by Debra Blaine, MD, CMT
Published 09/28/23, © 2023 Debra Blaine, MD
Within the current structure of the privatized healthcare system in America, it can be hugely challenging to find time and resources to reach out to underserved communities.
But let me tell you about a remarkable physician who works for one of the largest medical organizations in the country and is responsible for the management of all their urgent care centers in New York.
Instead of beleaguering the challenges of productivity requirements, revenue needs, and patient satisfaction ratings, he is implementing new standards of care for marginalized communities, and making medical facilities a more comfortable and comforting place to come to, even in this age of high-volume, high-profit healthcare—and he has the blessing of his institution.
And he works quietly, without bringing much attention to himself or the wonders he’s performing.
How His Story Started
Dr. Neal Shipley originally chose emergency medicine as a specialty because he wanted to provide for patients who were most in need. These included those with critical injuries and illnesses, of course, but he soon found that the emergency department (or ED) had also become the principal point of care for anyone without a primary care doctor or health insurance.
Many of these patients fell outside the mainstream population, whether for reasons of socioeconomic status, race, ethnicity, or lifestyle preferences, and had no other access to healthcare. And they were very much in need.
After practicing as a hospital attending for a number of years, he opened a private urgent care practice hoping to bring many of the benefits of the ED to the outpatient, less frenzied environment, and in 2015, Dr. Shipley and his practice joined Northwell Health-GoHealth.
He’s had a rather successful career, and is now Medical Director of the entire New York Market where he oversees approximately 60 sites and a workforce of roughly 300 providers and 700 staff members. For most people, this would entail quite enough bureaucratic responsibilities to fill their day.
So why did he also establish a program for free HIV testing and treatment referral in New York City? And why is he working toward revamping New York State regulations to make HIV testing a mandatory offering in all urgent care centers?
An Inciting Factor
One day in 2019, Dr. Shipley treated a patient who was a member of the LGBTQ community and who also just happened to be a fellow physician.
He employed his usual excellent medical competence, but he says he completely botched the job on the emotional sensitivity scale. He and his staff stumbled over which pronoun to use, were puzzled over the person’s name, which did not appear to match their gender, and were generally awkward regarding the individual’s sense of identity and their place in the world.
The patient had an awful experience and wrote a detailed and passionate letter to him telling him so.
Now, many doctors would have just tossed the letter in the trash, made the excuse of how much work they were trying to do in so little time, that it was just one patient’s experience—a patient who actually did receive appropriate treatment, and gone on with their lives and their careers. But Dr. Shipley took it to heart. He was mortified that his actions had personally led to someone feeling judged and morally injured.
Medicine is supposed to heal wounds, not cause them.
So, Dr. Shipley started looking for ways that he and his entire organization could do better. Many members of the LGBTQ community are at higher risk for STIs and cancer than the general population, and if their mistrust of the healthcare system caused them to shy away from getting medical care, that would adversely contribute to the city’s health challenges all around. But if he could change the way patients perceive the office environment, it would be a boon for getting sick people in for treatment.
After doing some research, he found the HEI, or the Healthcare Equality Index. The HEI is a national human rights campaign that specifically helps healthcare systems benchmark themselves toward competency in caring for the LGBTQ community.
It measures how culturally competent the workspace is for patients, so that individuals can feel comfortable selecting their gender, finding unisex-labeled bathrooms, and being treated by the staff with dignity and respect, and it also looks at internal benefits for employees who may have same-sex spouses they wish to cover on their insurance plans.
Dr. Shipley was able to have this policy adopted as part of his own business’s protocol. To endorse the process, he started wearing a PRIDE pin on his ID badge and his stethoscope, and he says it paid off right away.
He remembers walking into an exam room to see a young girl who was there with both of her mothers. The mothers looked at his pin and then looked at each other and he could feel them relax; he says he knew exactly what they were thinking: They didn’t need to explain their situation to him and they wouldn’t get any raised eyebrows or remarks about which of them was the child’s mother. They knew he got it.
While it’s certainly not a requirement that his staff wear pride pins, knowing that due to the training he implemented, all patients can find a similarly calming atmosphere that is accepting of their lifestyle, no matter which Northwell-GoHealth office they frequent, gives him a deep feeling of accomplishment.
He is especially proud that now Northwell Health scores at the top of the HEI ranking, and continues to educate its staff to be sensitive to the needs of all patients.
