Since it opened permanently in 2002, the Loudoun Community Free Clinic has steadily increased the number of patient visits, volunteer hours and dollars of free medical care to uninsured residents of Loudoun County.
But with the departure of two volunteer physicians due to relocation, the clinic is facing some difficult choices. The diabetic clinic has already been canceled on Thursdays and combined instead with a Monday acute care clinic, giving all those patients to one volunteer physician.
Many of the clinic's volunteer physicians are retired or travel from Fairfax County or Washington to the clinic's location in the old hospital building on Cornwall Street in Leesburg, according to executive director Lyle Werner.
Dr. Ray Hoare, a retired cardiologist who has been active in both the Loudoun Community Free Clinic and the Arlington Free Clinic, drives from his home in McLean to Leesburg twice a week.
"It's really a great thing to be a physician and I think we always need to share our gift with the less fortunate," Hoare said.
"The retired physicians have done a good job of getting this clinic on its feet," she said. "Now it's time for the local physicians to continue its success."
In 2004, the clinic saw 2,300 patient visits, a 28 percent jump over the year before. Any Loudoun resident between the ages of 18 and 64 who has no health insurance qualifies for care. And when the clinic can't treat the problem, patients are referred to local or far-flung hospitals who treat the condition for free.
Werner estimates that the clinic gets five dollars' worth of health care for every one dollar out of its budget. But the clinic can't continue to function without doctors.
"We're at a critical juncture in the growth and life of the clinic," Werner said. "If the local physician community doesn't make it a success, the clinic won't be here in a year."
DR. GEORGE HOCKER founded Loudoun's first free clinic in 1964. A Leesburg general practitioner, Hocker considers his volunteer time at the clinic "a public duty" because health insurance isn't always available, even for those who have jobs.
"There's always that fringe element that falls through," he said.
Even with his own practice still running, Hocker finds time to spend an evening at the clinic once a month.
"I find that you normally can find time to do what you want to do in life," he said.
Doctors sometimes find that treating patients at the clinic is like a vacation from the hassles of insurance and HMOs — it's "medicine at its purest, most basic level," Werner said. "They find it very freeing."
"The atmosphere is very nice at the free clinic," said Dr. Banti Chand, an internist with Kaiser Permanente at Loudoun Hospital Center. "Everyone has a common goal and it's very relaxed, compared to my day job."
According to Werner, research shows that doctors respond best to other doctors; so by working with the clinic's volunteer medical director — a physician — the clinic has tried to reach out to the local medical community with letters and speeches at department meetings. A mailing is what prompted Chand to join up.
Doctors can also volunteer by agreeing to take referrals in cases the clinic can't treat. That, said Dr. Kevin O'Connor, chief of staff at Loudoun Hospital Center, is how many physicians contribute.
"We're providing care free of charge," he said. "It is difficult for physicians to give their precious evening time."
Hoare, too, is sympathetic to the pressures on working physicians, for whom an extra three hours added on the time clock is a significant toll.
"You know, it's hard to ask people to do that," he said. "I don't know what the answer's going to be. I'm retired. This is fun for me. It's a great way to help people."
CUTS AT THE FREE clinic would be bad news for Good Shepherd Alliance, which refers everyone at its shelter to the clinic.
"We need them expanding, not declining," Good Shepherd executive director John Brothers said. "They do make magic."
On a normal evening with three doctors volunteering, the clinic can see around 40 patients. With just one doctor pulling all the weight, Werner said, only about 12 patients will be treated. The clinic is currently open Mondays from 10 a.m. to 3 p.m. by appointment only, and Wednesdays and Thursdays from 5:30 p.m. to 9 p.m. on a walk-in basis.