Health care in America today is a huge business, and young physicians interested in providing primary care in medically underserved areas are “swimming against a strong current,” say two leaders of Resurrection Health, a primary care health network in Memphis, Tennessee.
But as their own experience with Resurrection Health shows, it can be done.
“As difficult as it can be, we’ve created a fairly robust primary care safety net for the poor in a city with a lot of poor people,” said Dr. Rick Donlon, the CEO of Resurrection Health and former CEO of Christ Community Health Services. “If you have eyes to see, you can do things that have profound and even eternal consequences.”
Traditional markers of success in medicine such as income, prestige and research advances are attractive to medical students pondering their future careers, but those are ultimately idols, Donlon said.
“There are things unseen that are much more valuable and true,” he said. “That’s what we’re trying to call these younger health care professionals to.”
Working in primary care in underserved areas is about more than medical practice, said the Rev. Nathan Cook, Resurrection’s chief strategy officer and the spiritual director of the network’s family practice residency training program.
“It’s not about being a physician,” Cook said. “It’s about serving the Lord Jesus Christ, and it’s about Jesus’ ministry to the poor, and that we are following in Christ’s footsteps as we make sacrifices, as we deny ourselves. It’s being a part of this upside-down kingdom.”
In 1995, Donlon and Dr. David Pepperman helped co-found Christ Community Health Services -- now Memphis’ largest primary care provider. Two years ago, they left that organization to start Resurrection Health. They have also founded a network of house churches in areas served by the organizations’ clinics.
Donlon and Cook spoke with Faith & Leadership while at Duke Divinity School recently to present a seminar about Resurrection Health and integrated, incarnational health care. The following is an edited transcript.
Q: Give us an overview of Resurrection Health.
Donlon: Resurrection Health is only two years old, but it is a reiteration of the work we’ve been doing in Memphis for about 21 years. We began as a clinic in an underserved part of Memphis in 1995 and grew to a network of seven health centers -- Christ Community Health Services, the city’s largest primary care provider.
Resurrection Health came about when I and some other physicians and providers left Christ Community a couple of years ago and started Resurrection Health.
We have three primary care health centers. And we also have a family medicine residency training program that matches eight residents a year for three years, so we’re training 24 young doctors.
They live with us in the inner city where we have health centers, and they learn medicine in order to do a similar work among low-income people either in the United States or overseas.
Memphis is the lowest-income city in the nation, so it’s had a lot of people without primary health care for years.
Christ Community Health Services, our first organization, is a roughly $30 million a year organization. Resurrection, in our first couple of years, is closer to an $8 million or $9 million organization.
We recently merged with another network of health centers in East Tennessee, Cherokee Health Systems. The total budget for the Resurrection Cherokee operation is probably going to be close to $60 million a year.
All these health centers are located in underserved communities, so the patients are people with Medicaid or no insurance, and relatively small minorities of people with Medicare or private commercial insurance.
Q: You and Nathan Cook are in Durham for an event called “For What Is Seen Is Temporary” -- a discussion sponsored by Duke Divinity School’s Theology, Medicine, and Culture initiative and other partners. Tell us about that.
Donlon: Nathan and I are [visiting] several campuses. We hope we’ll connect with young medical students and other health professionals early in their careers and persuade them that, as difficult as it can be, we’ve created a fairly robust primary care safety net for the poor in a city with a lot of poor people.
We’ve also planted 15 churches in low-income neighborhoods, and we’ve sent probably at least that many missionaries to difficult, unreached places.
The argument to be made to these young medical students is that you really can do this. If you have eyes to see, you can do things that have profound and even eternal consequences.
The title of the event is a reference to 2 Corinthians 4:18, I don’t know if I have it memorized, but the point is that what is seen is temporary, and what’s invisible is eternal.
We have to understand that some of the accoutrements of medical success or church success -- i.e., popularity, big numbers, income, fame, research success -- are attractive, but they’re ultimately idols, and there are things unseen that are much more valuable and true. That’s what we’re trying to call these younger health care professionals to.
Q: I’d guess that when you start from that premise, it shapes a completely different understanding of and approach to the practice of medicine.
Donlon: It does.
Part of what we'll do is invite students to spend two to four weeks with us and live in these low-income African-American neighborhoods and work in the health centers. But they’ll also spend time talking with Nathan about the values and the assumptions that they bring and how those really clash with the truth.
Cook: Because Rick does this so naturally, it’s not top-of-mind to him, but the key to raising up leaders is vision.
We’re connected to about 300 clinics through a national organization called the Christian Community Health Fellowship, and we see that across the country, one of the big struggles for medical organizations that are trying to care for the poor is recruiting physicians.
I’ve worked with Rick for the last 10 years, and we haven’t had that problem. And it’s because of Rick’s ability to cast a vision and to tap into a deeper sense of values and mission.
It’s not about being a physician. It’s about serving the Lord Jesus Christ, and it’s about Jesus’ ministry to the poor, and that we are following in Christ’s footsteps as we make sacrifices, as we deny ourselves. It’s being a part of this upside-down kingdom.
A lot of what we talk about with the medical students is, “What are the values of your peers in medical school? What are the side conversations? When you do your rotations, how do physicians make their appeals to come into their specific specialty?”
Very rarely is the message, “You need to deny yourself. You need to take less money. You need to work longer hours for the sake and for the benefit of somebody else.”
The people who come to our organization want to be a part of something bigger than themselves. They want to be a part of God’s mission. They’re looking for a sense of community, a sense of being around other people who share those same values. Because a lot of them are afraid that they’re going to get pulled off of mission and into this worldly concept of medicine.
