Medical Fees De-emphasized

I LJ - (Editor's note: ïhis. is the jirst of two articles on medical facilities in Aiin Arbor which provide health care for the needy. The next article will discuss the Ann Arbor Free People's Clinic). By Jan Stucker (News Staíf Reporter) The image of physicians doctoring only those patients who can afford their services is well known in American society. The three MD's who provide medical care at Ann Arbor's unusual Summit Street Medical Center are aware of that image, too. But they are trying to do something about it. I Founded in the fall of 1968 iby former city councilraan [Edward C. Pierce, the clinic I treats most y low-income I families at sharply reduced rates. Sixty per cent of the patients are black. "I don't think medicine has been conseiously racist," muses tall, tousle-haired Ed Pierce. "But I feit there was a definite relationship in Ann Arbor between one's level of income and the type of medi[cal care received." He adds: "I had been actively involved in civil rights and feit this was the most concrete thing I could do." So 42-year-old Ed Pierce, unsuccessful Democratie candidate for mayor in 1967, gave up a lucrativo practice on the west side of Ann Arbor to found a clinic for the poor, the black, the forgotten. "I took care of a lot of nice people in my former practice," he explains offhandedly, "but I wanted to take care of another class of people who really needed me." He was joined in the summer of 1969 by Dr. Jerry S, Walden, 30, a gradúate of the University of Michigan Medical School. (Pierce also ís a U-M Medical School gradúate). And last f all, Dr. Keith Grazier, 28, likewise a University of Michigan Medical School alumnus, hung out liis shingle. (Grazier is moving to California this uummer; he is expected to be replaced by a Iblack physician). The doctors are salaned at $18,000 per year by the citizen Board of Directors w h i c h manages the non-profit medical center. Funds come mainly from patiënt fees and physical examination, prenatal and baby checkups, obstetrical services. But at the core of the clinic's philosophy is the belief that it is also an educational center. The center sponsors, for example, nutritional and exercise classes for expectant mothers, along with post-natal and child-care classes. The Summit staff inaugurated and ran a methadone program for heroin addicts until it was taken over by the Community Mental Health office. And it höpes to begin an alcoholic counseling program, plus expanded social work aid. The large, pleasant waiting room of the medical center is sis for patients who msut see a doctor but cannot get to Spring St. on their own. "What other place would do that?" asked one grateful patient. Drs. Pierce, Walden and Grazier put in busy days and nights (the medical center is open Monday through Saturday, plus Monday through Thursday evenings), but not in the traditional white coats. "It's jut not our style , ' ' Pierce explains. "Besides, wearing a white coat doesn't improve medical care." What do the patients think of the clinic? "All the people make you feel so welcome here," answered the black mother of f our youngsters. purpose of the clinic. But costs continue to rise, and recent donations haven't taken up the slack. "We raise money any way I we can," says Janet Klaver, a member, of the board of Directors. "But we really are at a critical stage financially. All the board has been talking about recently is what are we goingtodo?" Receptionist Marcia Barrabee added wryly: "We're a non-profit Corporation, all right." The Board of Directors last month launched its second I fund-raising campaign through mail appeals to the public. The Medical Center is a tax-exetnpt oreanization. I vate contnbutions, thougn Model Cities underwrites a portion of Dr. Grazier's salary. "We wanted a kind of practico that would make lowincome families. feel at home here," Ed Pierce tells you. Currently, about 60 patients a day - or 1,800 per month - flow through the large, remodeled house at 704 Spring St. which has been the medical center's home for the past year. Previously, it was located in cramped quarters on nearby Summit St. In general, fees are 50 per cent less than those normally charged in private practice in Ann Arbor. Bills are computed on a sliding-scale basis according to the family's income and the number of people in the f amily who depend on that income. Only 85 per cent of the patients are paying ones, including those (about 1 in 10) who followed Dr. Pierce to the Summit Medical Center f rom his previous practice. Some of the poorest patients cannot Ipay. They are not turned laway. Much of the doctor's work lis routine family practice - Iminor accidents and illness, tients. Oíten, i t ' s standing room only. Shirley Chisholm for President posters and literature are prominent throughout the room, along with a photo of Dr. Martin Luther King and an artistic photo of a black mother and child. Seven cheery examining rooms, a laboratory, a lounge and a downstairs classroom replete with blackboard complete the center's facilities. "It's a wonderful place to work, so much more personal and friendly than most doctors' offices," comments one of the black receptionists. Another receptionist - also black - answers the telephone to make an appointment for a patiënt. When she recognizes the voice she says, "I hear you got a new car, that's great? And how are all the kids?" The friendly atmosphere of the clinic carries over to the children. "We babysit a lot here for patients when they come in for an appointment and have to bring their kids. Babies and children are special here," you're told. Transportation also is arranged on an emergency medical care," she added. "I wouldn't go anywhere else." Another woman had been a patiënt of Dr. Pierce for several years at his previous practice. So she, her husband and three children followed him when he moved. "Everyone takes a personal interest in the patients here," she said. "And the atmosphere is much less frightening for kids because the doctors don't wear white coats and it doesn't seem like a doctor's office. It just seems like somebody's house." But it is a medical center, and expenses are high. Funds come primarily from patients' fees, but at least 15 per cent of the clinic's opera ting budget comes from community contributions. "We are subsidized! by the good people of Ann Arbor," Dr. Pierce says. The doctors feel those subsidies give them a lot more flexibility in "setting reasonable fees. "It Iets us sleep nights," Dr. Walden declared. But the financial pressure on the Medical Center is constant and real. The doctors don't like to raise fees, for they feel that undercuts the But despite money problems, both patients and the staff of the Summit Stneet Medical Center seem delighted with the set up. "It's very challenging and suits me bet-l ter than another type of practice," says Dr. Walden, whoj previously was engaged inj public health work and prisorJ medicine. "I was looking f om this kind of work." Dr. Grazier hopes to setupj a similar clinic in Califonial when he moves to ihat west-I ern state. And he is optimistiel that there is a "fairly large" number of young doctors today "interested in deliyering health care to the people who need it. Before, most doctors seemed to be interested in. delivering heatlh care to those who could afford it." D . Pierce acknowledges that he and his associates will not become walthy with their type of practice. "But I'm not going to turn back. Happiness for me is solving problems I'm. interested in." He adds: "The main thing is that our patients - many for the firstj time - are getting reasonablyl comprehensive medical carej They finally have doctors ofl their own."