I am not normally big on “weeks” but I am big on health centers! This year, the Health Center Week theme is “Home of America’s Health Care Heroes” and is that true! To those of you who have never worked at or frequented a health center, that may seem a bit much, but as someone who has worked in a Federally Qualified Health Center (FQHC) or related health centers providing health care to poor and uninsured patients for decades, I certainly understand the heroics. It does take a hero to do this work every day.

FQHCs accept everyone and anyone who walks in the door, and of those who do walk in, the majority are uninsured. From a provider prospective, the layering of lack of insurance on top of complex health and social needs is a significant challenge. It is, in fact, a daily moral dilemma.

Every clinic day I enter with the full intent to provide the highest quality care but it is HARD. I can never “just” write a prescription for a medication or order a diagnostic test or a referral. Each decision requires thoughtful consideration of essential vs ideal all the while maintaining quality standards. Once I decide what I want to do, I then have to move on to consideration of the “least expensive” best medication and/or beginning the process of finding services at low or no cost. FQHCs have a complex system of support for these services but navigating them isn’t easy for providers or patients and sometimes there just isn’t a solution. And this challenge is further complicated by the fact that these patients live in poverty, often have limited social support, and even limited access to transportation.

I will tell you, at the end of the day I do sometimes feel like a hero! Let me be clear, I readily accept this challenge. I love the work and my patients, but that doesn’t make it any less challenging. And feeling like a hero isn’t all its played up to be. By the time I get home and am re-thinking the day, I am overthinking decisions and find myself in a complex inner dialogue to justify my choices.

So I am glad we have FQHCs. The decision years ago to establish them within the US health care system was a good one and it is applaudable that our leaders choose to continue to fund them. And the folks who go to work at these clinics every day are heroes! But at the end of the day, I wish we didn’t need them or that we didn’t need to have this complex system to manage uninsured and poor patients. I wish we would choose as a society to provide funding that assures quality health care for all. Health care heroes should not be forced to make decisions every day about how to get quality health care to people with real problems; they should be free to work with all of their patients to provide the best quality, cost effective care in a patient centered manner. Health centers do that, but at price; I know because I feel it at the end of every clinical day.