American Osteopathic Association

Advancing the distinctive philosophy and practice of osteopathic medicine

Pro Bono Care Survey Results

Executive Summary: 

In response to reports suggesting that the percentage of physicians providing charity or pro bono care was declining, the American Osteopathic Association conducted a web survey on charity care provided by osteopathic physicians. A total of 1,624 osteopathic physicians completed the web survey (an active response rate of 10.8%) between October 17, 2005 and January 30, 2006. Respondents were asked to describe the charity care they provided “in the past year.”

Ninety percent of the responding DOs provided charity care. This care included office visits, clinical laboratory services, imaging services and medications. Eight percent reported that they had not been asked to provide charity care. Less than 1% turned down a request for charity care. Male DOs, DOs aged 40-64, DOs working in physician-owned practices, or DOs in rural areas were more likely to have provided charity care than other DOs. The median value of this charity care was $10,000, although 25% of DOs reported charity care of at least $35,000. Sixty-nine percent of the respondents reported that demands for charity care increased during the past year.

Responding DOs saw a median of 50 charity patients during the past year. Fifty-nine percent of their charity care patients were new patients rather than existing patients. Respondents saw 57% of their charity care patients more than once during the past year, suggesting that they become ongoing patients and therefore an ongoing financial commitment. While thirty percent of their charity care patients had health insurance, their needs included services that were not covered.

Thirty-two percent of all responding DOs and 68% of those who owned clinical laboratory equipment provided pro bono clinical laboratory services. The median value of these services was $1,000. Twenty-three percent of all responding DOs and 65% of those who owned imaging equipment provided pro bono imaging services. DOs who provided these services pro bono were much more likely than other DOs to report an increased demand for these uncompensated services.

Seventy-one percent of responding DOs provided pro bono medications to patients. Sixty-four percent provided free samples, 50% referred patients to manufacturers’ assistance programs and 39% referred patients to outside agencies. While some respondents commented that they helped their patients apply to manufacturers’ assistance programs, only 45% were familiar or very familiar with this way to provide medications pro bono. DOs not in solo practice frequently must obtain approval before providing charity care. While 76% of DOs in group practices are involved in the decision to provide charity care, only 38% have sole authority to authorize charity care. Ninety-seven percent of DOs in group practices who are able to authorize charity care provided this care compared with only 70% of DOs with no input into the charity care decision.

Previous studies of physician charity care have found that physicians in solo practice or in other physician-owned practices are more likely to provide charity care than other physicians. The large number of DOs in solo practice suggests that DOs will continue to be important providers of pro bono care.