Don't just volunteer, be good at it

Physicians aren't typically OK with mediocrity. So it stands to reason that internists who want to volunteer would want to do it well. Some of them learned how during an Internal Medicine Meeting 2016 session, “What Makes a Good Volunteer?”

“Virtually anybody in this room can be an effective volunteer. I think the key is to be placed at an appropriate site and find a volunteering experience that suits your needs,” Cary Bjork, MD, FACP, told attendees. Dr. Bjork, a Michigan internist, has decades of international volunteer experience, including serving as the project director at a hospital in Uganda for Health Volunteers Overseas.

Offering the domestic perspective on medical volunteering was Sheila Ryan, RN, MPH, director of clinical services at the Arlington Free Clinic in Arlington, Va. “There are still 33 million Americans who are uninsured, and unless people like you volunteer your services, they will not get care,” she said.

What to do

The first step in beginning to volunteer is deciding what you will do, the experts said. “There are many roles physicians play in a volunteer environment. The most obvious one is evaluate,” said Ms. Ryan. “Our physicians, for the most part, see patients and develop treatment plans for them.”

That can mean coming to the clinic on a regular basis, or seeing clinic patients at one's own facility. “Many physicians volunteer to take 1 to 3 patients a month in their office,” she said.

Physicians can also work behind the scenes to help the clinic maintain continuity of care. “Doctors come to our clinic once a month, every 2 months, and many of them will order tests and X-rays. So we have a group of physicians who come in and just review the tests and X-rays 4 days a week, so that nobody falls through the cracks,” Ms. Ryan said.

She also has physicians who volunteer as an emergency contact. “Often there is not a physician [at the clinic], and a crisis may occur, so I do have a list of doctors that I call that will answer their phone and give me advice,” Ms. Ryan said. Clinics may also need physicians, especially subspecialists, to provide mentoring or education, she added.

Teaching clinicians can be a major component of an international volunteering project, noted Dr. Bjork. “If you go to another country to see patients or to teach, you want to do what you're familiar with, what you do every day, what you're expert at. You don't want to teach them about the tropical diseases and conditions that you are not familiar with,” he said.

Volunteering through an established organization can make it easier to figure out how your skills match up with a program's needs. “This can often be done by reviewing reports or speaking with previous volunteers to see what they've done and what they perceive the needs to be,” Dr. Bjork said.

What to ask

What skills are needed is only 1 of many questions you'll want to ask when considering a volunteer opportunity, the experts said.

“If you're looking to volunteer at a clinic, you need to find out if they have a hospital that is supporting them. There's no way you can have a free clinic without a hospital that is providing labs and X-rays and maybe some other support services,” said Ms. Ryan. Physician volunteers may also want to confirm how patients get follow-up and medications; her clinic has volunteers dedicated to those tasks.

Malpractice coverage should also be discussed. “It's probably important, depending on where you live, to look at what your state provides and then your own malpractice insurance,” she said. Session moderator George Meyer, MD, MACP, added that only 7 U.S. states don't cover malpractice by physician volunteers. “Unfortunately, my state, California, is one of them, and we've been trying to push for that,” he said.

Ask about the technological setup, too. “We've had a number of physicians [volunteering] who left practice because they hated the EMR. It was really sad when I had to tell them we had an EMR, but we do provide scribes for any of the physicians who do not want to use the EMR,” said Ms. Ryan.

Language may be an issue in volunteer settings both in and out of the U.S. Although Dr. Bjork was pleased to find that all medical education in Uganda was done in English, only 9% of the Arlington clinic's patients speak English as their first language. “We can usually get Spanish-speaking interpreters, but it's the Mongolian, Amharic, Bengali that's a little bit more difficult. If you're going to go in a clinic, ask them about the availability of a translation service,” said Ms. Ryan.

Ask yourself

Physicians embarking on a volunteer effort should also think about their own availability. International programs may require just a single 2- to 4-week commitment, but domestic volunteering usually entails ongoing involvement.

“There are times when a physician comes in and they're really excited and we spend the time credentialing them and teaching them how to use the EMR and then the first night they're supposed to come ... I call them and they're like, ‘Oh, I forgot. I'm at the gym. Can you get another doctor to cover?’” said Ms. Ryan.

A physician no-show not only disappoints patients but also wastes the time of other volunteers. “When a physician is scheduled to come, I bring other volunteers in to support the physician, like the scribe, the interpreter, the intake person, and the discharge person,” she said. “As you're looking at different options to volunteer, look at your life, and if you've got a lot going on with kids and work and everything else, maybe committing once a month isn't the right thing for you.”

International volunteering requires self-appraisal on a number of fronts. “Being flexible and patient is extremely important, because the schedule in developing countries' hospitals often doesn't run by the clock as much as we're used to,” said Dr. Bjork. “Some people get very upset if rounds don't start on time or clinics don't end on time, but you've just got to go with the flow.”

It's also necessary for international volunteers to be enthusiastically self-starting. “The faculty and housestaff, etc., have many other responsibilities ... They don't really have time to take a volunteer by the hand the whole month,” Dr. Bjork said.

The ideal international volunteer also has a sense of humor, good communication skills, and cultural sensitivity, he added. “The patient care is sometimes not at the level we're used to dealing with, but you've got to be sensitive to the fact that this isn't because of the intelligence or dedication of the doctors. It's usually due to lack of resources and finances.”

Finally, both domestic and international volunteers could benefit from thinking about why they're signing up, the experts said. “The more that you understand why you want to do the volunteering, the more likely you are to be satisfied with your experience,” said Dr. Bjork.

Common reasons for medical volunteering include enjoyable patient interactions, spiritual fulfillment, benefit to the community, and socializing with fellow volunteers, Ms. Ryan noted. “You will be appreciated and the rewards can be very significant,” said Dr. Bjork. “It's really true, the old saying that you learn more than you teach, and you receive more than you give.”