Pro Bono Work

[Scanner]

I normally take on 3 pro bono cases at any one time. NOt because I am required to, but I just feel a moral obligation to help people with my services (a chiropractor).

I recently took on a woman who had a case of spousal abuse, breast cancer, and joblessness. She has chronic musculoskeletal problems so I told her to come in as needed and that what the service was there for.

Come to find out, on our last visit, she told me she just got out of a Cadillac Escapade payment and is now driving a Hyundai Sante Fe (what year, I don't know).

Okay, I am not angry (as I drive around a used Chevy Venture - 2003). . .as I know this is part of the game with doing pro bono work. It's usually a little elderly lady who comes in crying she's on a budget but has $1,000,000 for each grandchild.

The question is. . .how do I cut her off at this point? Do I just say I need to make room for other needy people?

Would be interested in the "public" opinion on this as well as the practicioners out there ( I know there is a family doc and a dentist).

EDIT: Cadillac Escalade. . .not Escapade, although it may feel like one

[MonkeyMama]

I am curious how you decide to do pro bono work, in the first place? (How do these people qualify?)

Having always driven extremely modest vehicles, I am resigned to the fact that most people I know on some sort of public assistance (& in deep financial doo doo) will indeed drive a nicer car than me. As such, I am not sure it means much of anything. {It's like the first rule of being broke is having a huge car payment}.

[Scanner]

I am curious how you decide to do pro bono work, in the first place? (How do these people qualify?)

Well, it's not like very scientific or actuarial by any means. I used to participate with Medicaid (which is scientific about it, I guess) but getting $6.00/visit and having to go through $30.00 of paperwork just didn't make sense so I let my provider status just lapse and just decided to volunteer/do pro bono instead.

So. . .I just kind of "sense" circumstances and then just inform them. I also let my staff (who are usually pretty good with radar of who needs it and who just "wants" it) also chime in. We kind of have a vote on it. My office manager just agreed with me when she heard - time to cut her off.

You could say she had us all fooled.

Don't get me wrong. . .we watched her lose her hair through chemo while her husband was occasionally assaulting her. . .I know her house was bank owned too (according to her anyway).

I am not going to fume about this. . .yet. . .well, a Cadillac Escalade? Aren't they like $50,000?

I have to tell you - the whole saleman-bank/financing co "complex" was really amazing when you think about it. What fantastic (screwed up) times we lived in from 2002 to 2008.

I am not sure, as any salesman with any conscience, that I could sell someone a Cadillac Escalade to a person who's husband was an airplane mechanic and she's a SAHM with no job skills.

But that was our country.

Party's over.

[MonkeyMama]

I think whether you just go with a feel/vote, or you were more scientific about it, either way - these type situations will come up over and over.

I'd just tell her you are no longer doing pro bono work for her - I don't see that you have to get into the *why.*

[creditcardfree]

Could you start limiting her visits....provide a free visit less often? Once a month, then every two months, then six? I think she might start to get the hint and you would be giving away less time to her. Just a thought, but I think you have every right to limit your pro bono work with her.

[tulog]

Just want to point out that having an expensive car with a car payment is not a sign of wealth.

[disneysteve]

Just want to point out that having an expensive car with a car payment is not a sign of wealth.

True. More likely, it is a sign of poor money management which I think is Scanner's point. Why should he give her free care when she is out spending whatever money she does have to drive a 60K vehicle?

I don't really face this too much in my practice, though I guess we do to some extent. We do charge a discounted fee for uninsured patients but we do that across the board. On rare occasions when there is a patient or family that we know well and know to be struggling, we may waive the fee because I don't want to turn them away when they're sick. They are always appreciative and I'm not aware of anyone having abused that deal. When they get back to work or they start receiving their disability checks or whatever improves their situation, they start paying again.

My situation is a bit different because I'm dealing with sick people who could suffer significant harm if I don't treat them. Also, I'm in an extremely poor area where some of my patients can't afford to keep their power on at times so I know if they are living in the dark, they sure can't afford to pay me. They aren't driving Escalades. Many of them don't have cars or even telephones.

[Scanner]

DS,

Yeah, well, that's the thing. It is certainly debatable and I would tend to agree with you - chiropractic is really not an "essential service" like your services, although when her back is out, she may disagree with us.

Still, I do think all health professions should have some moral obligation to help out the needy - optometry could be argued isn't "essential", but jeez, I couldn't live w/out my contacts or glasses.

She was appreciative - don't want to give out the wrong impression there but you hit upon it of what was bothering me about this.

Thanks for the input.

[SnoopyCool]

"Ms. Escalade, it has been a pleasure helping you. We would love to retain you as a client, and hope you understand that because we reach-out to the community in many ways and our time is limited, we must now begin charging for our services. Our fee is $xx. Would you like to set your next appointment?"

Your time is valuable. If you must, show her how much in services she has received, for free, if she argues. If you feel so, then perhaps you can offer her a discounted rate because you feel for her situation and would like to continue to help her in some way. The sooner you handle this, the better.

[bjl584]

Unfortunately there will always be cases of someone abusing some system of charity and/or public assistance.

I suppose that you could stone cold cut her off, or you could take a more gentle approach and start charging her a nominal fee.

[DRILLINDK]

"Ms. Escalade, it has been a pleasure helping you. We would love to retain you as a client, and hope you understand that because we reach-out to the community in many ways and our time is limited, we must now begin charging for our services. Our fee is $xx. Would you like to set your next appointment?"

Your time is valuable. If you must, show her how much in services she has received, for free, if she argues. If you feel so, then perhaps you can offer her a discounted rate because you feel for her situation and would like to continue to help her in some way. The sooner you handle this, the better.

This isn't a bad approach. Also considering scheduling your low production procedures (ie- Ms Escalade) at low demand times in your schedule.

Instead of letting her choose her appt times have your staff provide her with a few options that are not in prime times of your day.