If we’re looking to bring healing to church leadership or to medical leadership, it starts with vision, and casting a vision that our lives are about more than what makes us feel good. It’s about understanding who Jesus is, submitting to his leadership in our life, and being willing to go to the hard places and serve.
Q: Is that a hard sell for medical students? I assume all the incentives must be to go into arguably more prestigious specialties and practices.
Cook: Those are the struggles. In working with medical students, I don’t think I’ve ever convinced anybody to make that change. But when we talk through these things, a handful of people really resonate with it. It’s like, “This is what I’ve been looking for all of my life, and here is a group of people that I can do this with.”
It’s more a matter of getting this message out into a wide enough audience to capture the two or three people that it resonates with.
Donlon: Health care is a huge business. And the large and growing majority of physicians are now employed by health systems, by universities. And it’s just harder and harder, even for someone who wants to go in the right direction, to do it. You’re swimming against a strong current.
Q: Speak some about justice in health care -- specifically, Christian understandings of justice and the realities of the American health care system.
Donlon: If you take Memphis as an example, our city is very racially divided. The reality is that your ZIP code could determine your health more than lots of other things.
It is an injustice that in Memphis we have enough primary care doctors but that the large majority are concentrated in parts of the city where they compete with one another for patients, because of the revenue associated with that work. Whereas other parts of the city have few or no primary care doctors for patients who have, in every measure, worse health outcomes -- higher cancer rates, earlier deaths from cancer, higher deaths from heart disease, HIV, infant mortality.
It is not just that a group of people suffer more and a health system hasn’t tried to tackle it. It’s that you have a health system that’s driven largely by financial interests.
The Old Testament and the entire Christian Scripture are replete with directives and commandments to right injustice.
One of my favorite passages from the book of Psalms is Psalm 72, which describes the characteristics of the Messiah’s reign. Over and over, it refers to concern for the oppressed, and the poor, and fighting on behalf of people who are marginalized and needy. That’s the patient population we’re talking about in Memphis and in every major U.S. city.
The pressures that we talked about earlier -- salary and prestige and lifestyle -- drive the decision making of physicians. Though they don’t recognize it, the people who make those decisions are complicit in the ongoing injustice, because if health care resources continue to be directed in those ways and away from the needy, then we’re perpetuating injustice.
That’s part of what we’re saying to these young students -- “Come, take your sword out of its scabbard and charge into the dark, difficult place of trying to find a way to even out the fairness of health care.”
It’s very complicated. Health care disparities aren’t entirely about access, but it’s a big factor.
Q: With the ongoing discussion about the Affordable Care Act and health care generally, how do you see that playing out? And what’s the role for the church in all of this?
Cook: I start with Scripture. In Ezekiel 34, God through Ezekiel rebukes the religious leaders of his day for not binding up the wounds of the sheep that are in their care, for basically taking advantage of them, feeding themselves off the fat of the sheep.
The religious leaders, the Levites, aren’t taking the portion of the tithe and redistributing it to the widow, the orphan, the poor. Instead, they’re using it on themselves. They’re taking care of their own lifestyle to the exclusion of those in poverty, those that are hurting, those that God has made provision for.
In the New Testament, when Jesus is asked, “What must I do to inherit eternal life?” he tells the story of the Samaritan man who’s caring for someone who is hurt and neglected and needs medical attention.
The religious leaders, again, neglect to care for him. It’s the Samaritan who goes out of his way and at his own expense bandages the man’s wounds and provides him respite care in a hotel. He is the example of a loving neighbor.
Those stories are related to the church and to health care. Our society realizes that health care is needed, but the debate is over who’s going to pay for it. Is it the government? Is it business? Is it the individual? And Jesus turns that question on its head by saying, “Shouldn’t we be motivated out of compassion to care for those in need when we see the need arise?”
Part of what the church needs to do is to engage with the prophetic voice and lead by example. And I’m not necessarily talking about pastors. I’m talking about physicians who are members of the church and who need to repent of this kind of self-motivation that drives them and just say, “Look, I’m going to take a loss on this percentage of patients, knowing that they can’t afford it. Not because of a business model but because of my own faith motivation to care for those that God has directed us to care for.”
Donlon: Nathan mentioned CCHF, the network of 300 clinics across the country. Probably the most famous clinic in our network is the Lawndale Christian Health Center in Chicago, and it was started by a church, the Lawndale Christian Community Church.
Everything that we’ve done is by the grace of God and sort of trial and error. And oddly enough, in Memphis, through Christ Community and Resurrection, we have planted 15 churches.
There are people in our house churches who are not connected to our health clinics. And there are lots of people in our health clinics that don’t participate in the house churches.
But by engaging the culture at a place of need, we’re seeing the opposite of what denominations are seeing. We’re seeing growth in the church. We’re seeing churches being planted in low-income areas. We’re beginning to see the diversification of the church, racially and economically. And we did it not because we had clever church-planning strategies or we had money to do it; we have a house church network structure. We don’t have a single paid ministerial person. We don’t own a brick.
Q: These are all house churches?
Donlon: These are all meeting in houses. We rent space one Sunday a month for all the churches to gather together in what looks like a traditional service. But this movement of seeking to right injustice has drawn health care professionals and others. We’ve got a significant number of young teachers who have come in, and they’ve participated in special training to work in low-income failing public schools in our city.
It’s the church revitalizing from within. And it’s not from figuring out how we can do a little bit of our budget for this or that. It’s sort of “all-in.”
The people are immersed, because they live in the neighborhood and they care about the neighborhood. Their work and their ministry and their lives are integrated in a way that’s not what you see in traditional churches.
There’s an energy in that. I think it’s the Holy Spirit that is moving. And we’re seeing growth and missionary sending that I don’t think we could have ever imagined if we’d tried to plan it.