Doctors’ Day 2023: Dr. David M. Boren, M.D.
This week, Integrity Locums is celebrating Doctors Day! What better way to kick off the occasion than to recognize a few doctors who make a difference in patient lives across the country? Today, we feature Dr. David M Boren, M.D. who shares his story about a free clinic that he helped open to support his community.
What is your name and medical specialty?
Dr. David M. Boren, M.D.
Preventive Medicine – subspecialty Occupational & Environmental Medicine (OEM). Board certified by the American Board of Preventive Medicine (ABPM) since 2018.
Internal Medicine
Tell us about your free clinic.
Our clinic is a community-run health clinic whose mission is to increase access to quality healthcare among lower middle-wage earners in the Noncoastal West. We provide outpatient and telemedicine services in internal medicine and employment health. We are by appointment only. We do NOT provide emergency care. For emergencies, people should call 911. We work predominantly with rural patients in the Noncoastal West including patients from AR, AZ, CO, IA, ID, KS, LA, MN, MO, MT, NM, ND, NE, NV, OK, SD, TX, UT, and WY. To date; our patients speak English, Spanish, and Vietnamese. Most of our patients are chronically ill with countless ailments and are on many medications.
What was your motivation for opening your clinic?
My motivation was to reach out to make employment health services accessible to people who work. IFEHC has always had the vision of increasing access to quality healthcare among lower middle-wage earners in the Noncoastal West. We fulfilled this by being open 10-10 x 7 days a week, including weekends and holidays, by appointment only. IFEHC did not originally provide a free clinic, much less one that provided internal medicine. We originally were very affordable but not free. We only provided employment health physical exams. We incrementally became who we are today by listening to feedback from patients/examinees and the communities we serve. It is by continuing to listen to feedback from our patients/examinees and the community that we will continue to evolve. People convinced me that not only could I be of help, but that my clinic provided the only accessible resources to meet certain needs. I continue to be motivated knowing my work is making a difference and people seem grateful.
Can you share a patient story that best encompasses the impact your clinic has on the community it serves?
A few cases come to mind. By far the cases that stand out the most are the pediatric cases. Since I am not a pediatrician, it stands out when people ask me to take care of their children. Notably, many healthcare providers (viz, who are familiar with my work) ask me to see their children for acute illnesses. These are typically infections. I received feedback that all of the pediatric cases completely recovered.
The case that stands out next after the pediatric cases is the management of a noncomplicated obstetrics case. Of note, we do not deliver babies. We still advise patients to find an obstetrician. For the early management, we were able to provide the essential diagnostic tests and recommended management. To do this, I proudly consulted with two colleagues in OB/GYN. My clinic has been building a network of specialists.
The third that stands out is management of dermatology cases. One individual had a disfiguring infection that lasted decades. Because I consulted my network of providers that includes a dermatologist and infectious disease expert, I was able to effect a positive outcome.
Finally, a few mental health cases stand out. Psychiatry is part of primary care. Especially with mental health, it is key to have an accessible provider. I have received feedback that all of my psychiatry cases had favorable outcomes. I attribute that largely to my patients being able to reach me. The most common concern is last-minute concerns about refills. People also reach me who are in crisis. I believe it matters to people in crisis being able to reach those they know and trust. For some of the more complicated cases, I have also reached out to specialists in my network. These include psychiatrists as well as other trained individuals at the Suicide and Crisis Lifeline (988).
Is there an achievement or contribution from your clinic that you are most proud of?
(1) The quality of our healthcare. This includes providing basic diagnostic services like labs and imaging. About a quarter of people who call due to word of mouth indicate being surprised to learn the care is free.
(2) Our accessibility. For non-established patients and examinees, this means that our free clinic is open on weekends and major holidays. For established patients and examinees, this means having 24/7 access.
(3) That our patients and examinees so far come from a radius of approximately 750 miles (diameter of approximately 1,500 miles) because they feel they cannot receive comparable care elsewhere. Our patients and examinees likewise come from ten (and counting!) states in three different time zones!
