Being a primary-care doctor is no picnic these days, with shriveling payments and swelling patient demand. New doctors are shunning primary care, while seasoned physicians are giving up. Not Regina Benjamin.
For 18 years, Benjamin has served as one of the few doctors in Bayou La Batre, Ala., a job that entails treating all comers, making house calls in a muddy Toyota pickup, and ripping hurricane-soaked sheetrock from exam room walls. The job is neither glamorous nor lucrative; Benjamin has moonlighted in emergency rooms to pay the bills for the clinic in this scruffy shrimping hamlet, where some 40 percent of the 2,315 residents have no health insurance. Yet at the same time that she's been giving tetanus shots and treating diabetics, Benjamin has played a growing role in advancing healthcare reform, pushing for better access for underserved communities through groups like the American Medical Association.
Hanging tough. "She's done very well in emphasizing the importance of primary care," says Louis Sullivan, a former secretary of health and human services who has known Benjamin since her student days at Morehouse School of Medicine. And she's done that while refusing to abandon the clinic. "She's determined to stay there, despite all the difficulties she's had," Sullivan says.
Difficulties, indeed. In 1998, Hurricane Georges destroyed Benjamin's storefront office. She rebuilt on higher ground. In 2005, Hurricane Katrina's 25-foot storm surge inundated the clinic. Benjamin and her staffers ripped out soaked carpets and laid patient records out in the sun to dry. Just before the clinic was to reopen, the building was gutted by fire. The Bayou La Batre Rural Health Clinic now operates out of a tiny rented house, while Benjamin raises cash to build anew. "Even in a small rural town, patients deserve quality care," says Benjamin, 52. "Trying to deliver the same outcomes as in downtown Manhattan isn't always easy, but it's worth trying."
Specialty care is a daunting challenge, because patients have to go to Mobile, a 30-minute drive away, for dialysis or chemotherapy. Many of her patients can't afford the gas money. Others don't have a car. "That's why it's so important that the primary-care services are here, that they get preventive care," Benjamin says. "They can't afford to get sick."
Wooing help. Benjamin has never been naive about how hard delivering quality care in rural Alabama would be. She grew up on the other side of Mobile Bay, and her mother worked as a waitress to support the family. It wasn't until Benjamin went to college in New Orleans that she saw an African-American doctor. After medical school, she returned to southern Alabama determined to run her own solo practice. She quickly realized the practice was in danger of going bankrupt and got an M.B.A. on the side. Her solution: make the clinic a nonprofit. Benjamin has proved adept at wooing help, from college students who designed the clinic's website without charge to a company that donated an electronic medical record system. But she realizes other small practices that serve the nation's 45 million people without health insurance can't do that—and shouldn't have to. "At some point, we have to pay attention to the financial model for these primary-care community practices," she says. "I'm trying to work on that."
That work increasingly takes Benjamin away from the bayou to meetings in Washington, Chicago, and even South Africa. The staff, including a physician assistant, a newly hired, federally funded doctor, and 78-year-old nurse Nell Stoddard, keep things humming. Still, her patients know that they can call her anytime. One older patient called while Benjamin was in Chicago for a meeting of the AMA board of directors. "She said, 'You're in Chicago? You tell Oprah Winfrey she needs to do something about lupus!' I said, 'I don't know Oprah.' She said, 'You know everybody!' "
Ever since winning a MacArthur "genius" award this fall, Benjamin has been torn between putting the $500,000 prize into an endowment for the clinic or into scholarships for local students to study math and science. That fits into her vision for healthcare reform. "The first thing I would do is make sure our K-12 education is strong. If you have a good education, you can get a good job and pay for insurance. Not only that, you understand health and make good choices."
Back in Bayou La Batre, no one gets turned away at the clinic for being short on cash; patients pay however they can. "We get shrimp, oysters," Stoddard says. "Mostly just love." The doctor and her staff reciprocate, dispensing hugs as an essential ingredient of high-quality healthcare.
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