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Opinions on Practice Management

Paul Bergstresser, MD

Volunteering: Alive and Well Among Dermatologists

Paul Bergstresser

Tuesday, November 08, 2005

The word "volunteer" is unusual in that it may be used as a noun, verb, or adjective. As a noun, it identifies a person who performs a service of his or her own free will, and, importantly, as a verb, it means to do charitable or helpful work without pay.

In North America, useful work performed without pay by volunteers is common in medicine, and it is perhaps even more common for those who practice dermatology. Although the comments that follow focus primarily on voluntary service by dermatologists in North America, I know of many instances in which it is practiced at other places in the world.

My goals in presenting the types of volunteer opportunities found in dermatology are, first, to recognize these valuable contributions and, second, to encourage even more participation. And I can assure readers that I do have a conflict of interest, because our own department in Dallas has benefited enormously from the contributions of more than 50 or so dermatologists over the last 30 years. Volunteering is alive and well in general, and it is alive and well in academic teaching programs.

The most obvious time-honored volunteer tradition has been for practicing dermatologists to "give back" teaching time to local training programs. These efforts ordinarily focus in 1 of 3 areas:

  1. Serving as attending physicians in outpatient clinics at "charity" medical centers, clinics that provide care for medically indigent patients.
  2. Serving as "super-specialists" in university teaching clinics. This may involve patients with special needs, such as allergic dermatitis, pediatric diseases, or specialized cutaneous surgery.
  3. Making their private practices available for rotating residents and medical students.

Work in all 3 of these areas takes time away from patient care, so that the financial contributions are substantial even when a modest honorarium is provided. On the other hand, knowledgeable trainees bring enthusiasm and gratitude to the volunteer dermatologists as well as stimulating their own "continuing education." Many dermatologists see this contribution as a partial "pay-back" for the enjoyable career that the specialty of dermatology has provided for them. Readers who have not approached leaders in academic teaching centers to learn about teaching opportunities may be missing an important opportunity for both continuing education and recognition.

Throughout the United States, there are cities and towns that have relatively large numbers of people who are medically indigent. In fact, it is estimated that as many as 15% of the population does not have health insurance, and most of these individuals certainly cannot afford modern medical care. In many of these cities, individuals and charitable organizations have established "free" clinics that offer limited medical care for relatively large numbers of people. Many are organized through churches and other local charities. These clinics operate at a very low level of finance, invariably staffed by physicians, nurses, medical students, and voluntary administrative personnel. In many localities, foreign-language skills are also valued. As one example of the literally thousands of opportunities, a consortium of churches has established the Agape Clinic in Dallas. Other volunteer opportunities of this sort exist throughout the world.

Volunteer Services to Professional Organizations and Societies

The United States has numerous city, county, state, regional, and national societies. Most of the teaching activities and many of the administrative activities that sustain these organizations are performed by volunteers. Not only do they provide educational benefits to their members, the amount of volunteer time is enormous. For example, the Women's Dermatologic Society has provided useful services to its members, most often by volunteer participants. Furthermore, professional organizations, such as the American Academy of Dermatology (AAD), commonly emphasize voluntary service. A visit to the AAD website reveals that a portion of the site is devoted to recruiting volunteers.

Moving to the international level, there are many well-recognized international charitable organizations that emphasize medical care in various underserved countries and regions of the world. A prime example is the Regional Dermatology Training Centre in Moshi, Tanzania (RDTC) sponsored by the International League of Dermatology Societies (ILDS) through the International Foundation for Dermatology.

Other organizations are more general in nature, such as Doctors Without Borders/Médecins Sans Frontières (MSF), an international independent medical humanitarian organization that delivers emergency aid to people throughout the world.

Ultimately, money and time are in many ways interchangeable. Those who have less time for volunteer service may choose to donate money instead. In fact, virtually all charitable organizations are short of money, meaning that donations, commonly tax deductible, are encouraged. Once again, many dermatologists are already major donors to such organizations. We hope that this brief review of a limited number of opportunities for volunteer service will stimulate further discussion and increased participation by those who practice dermatology.