(4) Being able to do the above on a shoestring budget of $40-$45 thousand a year.
(5) The opportunities we have provided the community – with our shoestring budget. We have provided a Paid Internship sponsored by Lookout Credit Union. We also have a Four-Year Pharmacy Fellow.
(6) We are proud of our original labor rights program (https://ifehc.com/labor-laws), which includes OSHA (https://ifehc.com/osha-compliance). Despite seldom having employees, this program is extensive. The program has a Compliance Officer, 10 hours of annual General Industry training, and our own in-house exam.
What do you think other people should know about your organization?
First, IFEHC would like people to know how to qualify for its services. There is NO means testing. IFEHC does NOT collect any financial information and only collects personal information on a demonstrated need-to-know basis (e.g., if legally mandated). IFEHC requires its patients/examinees to be permanent residents of any of the 19 non-coastal Western states. Those are AR, AZ, CO, IA, ID, KS, LA, MN, MO, MT, NM, ND, NE, NV, OK, SD, TX, UT, and WY. We do take people with private insurance, as we understand that many plans have “doughnut holes” that result in reduced coverage. This especially includes veterans, many of whom only have limited coverage since coverage is based on a formula for service-relatedness. N.B., IFEHC does NOT participate in any insurance plans. Patients are responsible for being familiar with the rules of their insurance plans, including whether any prescriptions written by us will be covered. You should NOT be on Medicaid. We do make exceptions, but remember that our mission is specific to people who need us the most. You do NOT have to speak English. We have served Spanish and Vietnamese speakers. We believe we can help anyone who speaks a language that uses the Roman alphabet. Our clinic is NOT for medical emergencies. For medical emergencies, you should call 911.
The following are the environments of the services. There are TWO outpatient clinics. The main one is in Idaho Falls. The second is in Boise. BOTH (including the one in Boise) are called the Idaho Falls Employment Health Clinic, PLLC. We offer telemedicine. To receive services by telecommunications, you should be present in a jurisdiction where the Medical Director is licensed. Currently, those jurisdictions are UT and ID. However, the Medical Director is applying for licensure in the remaining 17 Noncoastal Western States. We also offer house call. The greatest traveling the Medical Director did in one week was slightly over 200 miles. This option is ideal for those who are incapacitated by acute illness, otherwise immobile (e.g., vision problems recent driving), or who are long-term caregivers.
As indicated above, even more important to IEFHC than being known as a free clinic that serves a unique need (i.e., providing to those who do not qualify for public aid) is being known for its quality. The Medical Director himself has many qualifications. In addition to five college degrees and three years of training are his aforementioned Board certification in his subspecialty. He also has active certificates in Advanced Trauma Life Support (ATLS), Advanced Cardiac Life Support (ACLS), Basic Life Support (BLS), as a Medical Review Officer (MRO), and as a NIOSH trained spirometry administrator. The Medical Director personally interviews prospective patients and examinees to make sure they are reasonable fits for the clinic’s technical capabilities. He calls them to follow up. In recommending treatments, he consults his network of providers. Based on informal surveying of applicable patients who could be reached, IFEHC believes its outcomes to be superior.
Running accessible clinics is only one of the three organizational objectives. IFEHC also provides educational opportunities for aspiring healthcare providers and non-politically partisan advocacy. Our opportunities include our paid internship sponsored by Lookout Credit Union and our new four year pharmacy fellowship. IFEHC’s advocacy has included the following: We annually inform the public of the open enrollment periods; We partner with various community organizations such as the local department of public health, Idaho Association of Free & Charitable Clinics (IAFCC); and other community outreach efforts.
In addition to IFEHC’s objectives is its creed that includes listening to feedback from the community at large. We became who we are, including the scope of services we provide, by listening to feedback from the community. Even if we do not offer a service; if you need it, you should ask. If the Medical Director believes that the request meets a community need and is within the clinic’s means, the Medical Director will do his best to provide the service.
