Before I retired last year, I worked for 19 years in a small primary-care clinic at 28th Street and Chicago Avenue S. in Minneapolis.
While we had a diverse patient population, most of our patients had low incomes and didn't own cars. They got rides to the clinic, or took the No. 5 bus, which runs along Emerson and Fremont avenues in north Minneapolis and Chicago Avenue in south Minneapolis.
We had some funding outside of patient revenue, but like any business we needed to keep an eye on our budget. When the economy worsened, patient visits declined (but overhead did not) and we had to cut staff. When the Affordable Care Act was passed, visits increased. We employed a social worker who more than paid for her salary by helping uninsured patients apply for Minnesota Care (insurance for the working poor with sliding-scale premiums) and Medical Assistance (Minnesota's version of Medicaid).
A major problem was patients who didn't show up or showed up late. If the first patient is late, it's almost impossible to catch up. The result is that all of the other patients on the schedule have to wait to be seen. They don't like this, and some go elsewhere. So we instituted a policy: more than 15 minutes late and you have to reschedule. (We allowed some leeway, especially on snow days or when a patient was new in town, elderly or didn't speak English.)
As the senior doctor in the clinic, I was repeatedly called to the front desk to see patients who wanted to explain why they were late and beg to be seen. Some were angry; some were in tears. The most common problems: the bus was late or I missed my transfer.
I remember one patient in particular, who burst into tears at the front desk and was ushered into an exam room and given a box of tissues. She was a woman of about 35 with a grade-school-age daughter. A few months earlier, she had mustered up the courage to leave her husband after he began to punch her every time he had a few drinks.
She described her schedule: get her daughter up early and off to school, take the bus to work and back, take another bus to pick up her daughter from the after-school Minneapolis Kids program, take buses to get groceries and to see the doctor. So when our office said we couldn't see her because she was late, she lost it. "Why do I even try to work? I want my daughter to be proud of me, to believe that you can make it if you try hard enough. Well, I'm not making it!"
I said that we would make an exception and see her. A fast forward six months. She got a new apartment near the light-rail Blue Line and a new job at the airport with a much better salary. Hooray!
A recent Harvard study showed that the most important factor predicting that children will escape poverty is how many minutes it takes their parents to get to work. A short commute means time left over for parenting and all of the little things that make life worthwhile.
As this metropolitan area grows and decides to deal with its large socioeconomic disparities, a comprehensive, reliable transit system is an investment that will pay big dividends. One of them is for all of our citizens to regain the feeling that hard work and personal responsibility is a path forward.
Richard Adair is a physician in Minneapolis.
