has increased these. Difficult for parents of children to get childcare for evening. I don't think that people do not volunteer for lack of interest but rather out of time constraints.Discuss more with faculty to make them aware of the opportunity, have students contact faculty.Disseminate more information concerning what sorts of services are being offered through the clinic. What needs to the clinics have. For instance, I am a clinical neuropsychologist in the Dpt of Psychiatry. I don't know what services I might be able to offer. Brief mental health or cognitive screenings?Educate them about the clinics, give contact numbers, provide a mentor for those not in primary care, and extend sovereign immunity for volunteer work.face to face at dept meetings/ grand rounds to provide personal approachFind ways to reduce the already encroached upon personal time - EPIC. With an institution that is putting tenure out of reach for most academic faculty (e.g. no grant support) perhaps working in free clinics can be incentivized

within the academic portfolioFor me, it is the times of the clinic. I cannot go to clinic when I am still in my own clinic or doing other aspects of my required job. The Equal Access clinic is only on Thursday at 6pm, and I often have conflicts with that day, especially if you are attending on inpatient service. I think most faculty want to help and give back, but there are only so many hours in the day, and if you have a family you want to be there for them as well, especially at dinner time. Maybe consider a Saturday AM clinic 8-noon.FTE support or some sort of recognition - for promotion, incentives, etcget med school deans to somehow reward faculty who give time to the clinics?Give a short orientation session one evening to familiarize us with the clinics. Give teaching credit/evaluations for time spent with the students.Give more time off from clinical dutieshave students call or face to face invite attendings. email is a challenging form of communication for some.Help non-primary care physicians contributeHold clinics at Shands assure malpractice coverageI am a physician assistant, and I don't know how to go about getting set up with the free clinics, what is the protocol for finding a supervising physician, if PAs are wanted at the clinics, and if PAs are even utilized at the clinics.I am already away from my family too much, and can't give up the limited time I have w my young family.I don't think anything else can be added to current effortsI have been here 4 years and never heard about them. Why not give a 5 min overview at a Medical Grand Rounds?I suspect most of the highly sub specialized faculty do not feel competent to manage general medical issues. If you were to have clinics by specialty you would likely see more volunteers.I think incentivizing physicians through their departments is a great idea.I would like to volunteer but felt pressured to volunteer on a monthly basis. If less frequent volunteering were presented as an option, I think more physicians would feel comfortable participating.If the deans and the top 99 percent give then the rest will come!!incentived and encouraged with COM administrationincentivize for promotion, pair specialists with primary care mentorsinclude as a requirement for promotion and tenure; encourage Chairs to participateintermittent emails with details about the opportunities; I like the incentivizing idea tooIt is a time factor. I run an hour behind in clinic then have at least 2hours of EPIC work each night. I am worried about getting to Equal access and then still having all my EPIC charting deep in the night with clinic the next dayIt is very difficult to staff a clinic at night when you have been working all day. Maybe have the clinic during the day and have departments allow faculty to staff teh clinic in place of regular clinics.It's just a matter of time. With 2 young kids who are active in sports, and being full time with call responsibilities, there is just not enough time for volunteering.Just continue to approach faculty often and early to schedule them well in advance for open slots.Make it during daily working hours, and allow us to be free from other obligations to do it. It is very hard to go out after work, especially if you have small kids at home. You need to get home to family. That is the biggest limitation.Make the need known and keep the logistics simple.Make them aware of impact in student development and lack of rvu pressure with lots of humanistic reward

