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Bruce H. Doblin, MD, MPH; Lillian Gelberg, MD, MSPH; Howard E. Freeman, PhD

JAMA. 1992;267(5):698-701.

Abstract
Objective.
—To describe the patient care and staffing patterns of the 157 clinics that receive federal funding to provide health care to the homeless.

Data Sources.
—Telephone interviews with clinic medical directors.

Results.
—Clinics treated a mean of 96 homeless patients per week, approximately 50% of the estimated homeless population. Three quarters treated homeless patients only, the others integrated homeless patients into an existing setting. One third of the clinics had no physician more than 5 hours per week, 10% had no physician staff at all, and 80% employed a nurse practitioner. The proportion of patients initially examined by a nurse practitioner and the proportion subsequently referred to a physician ranged between 10% and 100% Clinic directors reported that in over 50% of clinics, physician recruitment was hampered by poor working conditions, inadequate salaries, physician biases against working with the homeless, and the lack of respect this work receives from the medical profession.

Conclusions.
—Current financial constraints may be impeding the ability of clinics serving the homeless to ensure adequate access to high quality care. Additional research should evaluate the impact various staffing patterns have on access and quality of care and develop methods to improve physician recruitment.

(JAMA. 1992;267:698-701)

Author Affiliations
From the Department of Medicine, Divisions of General Internal Medicine (Dr Doblin) and Family Medicine (Dr Gelberg), and the Department of Sociology (Dr Freeman), University of California at Los Angeles.

Footnotes
The views expressed herein are those of the authors and do not necessarily reflect those of the University of California at Los Angeles or the Robert Wood Johnson Foundation.

Reprint requests to Department of Medicine, Division of Family Medicine, 50-071 CHS, 10833 Le Conte Ave, Los Angeles, CA 90024-1683 (Dr Gelberg).

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