After nearly 40 years in clinical medicine, I retired in 2022. While I expected to feel a sense of freedom, quitting medicine brought me an unexpected sense of loss over the thought of decades of accumulated knowledge, experience, and judgment suddenly going to waste.
Volunteering at a nonprofit community clinic gave me the chance to continue using my knowledge and skills. But it also taught me firsthand what I had not learned in private practice: For millions who must pay out of pocket for their health care, the options are very limited. Both community clinics and retired doctors are underutilized resources.
The community clinic serves the “working poor” — those who are employed but cannot afford high insurance premiums or deductibles, those who are ineligible for federal aid, and the unemployed. Most clinic patients do not speak English, and caring for them via translation is challenging and inefficient. Scribes assist by entering patient data into the electronic health record. Our scribes are pre-medical students who volunteer part time at the clinic to gain clinical experience, a requisite for admission to medical school. I enjoy mentoring these future doctors by explaining key clinical findings of patients we had seen, having them listen to a heart murmur through my stethoscope, or answering their many questions about life in medicine.
At the clinic, I learned that many modern imaging techniques are difficult to access or too expensive for the self-paying patient. An EKG machine is readily available, but advanced imaging such as echocardiography requires referral to an outside site and some diagnostic tests are prohibitively expensive despite “discounted prices.” For years, the National Institutes of Health had offered advanced cardiac imaging at no cost to uninsured patients who volunteered for clinical trials. However, in January 2025, the NIH enacted a stricter registration mandate requiring documentation of citizenship for all NIH campus visitors, which deterred many patients from this option. So, in evaluating patients, I must rely more on my eyes, my stethoscope, and my hands, using skills learned in medical school — skills that have been fading as clinicians increasingly rely on high-tech imaging.
I learned that for the self-paying patient, just filling a prescription can be daunting, because drug prices vary widely between pharmacies even for older generic drugs. On the GoodRx website, a one-month supply of lisinopril 10 mg, a commonly prescribed generic antihypertensive medication, costs $5.90 (“without coupon”) at one pharmacy and $29.21 at another. The cost of a one-month supply of generic sacubitril/valsartan used to treat heart failure varies between $39.33 and $700.75. Brand-name drugs are even more expensive. Medical therapy based on affordability makes it difficult to achieve optimal outcomes and often requires using combinations of several older, less effective drugs. Our clinic pharmacists spend countless hours price-hunting to help patients find the most affordable way to fill their prescriptions.
The stakes are higher when an uninsured patient requires urgent but non-emergency surgery. I evaluated a patient with a severely narrowed aortic valve who, in my former practice, would have been referred promptly for valve replacement. I was unable to find a private cardiologist who would accept an uninsured patient. Although the emergency room remains a safety net, my patient was reluctant to go, knowing he might be discharged with a bill if not deemed sick enough for admission. The clinic doctor is left walking a tightrope, managing patients conservatively until they are sick enough to be admitted, worrying that they will suddenly decompensate in the interim. It is both frightening and frustrating when former referral pathways are no longer available and established lifesaving treatment is difficult to access due to cost. I took the chance to “cold call” an ER physician at a nearby tertiary hospital, and fortunately, after I conveyed the seriousness of the patient’s condition, she agreed to admit the patient, who subsequently underwent successful lifesaving valve replacement surgery.
For the uninsured, limited access to care can be a matter of life and death. According to KFF, an estimated 26.7 million people in this country are uninsured. Increasing layoffs, stricter Medicaid work requirements, and reduced subsidies will only add to the number of the “working poor.” In addition to providing basic care, community clinics can lower overall health care expenditure by reducing preventable ER visits and hospitalizations. A published analysis of a California clinic found that every $1 invested yielded $13.18 in savings.
While millions lack access to basic care, thousands of physicians retire each year. This growing “retirement cliff” and “brain drain” represents a loss of valuable medical expertise. Community clinics like ours provide an ecosystem that could benefit multiple participants if hurdles are removed. Offering low-cost national licensure and expanding good Samaritan protections could encourage more retired physicians to volunteer. More hospital systems could partner with community clinics to coordinate essential post-discharge follow-up care. Nonprofit hospitals, in exchange for their tax-exempt status, could allocate a fair share of imaging and hospital care to uninsured patients at little or no cost.
It was only after retiring from mainstream medicine when I fully comprehended the callous limitations of our health care system and how it impacts the most vulnerable among us. In volunteering, I’ve learned how community nonprofit clinics can serve multiple needs: providing essential cost-effective care for safety net patients, clinical experience for future physicians, and renewed purpose for retired doctors who wish to continue practicing at a different pace. Volunteering at the clinic extends the value of my medical education and enables me to contribute a small amount of care to those our health care system has forsaken.
Benjamin I. Lee is a retired cardiologist who volunteers at a community-based clinic in Maryland.