IFEHC is efficiently run, and our first priority is spending on patients/examinees. The first two years, IFEHC had an annual budget about $40-$45 thousand. This budget included all costs: medical equipment, labor, rent, utilities, and advertisement. When the Medical Director (i.e., Dr. Boren) goes on business trips, he typically drives his own car and stays at either motels or AirBnB’s.
Finally, IFEHC believes itself to be among the most transparent organizations. IFEHC openly makes known its disclaimers. The most important of the disclaimers is IFEHC does NOT handle medical emergencies or perform abortions. The second disclaimer IFEHC has been making known is it is not listed by the IRS as a 501(c)(3). IFEHC prints countless disclaimers on its website. Please see IFEHC’s home page (https://IFEHC.com) as well as IFEHC’s registration page (https://ifehc.com/registration) for details. We believe this transparency serves everyone, as it helps both IFEHC and the community find good fit medical care.
Why have you chosen to work locum tenens?
IFEHC needs to raise money, but its policies limit its options. First, we proudly discourage our patients and our examinees from contributing financially. In the case of the latter, this is to prevent any optics of conflict of interest. Second; although our work is pro bono, we are not a 501(c)(3). This means there is no tax payoff for contributing to our organization. Third, we do not have personnel dedicated to raising funds. Again, that is because the majority of our clinic’s expenses go exclusively to patient care (viz, we would rather pay for medical equipment than extra personnel). I believe working in different environments makes me a better doctor. It is expected of clinicians that they always be striving to grow. Practicing in different settings fosters that growth
What made you choose to work with Integrity Locums?
I currently feel the closest connection with Integrity Locums of all the firms. This statement says a lot given that I have worked with locums tenens firms since 2018 and only remember having good experiences. My representatives at Integrity Locums (previously Mythili Hari, now Nick Blazek) care about me personally and the work I do. I believe they support my clinic’s vision and mission and want to help me find work that supports that vision and mission. A case in point is this is Q&A is the first time that a firm I worked with has taken the time to discuss my work and to ask me to discuss it. If Mythili and Nick’s work is representative of the company, I believe the recruiters take on a manageable caseload and know their clients well.
Do you have any advice for physicians exploring the locum tenens space?
The following are more suggested etiquette. Following this advice is not only the right thing to do, but it also puts your representatives in a position to advocate for you. First, be accessible. Once you are in contact, advise the best way to be reached. Be sure to check that mode of communication. Second, the personnel at the recruiting firms are experts at communication. I recommend addressing any questions and concerns to your representative. This especially means if you cannot go to an interview or if you decline a position. Third, be aware the firms are showing trust in deciding to present you to a client (i.e., an employer). It is both a breach of professionalism and trust if you do not communicate need to know information. Fourth; if you are really happy with the job the recruiter did, be sure to complete a survey. In this digital age, people only write to complain.
Any additional comments?
(1) The by appointment only basis serves three functions. It ensures quality by making sure that people have enough time. No one is rushed. A related function is safety. During a pandemic and flu season, people do not sit in a waiting area. The third function is privacy. There are no known incidental disclosures of protected health information (PHI) that occur since our clinic does not allow later appointments to sit in the office or anywhere audible.
(2) As indicated above, we became who we are by listening to feedback from patients/examinees and the community. Anyone who can think of any service s/he would like us to offer is encouraged to reach us.
(3) People can help us gain visibility by “like”-ing our Facebook page (https://www.facebook.com/IFEHC2020) and sharing the link to our page in different communities’ pages. Again, we are not just there for Idaho Falls. We serve residents from the 19 states in the Noncoastal West who travel to see us. As the Medical Director acquires more licenses, he will happily provide telemedicine in any of those 19 states.
About This Doctor’s Consultant
Dr. David M. Boren’s dedicated consultant is Nick Blazek. Nick has been with Integrity Locums since October 2022 and lives in Phoenix, AZ. His favorite part about working with locum tenens doctors at Integrity Locums is the opportunity to meet so many people who make a difference in other people’s lives. Connect with Nick on LinkedIn.