The San Francisco Free Clinic: How It All Began

Patricia Gibbs, MD, and Richard Gibbs, MD

Every man must decide whether he will walk in the light of creative altruism or in the darkness of destructive selfishness. -Martin Luther King, Jr.

Altruism in physicians is alive and well in San Francisco! And I'm not referring to the authors of this article.

It may sound contrary to popular belief, but it has, in fact, been proven repeatedly in our experience at the San Francisco Free Clinic.

My husband, Dr. Richard Gibbs, and I, both family physicians, founded the clinic in 1993. We had moved to San Francisco in 1990 and, despite the advice of many, started our own primary care practice in the medical building on 490 Post Street.

We were into our third year of an extremely busy practice with many managed care patients, and as such were consumed with our designated role as "gatekeeper" to the medical system. Unfortunately, this experience was less rewarding than we had hoped for. The majority of our days were spent haggling with patients and insurance companies about specialty referrals. To make matters worse, we weren't doing any charity care or even taking Medi-Cal because we couldn't afford to, given our tiny margin between income and expense.

Was this what why we'd spent years training at some of the country's best medical schools and hospitals?

As happens sometimes in life, a seemingly trivial matter, the timing of our lease renewal at 490 Post Street, was the detail that tipped everything in a very different direction. When faced with a new five-year commitment to continue our private practice, we suddenly thought, "Wait! Couldn't this be our chance?" Our chance to make a difference, to do the things we thought we'd be doing when we went to medical school, to do something about all those people who called our office and had no health insurance?

At that crucial turning point, we decided to essentially convert our practice from one that served insured patients to one that served the uninsured. We did have to move to another part of town and so chose an area that did not have a public health or community clinic at that time, the Richmond District.

Given the conversion from insured to uninsured patients, you might wonder: what possible source of income could they have in that scenario? We had applied and received status as a nonprofit public charity, and so were all set up to receive charitable donations. However, no one was giving. Donors were leery of providing grants to a couple of lone and perhaps not-so-mentally-sound doctors.

Here is where my first example of physician altruism comes in. At that point, we went to the physician community through the San Francisco Medical Society and our medical IPA, California Pacific Medical Group, and said, "Would you help us provide medical care to uninsured patients, either by volunteering at the clinic itself, or by seeing specialty referral patients in your own office?" Seventy physicians volunteered their time. Another 50 offered to provide us with excess sample medications, supplies, or donations. In total, we received a 10 percent positive response to our mailing, the single fact that convinced potential donors that we had a legitimate enterprise worthy of their support.

These initial donations allowed us to open our doors. The ongoing, continued volunteer efforts of these and new volunteers have convinced the donors to keep giving.

I remember very well the day we saw our first patients at the clinic. It was the day after Valentine's Day, February 15, 1994. There had been an article about the clinic in the San Francisco Chronicle the day before. That day, I received a number of phone calls from physicians wanting to help out. The one I remember best, however, was the one from Phil Tirman, a radiologist working at San Francisco Magnetic Resonance Center at the time. "Need any free MRI scans for your patients?" MRI scans? Wow!!!!

As I said, physician altruism is alive and well in San Francisco! Want to join in? Please feel free to contact us at (415) 750-9894.

Tricia and Richard Gibbs are family physicians, trained at the Family Medicine Residency at the University of Washington, Seattle. They both attended Yale University School of Medicine and are assistant clinical faculty members in the Department of Family Practice at the University of California, San Francisco. They are on the courtesy staff at California Pacific Medical Center and are diplomates of the American Board of Family Practice.