A case of clinical anxiety

The Community Healthcare Network's modest downtown clinic (Photo: Kimie Bunyasaranand)

It is Jose Ortiz’s third trip to the parking meter outside of the Community Healthcare Network’s downtown clinic on Essex Street. Despite having a scheduled appointment with his primary care physician, Ortiz does not know when his turn to see his doctor will come.

“Appointments are difficult to schedule. And you usually wait from 45 minutes to an hour just to see a nurse. Then you wait more to see the doctor,” said Ortiz, 53, who comes all the way from Williamsburg, Brooklyn, to be treated.

Ortiz is just one of the many patients who visit one of the Community Healthcare Network’s nine locations in New York City. The non-profit organization provides healthcare services ranging from primary care and women’s health to podiatry and mental health. As a Federally Qualified Health Center (FQHC), it receives funding from the government to address the shortage of primary care services in the city’s underserved communities. But limited resources hinder it from addressing the community’s overwhelming demands.

The organization began more than 25 years ago, initially as an agency of community family planning centers, and expanded its outreach substantially after becoming a FQHC. As a federally-funded group, it is required to provide comprehensive primary and preventative care to all patients, regardless of age, ability to pay or health insurance status. Some centers are set up directly by the government, while others, like the Community Healthcare Network, are non-profit organizations that receive FQHC status by meeting certain service provision requirements.

“Everyone is looking to reduce costs. We’re always concerned with our financial future.”

Nationally, clinics serve an average of 1,799 patients, according to a 1999 study by the National Association of Free Clinics. In New York State, FQHCs at 457 locations serve approximately 1.4 million patients—an average of more than 3,000 patients per site.  That leads to a persistent discrepancy between patient demand and supply of doctors.

“It’s always full of action,” said Lionel Samuel, a medical assistant at the organization’s main administrative office at 60 Madison Ave.

On Essex St. (Photo: Kimie Bunyasaranand)

On a Wednesday morning at the clinic, nine patients wait in line in front of the receptionists’ desk. Others play on their cell phones or watch CNN Healthline on the flat-screen TV bolted to the wall. Five administrative assistants in blue scrubs respond to patients as they rummage through files and papers. A sign in front of the second window reads, “Closed, please see next window,” with the same message translated into Spanish and Chinese underneath. A young woman wearing white leggings and a dark jacket grabs a handful of condoms from a plastic bucket on the desk while she waits in line.

Felipe Amonte, an elderly man with a cane, chats in Spanish with two women who are reading pamphlets that read, “Quien es Jejova,” or “Who is Jehova.” He has been waiting for more than an hour to see a doctor.

Annette Dancy, a 54-year-old health aide at the non-profit healthcare organization, Partners in Care, said she travels out of her way from her Bronx home to come to the Community Healthcare Network’s Harlem location to see her specific doctor for a physical and gynecological exam. Dancy explained that triage nurses evaluate walk-ins, and non-urgent cases are deprioritized. “It’s all about patience,” she said. “You have to be prepared to wait.”

Dancy added that there is a culture of fear when it comes to doctors’ visits in low-income areas: Patients are scared of what condition a doctor might identify, and this keeps them from seeking preventative care. “Neighborhood people are scared to come for check-ups,” she said. “Then it’s too late.”

Felicita Fermine came in on a Monday afternoon to have a painful toothache treated. However, because she did not have an appointment, she left the clinic about 20 minutes later without being treated, still in pain. “I’ll come back on Wednesday and try to walk in again,” she said. Fermine’s official appointment is scheduled in June.

Elizabeth Howell, Vice President of Development and Public Relations at the Community Healthcare Network, said it is difficult to recruit physicians to work at the clinic. “It can be tricky filling in doctors at several locations,” she said. Primary care physicians are in short supply, and so are nurses qualified and willing to work at low-income health clinics.

The high frequency of missed appointments adds to the administrative problems. “The no-show rate is higher than you would find in a private practice,” said Howell. “Because we’re dealing with a lot of low-income families that are dealing with multiple priorities, they skip appointments.”

Approximately 10 to 20 percent of the budget for FQHCs in New York comes from federal funding, which is a constant concern for the clinics. “We know that healthcare is a huge ticket line on everyone’s budget,” said Howell. “Everyone is looking to reduce costs. We’re always concerned with our financial future.”