WESLACO, RGV – The longterm medical director of El Milagro Clinic has blasted secondary and specialty doctors who do not help the indigent poor.
Dr. Roberto Gonzalez has been a family practice physician for 40 years and has served the uninsured and the underinsured at El Milagro in McAllen for 17 years.
“I am ashamed my profession does not step up, is not willing to contribute more to the problem that we have in the Valley. I just feel like too many of the specialists feel that their time is more valuable than the primary care doctors’ time,” Gonzalez said.
“People cannot afford to pay three or four hundred dollars for a consultation that is going to take them 20 minutes, 30 minutes, in most cases. If they would even agree to charge what Medicare rates would be… I can tell you from experience, I went to see a specialist and Medicare paid about one fifth of what the doctor charged.”
Gonzalez made his comments during a panel discussion at last week’s “Gaps to Accessing Specialty Care in the Rio Grande Valley” summit. The summit was hosted by the RGV Equal Voice Network Health Working Group and held at Knapp Conference Center.
“I just feel like (specialty) doctors need to understand that their time is overrated. I really feel they need to pick up the slack and they need to give a damn about taking care of people,” Gonzalez said.
“I did not go to medical school because I wanted to become a millionaire. I went because I genuinely wanted to contribute to society. I understand that not everybody went to medical school for that reason but I think too many guys lose sight of the reason that they wanted to become doctors and they get so full of themselves.”
There was loud applause when Gonzalez explained why he went to medical school.
“I wish and I hope that doctors step up to the plate and are willing to help the people that need their help. We are not just talking about people with insurance. We are talking about people that just cannot afford to pay these outrageous rates.”
In his remarks, Gonzalez argued Hidalgo County’s indigent health program has room for improvement.
“We have the Hidalgo County Indigent Program that does provide a lot of help for people. Unfortunately, I do not why but most people that go and apply for that assistance are given the assistance usually for six months. They backdate the assistance to when they first made the application for the help so that even though they are given the assistance for six months, if they applied in March and they finally given the assistance in late April or May, they are already down to four months for that help.”
Gonzalez had a suggestion on how the program could be improved.
“I think there needs to be a way whereby if you are going to backdate that help you should backdate it for people who have bills because they were in the hospital in March and backdate it back to that date.”
Although Gonzalez knows Hidalgo County best, he said access to secondary care is a problem for all of South Texas. “I do not have the answers. I will leave that up to the people who are in the know about funding,” he said, before giving a shout out to Methodist Healthcare Ministries of South Texas, Knapp Foundation, and Valley Baptist System.
“I hope that funding does not dry up because we are going to be in a heck of a lot of problems.”
Gonzalez opened the panel discussion by talking about the challenges he and his staff face at El Milagro, one of the few safety net clinics in the Valley.
“It has been a real challenge from the get go because most of the patients we deal with are uninsured. A very good percentage of them are undocumented. So, they really don’t have access to insurance and don’t have the financial resources to take care of chronic illnesses,” Gonzalez said.
“Sometimes non-acute illnesses, a sore throat, a cold, bronchitis, diarrhea, things like that, they can usually afford to go an buy antibiotics at HEB or Walmart for four dollars. I learned very quickly that you have to make whatever treatment affordable because it does not do you any good to prescribe something that the patient just can’t afford to get because they are back to square one, they are not going to get better.”
As a result, Gonzalez said, doctors at El Milagro resort to getting lists from Walmart or HEB for discounted medications to treat diabetes, high blood pressure, high cholesterol, etc. “The antibiotics, they are going to be generic but for the most part it takes care of the problem,” he said. “Unfortunately, though, you cannot treat everybody with inexpensive medications. At El Milagro Clinic, we have a Patients Assistance Program that makes it easy for our patients… if they have a social security number.”
Gonzalez pointed out that most of the pharmaceutical companies will only help people that have a social security number.
“So, we can apply, help them fill out applications for medications that would normally be unaffordable. We provide it for them and we are able to help in that way but if they do not have a social security number there are only two or three pharmaceutical companies that will help these patients with medications. If they don’t (have a social security number) it is virtually impossible to provide the care that they desperately need.”
Gonzalez described the Valley as the Capital of the United States for Diabetes.
“The epidemic that we have of diabetes is just overwhelming. Every other week there is a new restaurant that pops up or new taco stand that, yes, it feeds the people but it is not healthy food. A lot of the times the population cannot afford the healthy food so they get food they can afford.”
About a year ago El Milagro hired a dietician and that has helped, Gonzalez said.
“That has helped tremendously. We refer our diabetic patients to the dietitians, steer them to the type of diet they need to follow. It is not just about prescribing medications and hoping that these patients are going to get their diabetes under control.”
The Valley needs a lot more dietitians, Gonzalez argued.
“It would be nice if we could get access to dietitians so that we can help our patients get the education that they need to facilitate treating their diabetes. It is super important,” Gonzalez said.
“And, obviously, specialty care. We haven’t been able to get specialists to pitch in. Sure, DHR has helped a lot because they have that program, DHR Cares. That has been able to help a lot of patients get some specialty care but they are overwhelmed and getting a patient to a cardiologist, sometimes patients have to wait several months to be able to get seen. When you have cancer, two or three months can mean that you are not going to have a good chance to overcome the cancer.”
Gonzalez concluded his remarks by urging secondary care doctors in the Valley to see more patients, whether they have insurance or not and whether they are documented or not.
“People are not knocking at their door because they are trying to beat the system. They are trying to survive and move on with their daily struggles. To be able to go to work. They are not here to try to get a handout. They are not here as crooks, like our president has said many times. Most people that come over here to get a better future with their families. I feel that because they are human beings we do need to help anybody that comes over here, because they want to better themselves.”
