A job of consequence

Dr. Marisa Abbo is the medical director of the Covenant Community Health Center in Royal Oak, Mich., just north of Detroit. The health center is one of six new or existing clinics operated by Covenant Community Care (CCC), a Christian nonprofit with the mission statement “to show and share the love of God, as seen in the good news of Jesus Christ, by providing integrated, affordable, and quality healthcare to those who need it most.”

Abbo could earn much more money working elsewhere, according to CEO Paul Propson, but she said she works at CCC because it “lets me do a job that is of consequence … to care for our community, those around us, anyone who is in need, our brothers and sisters.” Linda Dillian, another doctor at the CCC clinic in Royal Oak, said she felt called to serve “those who lack health insurance or have insurance that makes access to healthcare difficult.” The mission-driven nature of the clinic drew her and others: “People choose to work here because of the other people who work here.”

One of those others is Matthew Ott, a doctor working at the Royal Oak clinic while waiting for another CCC clinic to open in Detroit: “I work here because I wanted to start a clinic in my neighborhood. As a physician, I wanted to use my skills so I could show the love of Christ to our neighbors and friends in our community.” The commitment to mission doesn’t stop with doctors. Medical assistant Alketa Shehu comes originally from Albania and occasionally translates for Albanian patients who don’t speak English. She said teamwork and the “relationship with each other” set the clinic apart.

Yet last summer enough of the 40 hourly workers at CCC clinics signed union cards to require a vote on whether they would join the American Federation of State, County, and Municipal Employees (AFSCME).

In an interview two days before the scheduled vote, Propson said he wasn’t sure which way the vote would go. He hoped the hourly workers—clerical staff and medical assistants—would see that “the mission they are working on is more important than the agenda that the union has,” and that “the unity they need is the unity with the doctors and the dentists here. They don’t have any reason to have unity with AFSCME, who they don’t know and doesn’t share our mission.”

That team unity is important in a job with inherent frustrations. Abbo said, “The frustrations are less with the relationships and the people than with the system … finances are always a limitation about what we can do and what we can provide.”

Compliance is also a limitation, as patients’ circumstances might lead them to disregard doctors’ instruction: “The priority might be food on the table and not the medicine they need. … You may not see them for six months, 12 months, and you’re back to square one. You made progress, you were putting a dent, there was a sense of hope. And then sometimes it deteriorates because people are back to where they were before by virtue of their situation.”

Sometimes staff workers have to dig deep to find compassion for patients who appear to be gaming the system. CEO Propson said many very poor people come to CCC clinics, but “some come driving in nicer cars than our staff. Some come in with shoes that cost way more than their bill and tell you they don’t have $20.”

He added, “You can’t make the mistake of trying to block a person from inappropriately using charity because if you do that you’re going to block people who really need it. And you’re going to lose sleep when you hear their stories about how they really needed help and you treated them as though they were trying to abuse the system—and their mother, or their child, or they themselves suffered for it.”

The workers rejected the union by a vote of 25 to 11. Still, Propson described the election as a wake-up call: “We’ve been taking a second look and wish we’d done a better job caring for our 40 hourly employees.” Since then, CCC has instituted monthly meetings of professional and nonprofessional staff at each clinic to hear concerns before they become issues. CCC has adjusted pay scales, added benefits, and instituted continuing education credits.

CCC can raise pay scales for hourly workers because in 2007 it became a Federally Qualified Health Center (FQHC), which allows it to see patients covered by Medicare and Medicaid. Prior to that, CCC was a free clinic relying on volunteers and donations, but the organization decided the free-clinic model didn’t allow it to grow fast enough to meet the needs of the community.

Now, the budget has expanded to $9 million, with about 60 percent coming from insurance (including Medicaid and Medicare) and fees from the uninsured, whose payments add up to about $400,000 a year. The rest comes from grants, donations, and partnerships with other health organizations that enable CCC to open new clinics in underserved neighborhoods, adopt electronic medical records, and attain lab work and specialized care for patients.

Propson says he always worries about the unintended consequences of receiving government money, but they aren’t necessarily the ones that first come to mind. Government rules can drive a mindset that “is not the mindset of the gospel. … If you get in the mindset of doing the minimum for the government, you are going to think of the government as your master.” Instead, he said Christians need to ask, “What’s the Christian imperative behind this rule, and how can we go and fulfill that, even if it’s going to be harder work?”

And if the day comes when someone complains about an explicitly Christian group receiving government money? Propson said, “We should hold our success loosely, understanding that it comes from God.”