Raising Healthcare's Future: Learning the System

Several members of the have applied to medical and public health programs this cycle. In this second installment of the blog series, “Raising Healthcare’s Future” members of the National Health Corps - Florida (NHC-FL) provide insight into how their service experiences are shaping their experiences with patients, care providers, and the healthcare system. The second question posed to the group was:

What Have You Learned How the Public Health and Social Welfare Systems Work:

Alec (Health Educator at the I.M. Sulzbacher Center) - Most of my volunteering before joining the NHC-FL was in the Emergency Department (ED) of my local hospital. We would regularly receive patients who were homeless, had behavioral health conditions, and often both. I would sometimes wonder, “Where are these patients coming from?”, “How did they get here?”, “Where are they going?” and most importantly, “What is our society doing to care for them?” Serving at Sulzbacher I have learned from the outreach and case management teams about how unemployment, disability, Medicaid/Medicare, social security, food stamps, and various housing programs work to support the needy but also where their shortcomings are. Some of these issues are beyond things I would consider in my life, the “second sentence” of felony conviction being an inability to find work or the impact of having a poor public transportation system, and how our society is trying to overcome these barriers. Overall, I feel this knowledge will provide a more holistic understanding of my future patients’ circumstances.

Ben (Patient Navigator at I.M. Sulzbacher Center) - As someone who works with Social Welfare Systems and private pharmaceutical companies assistance programs every day, I can share my own personal frustrations with the “red tape” that surrounds the access to care that indigent patients require.  I have learned that many medications that our patients could not afford on their own can be gained cost-free through Prescription Assistance Programs (PAPs) with pharmaceutical companies, although this often requires extensive coordination and patience I did not know I had.  But, as the saying goes, “all comes to those who wait” or in my case stay on hold. These frustrations with this system have molded my conversations with medical school admissions committees and have given me real-world healthcare experience, a personal connection to the struggles of our indigent patient that few of my peers from undergrad were able to match, and the knowledge that I was helping sick people become better. 

Roshini (Patient Navigator at River Region Human Services) - When I started my service at River Region, I was thrown into assisting patients with social services navigation (transportation, food stamps, housing, insurance enrollment, etc.) with no prior experience in navigating the public healthcare system. I had only ever seen the clinical aspect of medicine and not the work of social workers, mental health counselors, and peer advisors. Working closely with the outpatient staff, I was able to get a better understanding of how to bridge the resource gaps for our clients and how to effectively coordinate care for patients that face barriers to medical access.

Maria (Care Coordinator at Barnabas) - Before National Health Corps AmeriCorps, I was under the false impression that anyone that couldn’t afford private health insurance were covered under the Affordable Care Act (ACA). I was shocked to learn that some states (including Florida) opted out of one of the ACA’s provisions, the expansion of Medicaid to those 133% below the poverty line. Therefore if you are not disabled and don’t make at least $15,300 a year, you don’t qualify for health insurance. At Barnabas, I have seen patients that have suffered from this loophole and others like it that keep patients from receiving care. An incredibly tragic example are cancer patients that do not make enough income to qualify for Medicaid and are technically not considered disabled, so they fail to receive the necessary chemotherapy. At Barnabas, we look for alternatives to finance cancer patients seeking treatment and are very thankful that charities and nonprofits exist to help cases like these. Through my service, I have learned about the cracks that patients can fall through in our healthcare system.

Eric (Health Educator at YMCA-Duval) - I’ve really gotten to see how essential of a role that the public school system plays in the lives of all children but especially from children of disadvantaged backgrounds. For some of the kids that I serve, school and after school programs serve as the only sources of academic support, intentional guidance, and a safe place to be physically active in their lives.  For other students, school might provide their only hot meal for the day and be a safe haven from home. On top of that, receiving a sound and supportive primary school education is essential to ensuring that children have the opportunity to attain better career prospects. I’m proud to be able to serve as yet another resource that students can have access to thanks to the school system.

Scott (Patient Navigator at I.M. Sulzbacher Beaches Clinic) - Before starting my service at the Sulzbacher Beaches Clinic, I never even thought about how low-income individuals received health care. As mentioned to my fellow AmeriCorps members at our midterm retreat, my prior experience with the U.S. health care system had been sitting in public health class and angrily asking myself, “Why is this reality and why can’t I fix it?” I now understand on a practical level the hurdles low-income patients face. However, my service has opened my eyes to the incredible people that dedicate their lives to providing health care services that would otherwise be unavailable to a large portion of the population. At the Beaches Clinic, we partner with a network of volunteer physicians that provide referral services at no cost, and right next door to our clinic is Beaches Emergency Assistance Ministry (BEAM), an organization that provides groceries to those who can’t afford them, among other things. This is in addition to the amazing work that our nurse practitioners, medical assistants, case managers, etc. do every day. What I am trying to get at is that, while sparse, help is out there. Unfortunately, it can be hard to find and be of lesser value . But by knowing that such help is out there, I feel that I can be a better future physician to all of those who will rely on my care, whether directly as a practitioner or indirectly through referrals.

Rebecca (Care Coordinator at UF Health-Healthy Start) -  My NHC term has repeatedly demonstrated the distinction between "health" and "wellness." While we can promote health within the medical setting, we can only achieve wellness when we respect the framework of our patients' lives outside of the clinical domain. My service to prenatal moms and postpartum mothers and infants at UF Health has proven how critical it is to engage within a larger, more complex public health and social service system than I had ever previously conceptualized. Before NHC, I had a limited understanding of the programs that I now find myself utilizing daily for patients. I have found that programs like Healthy Start and its partner organizations like the Florida Departments of Health, Medicaid, Women Infants and Children (WIC), assistance programs for food, housing, transportation, and maternity/baby items, and counseling programs for nutrition, mental health, smoking cessation, and substance abuse are all essential resources. But, while there is a strong network of social services in Jacksonville, their accessibility to patients and patients' awareness to them can be restrictive, leading to frustration or lack of utilization. Many mothers express surprise and relief when I tell them about these programs. This has shown me that we must champion our patients to help them receive the services needed for general wellness. Moreover, my favorite part of my service is when I can spend extra time seeking out resources specifically for each mom. I want her to know that I take her needs to heart and will navigate the system alongside her. Expressing my concern for her needs outside the hospital allows me to better connect with her medical needs within the hospital. Ultimately, it boils down to this quote I have posted in my office: "People don't care what you know until they know that you care."

Each of our members has gained experienced with how health is shaped and supported beyond the exam room, a knowledge base that will help them extend care beyond their individual interactions with patients. If you are seeking to learn about the programs in place to support good health beyond the patient-care provider relationship, the NHC-FL presents an outstanding opportunity to learn about the social services and public health systems.

This blog post was composed by the Blog Committee, Alec Kinczewski and Eric Bethea.