Minimize paperwork. Provide a trained scribe.More information to physiciansMy biggest limitation is time, and the desire to spend more time with my family. I don't know what you could do to help me have more time to volunteer.My specialty -radiology- has minimal direct patient care and my diagnostic skills are too rusty to be useful to a primary care cllinic. If basic x-rays were added to the mobile clinic service, i would be happy to volunteer to read them.news letter with sign ups make it a course so that get creditNot sureNot sure that the free clinics make much sense. They provide care that is clearly different/below the standard of the rest of the practice. Doesn't mean that bad care is provided, but does mean that the model of care delivery is one that would not be acceptable elsewhere in the practice.Nothing. I am overworked and every year the prod bar risesPediatricians do not feel comfortable seeing adult patients, and almost all pediatric patients can be seen in clinic for very reduced or no feesPresent at fac meetings to publicize and have mentors for first timersPromote it to primary care providers as an opportunity for close interaction with studentsProvide incentives or dedicated time to volunteer as faculty often quite busy with other competing dutiesProvide more information regarding what/who is needed. This may be more common in departments that likely have more to contribute in this environment than my own.Put the word out more. Have a website with FAQ about potential concerns - malpractice, continuity, etc. Have leadership volunteer.replace some of day work, I am overloaded and spread way too thin, so feel very protective of the little time I have offReward participation with an "RVU equivalent" for visits seen.Scribes, pharmacy students present, a colleague who is a primary care doc.Send out more information such as thisShare the experience of those who have volunteered. Invite physicians to "shadow" another volunteer physician the first time. Have physician orientations to the clinics, either live at the clinic or by video.Showing them the results of this powerful survey with an FAQ about myths/benefits would be a good start.Solicit Department Chairs to encourage their staff to volunteerThe college (dean's office) should support the free clinics with incentives/FTE support. Could be included/considered as clinical time (but not expected to produce RVUs). Or RVU targets could be reduced by some amount for each clinic one worked.The growth in the clinics has been great but it has created a heavier demand for preceptors. Some of the clinics don't necessarily need to be open every week especially those that frequently see repeat patients week after week. If there was a way to get fte support for dedicated faculty to have even 2 hours of coverage per month so that we can leave clinic a bit earlier in order to prepare and arrive to the free clinics that would probably help some. Perhaps a faculty member or more could get research support to attend at the clinics and then study how the clinics might influence ER visits or revisitsThere are so many clinics now that they are likely competing for the same limited pool of faculty volunteers. Some consolidation of clinics may be needed.unsure, it is difficult given physicians already work long hours and would cut further into family time

We are not aware (or at most vaguely aware) of these opportunities. It is not clear if there is any role for subspecialists (neurologist, for ex). another suggestion- get chairs to back this. if they encourage their faculty it woudl increase participation. it would be neat if they would give some rvu equivalent for a few of these per yr, but i doubt that would happen. even gettnig them to "permit" a few days of missed clinical revenue per yr, people could do this

References

1. Alachua County Health Profile. 2014. [online] Florida CHARTS. Available at: <http://www.floridacharts.com/charts/mapp_report.aspx> [Accessed 19 Apr. 2014].

2. Ambiee, J., 2007. Examining physicians' motivations to volunteer: An applied visual anthropological approach.

3. Kumar, A., Kallen, D. and Mathew, T., 2002. Volunteer faculty: what rewards or incentives do they prefer?. Teaching and learning in medicine, 14(2), pp.119--124.

4. Clary, E., Snyder, M., Ridge, R., Copel, Stukas, A., Haugen, J. and Miene, P., 1998. Understanding and assessing the motivations of volunteers: a functional approach. Journal of personality and social psychology, 74(6), p.1516.

5. Salinsky, E., 2004. Necessary but not sufficient?: physician volunteerism and the health care safety net.

6. McDaniel, B., & Hardt MD, N. (2013). Prevention of Unnecessary Emergency Department Visits. Nashville: Society of Student Run Free Clinics Conference.

7. Equal Access Student Officers, (2014). Equal Access Clinic Network. Retrieved June 6, 2014, from UF College of Medicine: http://equalaccess.med.ufl.edu/

8. Michalik, S., & Newton, A. (2014). Patient Satisfaction: Data on Overall Satisfaction, Emergency Room Usage, and Quality. Society of Student Run Free Clinics Conference. Nashville.

9. Antiel, R. M. (2009). Physicians' Beliefs and U.S. Health Care Reform — A National Survey. New England Journal of Medicine.