News & Announcements
Packard Clinic’s prescription for success
The Ann Arbor News – Sunday, May 23, 2004
By Anne Rueter, News Staff Reporter
At 30, the practice is a model for providing care for the uninsured
doctor’s
office
In the late 1960s, medical student Jerry Walden bristled with idealism.
A self–described “shy country boy” from Michigan’s
Thumb, he absorbed the social do–good spirit of his era. He had
grown up with parents who always pulled for the little guy.
So during his last year at the University of Michigan, Walden went
to Nigeria to work in a clinic, looking for a place where his skills
could make a big difference in people’s lives. That place, he
soon realized, could be back in the United States, right in Ann Arbor.
In 1973, Walden founded Packard Community Clinic in southeast Ann Arbor.
Energized by the civil rights movement, Waiden wanted to offer routine
medical care to people of modest means he saw shut out of the health–care
system then, including many African Americans. Then as now, too many
people had to set aside their health problems till they ended up in
emergency rooms.
Walden’s idealism didn’t fade. Today, he’s incensed
at what he considers “the indignity of having so many people left
out of the health–care system” with 44 million Americans
uninsured, as welt as the spiraling cost of prescriptions. “It
horrifies me,” he says, when he wonders why a patient’s
symptoms persist and the patient confesses, “I can’t afford
my drugs.”
The clinic didn’t fade either. It stands like a small greenery–edged
oasis between a hair salon and an auto parts store in a commercial strip
on Packard Road, a financially viable nonprofit primary care clinic
that serves close to 5,000 patients.
Walden and his wife Julie Tiplady, the clinic administrator, are proud
they’ve made his original concept work: Offer the consistent,
ongoing care typical of any good private primary care clinic, but don’t
turn away anyone who cannot pay. To do that, the clinic relies on revenues
from insured patients (85 percent of its operating budget), staff willing
to work for 20 to 40 percent less than market rates, community donors,
a community development block grant and low overhead.
The clinic has reached its 30th anniversary in good health in part
because of Tiplady’s management skills. The future holds inevitable
changes, however. In a few years, Walden, 62, and Tiplady, 57, plan
to turn over day–to–day management of the clinic to others,
though they’ll stay involved in lesser roles. Walden will probably
continue seeing patients, Tiplady will work on fund raising.
doctor and patient
They’ve thought a lot about the turnover “We’re really
co–owners of the dream,” says Walden.
“Who do we give it to?” says Tiplady. “Who will care
about this place as much as we do?”
Reputation for friendliness
Among a handful of other area outpatient practices that treat substantial
numbers of patients with little or no insurance, Packard is a mainstay
in the Ann Arbor area. About 2,000 uninsured and underin–sured
patients make up about 40 percent of the clientele. The clinic serves
more patients under the Washtenaw County Health Plan, which provides
health insurance based on income, than any other area provider. Yet
about 60 percent of Packard’s patients are people with full insurance
who come because they like the staff’s philosophy of caring personal
attention.
Mix of patients, with and without insurance
“I like the down–to–earth attitude of everyone who
works here,” says Ruth Diaz–Juarez, who says she has insurance
and coutd go elsewhere. They’re accepting of everyone. This is
a very multicultural–oriented service.”
“I like it because they remember your name,“ says Jennifer
Green, who’s come to the clinic off and on for 10 years, through
times when she’s had health insurance or tacked it. “That
didn’t matter to them,” she says. “I never felt I
was treated any differently.”
The past 30 years have shown the clinic can sustain itself while serving
its mix of patients with and without insurance, Tiplady says. She has
been on the clinic staff, coordinating staffing and fund raising, for
the past decade. She draws on her skills as a management consultant
and therapist.
Walden is the guiding force of the clinic. He revels in seeing the
same families –he’s treated five generations in one – and
the stories people tell him. “That’s why family medicine
is so beautiful,” he says. “You’re so intimately involved
in people’s lives.”
’My first thought is they’re probably irreplaceable, but
we have to train the next generation of leaders.’ Kathleen Reynolds,
executive director of the Washtenaw Community Health Organization speaking
about Walden and Tiplady’s plans to semi–retire.
“He has a very unique approach. It’s not just treating
the physical health of a patient, but the mental health,“ says
Kathleen Reynolds, executive director of the Washtenaw Community Health
Organization. She admires the clinic’s offerings to help patients
maintain their health, such as nutrition counseling and diabetes management.
Walden and Tipiady are a formidable team, Reynolds says. She works
closely with Tiplady on a pilot “integrated health care” program
that WCHO is funding at the clinic. WCHO pays for a part–time
psychiatrist and a social worker to work at the clinic, to give patients
and staff prompt help with mental–health issues such as depression.
Reynolds plans to present the idea to other private clinics.
Clinic in transition
“My first thought is they’re probably irreplaceable, but
we have to train the next generation of leaders,” says Reynolds
about Walden and Tiplady’s plans to semi–retire, “I
think they’re doing a good job of training the next generation.”
Tiplady says she hopes members of the current staff will want to take
the reins. The clinic has asked recent hires to commit to working there
five years, rather than the two–to–three–year commitment
that physicians and nurse practitioners can make more easily. Staff
come knowing their earnings are lower and won’t rise as they would
in the private sector.
Ray Rion left his job as a family physician at U–M Dexter Family
Practice a year and a half ago to work at Packard Community Clinic.
Deciding to work at Packard Community Clinic was not an about–face
for him. “This type of work is really why I went into medicine,’” says
Rion, who’s in his 40s. He admires Walden not only as a humanitarian
but as a doctor who keeps up in his field. “I’m really happy
here. I’m not planning on doing anything different,” Rion
says.
Rion recently shared his thoughts about the coming transition. “If
we rely on finding the next Jerry as an organization, that’s not
the way we need to go,” he says. “It’s been driven
by Jerry’s vision. That he’ll (continue to) be involved
is ’ great.” A minute later, Rion: adds, “I’ll
be honest: It’s not me. I’ve never met anyone like Jerry
in my 20 years in medicine.”
Having a single guiding light may not be in the cards for the clinic
as a maturing organization, he says. “Every organization needs
to change what they do.”
Tiplady and Walden want to spend more time in the future getting the
word out to more health–care providers that their model works.
A handful of Washtenaw County providers currently try to serve the county’s
estimated 35,000 uninsured, but there are significant gaps.
“I’m hoping some physicians will become a 501C3 (nonprofit),
probably early on, or that people will take more lower–income
patients as part of their practice,” says Walden. Many are committed
to the idea these patients need help, he thinks, but blame government
for not taking care of the problem.
“Many doctors think, It’s not really my responsibility
to fix it,” Walden says. “I just feel we have to fix this.”
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