When COVID Hit
The COVID-19 pandemic hit New York City hard, and medical services became scarce outside of the emergency departments or urgent care clinics. But that didn’t mean other health issues went away. Even once the coronavirus was in the background, there still remained vital health needs that weren’t being met.
And he could not forget the patient he had inadvertently slighted and caused such emotional pain.
So, he continued to focus on the LGBTQ population and searched for ways to increase HIV testing. In New York State, EDs and primary care offices are required to offer HIV testing once a year, and according to the World Health Organization (WHO), the best way to prevent disease is to do more testing, but awareness of the need to test for HIV and other diseases had fallen much by the wayside with the pandemic. If patients were not going to their primary care doctors or to the emergency departments, shouldn’t urgent care doctors try to step up and test them?
So Dr. Shipley went again to his leadership at Northwell-GoHealth and outlined his concerns.
Testing costs money, and companies like his that are not government-funded need to make a proﬁt in order to function, so he solicited Abbott Scientific, a lab that makes rapid HIV tests. They agreed to donate 4,000 tests to Northwell-GoHealth’s urgent care centers, and as a result, since May 2023, every GoHealth patient over the age of 18 in New York City has been offered an HIV test for free. Whether they’re there for an x-ray, stitches, or a COVID test, they can get their HIV test while they wait.
At the time of this article, the project has been up and running for a little over three months. Dr. Shipley reports that in the first six weeks, 400-500 people were tested. One person was found positive who’d had no idea, and 40 to 50 at-risk people have been referred to Northwell Health for PrEP, or pre-exposure prophylaxis. That means there’s a reasonable expectation that those people will never get HIV.
Shipley states clearly that he could not have done this without the support of Northwell Health, who is a willing partner in the project and who takes these referrals. And he maintains that this is financially good for everyone. “Good patient care is good for business,” he says. “When patients have a great experience, they come back and bring their friends.”
And Dr. Shipley isn’t done. He knows multiple people who have children on the autism spectrum who dread taking their kids to the doctor. They worry whether they will be treated decently and if the staff will understand what their particular problems are and how to treat them.
So next, he wants to address the needs of this marginalized population as well by elevating sensitivity and understanding of their unique situation. He recommends triaging autistic patients and bringing them back into a room faster so they are not overstimulated in the waiting room, and he hopes to provide sensory kits to help reduce their frustration and anxiety.
Why take on so much?
In a culture that is encouraging doctors to help optimize revenue, Dr. Shipley—with the support of Northwell Health-GoHealth—is focusing on bringing more compassion and dedicated medical care into the office setting.
This is a lot to do in the urgent care locale, and he’s sure some of the providers think he’s crazy. He’s still asking them to see a certain number of patients each day and keep the satisfaction ratings high while adding these additional—let’s face it—time-consuming tasks. He acknowledges their concern and understands the flow may slow down a little. But his goal remains to improve the lives of patients in any way he can within the four walls of the urgent care center.
When asked what motivated him to go from provider at the bedside in an emergency department to running an organization, he says this:
“It was nothing more than a force multiplier. Working in the emergency department, I was doing my twelve-hour shifts, seeing twenty to thirty patients a day. As a director, I’m in a position to change the lives of over a million patients a year. That’s an honor and a privilege and I take it very seriously.”
For Dr. Shipley, when he doesn’t get letters from patients saying how awful their experience was and when he knows he can be instrumental in making sure a patient never gets AIDS, it’s all worthwhile in the end.
“Dealing with all the other stuff of running the business, dealing with patient complaints, customer satisfaction, managing the schedule, the throughput time, the door-to-door times, financial performance, that’s all the price I’m willing to pay to do these other things.”
As for Northwell being onboard, Shipley says success breeds success, and doing the right thing will ultimately pay off.
“Urgent care is a great place to access the healthcare system,” he says. “Like, we’re not going to do colonoscopies, but we can darn sure do HIV testing. And we can also do PAP smears and identify people at risk for cervical cancer. Until someone tells me to stop, I feel like I need to keep going.”
About the Author
Debra E. Blaine, MD, CMT, practiced family and urgent care medicine for over thirty years on Long Island and Queens, NY. She now works full-time as a freelance writer and continues to add to her award-winning science fiction series, “The Sanctuary Seekers.” She can be reached through her website at AllThingsWriting.com or by emailing her at email@example.com.