THEO W. HODGE, JR., MD.

When Theo W. Hodge, Jr. graduated from the University of Virginia School of Medicine in 1987, he believed he would "take care of the world." He decided immediately that he would focus on caring for uninsured and underserved patients with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS).

He completed his residency in internal medicine at Georgetown University Hospital in 1990 and then served in the Gulf War as a US Army captain. In 1995, he completed a 2-year post-graduate fellowship in infectious diseases at the Washington Hospital Center and the Veterans Affairs Medical Center in Washington, DC, where his patients were mostly gay males and male intravenous drug abusers.

Since beginning his practice in 1996, Hodge has been trying to realize his ideal of himself as a physician. Many of his self-expectations have been tempered by the reality that his original ideal did not allow him the ability to maintain himself financially. The experiences of not being able to pay his mortgage, office expenses, and staff salaries because of low or late Medicaid reimbursements have shown him the obstacles to treating the community he most wants to serve.

Initially, many of Hodge's patients were uninsured and had been recently released from the hospital after receiving urgent care. He became familiar with these patients through his consultations at the Greater Southeast Community Hospital--a facility in the District of Columbia that serves a large population of uninsured persons.

Hodge explains that during hospitalization, self-pay patients receive the necessary medication to intervene effectively upon the disease process. After discharge, however, because of lack of supportive resources and lack of follow-up care, it is common for these patients to discontinue their medications. As a consequence, they develop increased viral complications.

The transition from the hospital to the community is not managed very well, Hodge observes, especially in low-income areas where there is a greater need for more social workers and family involvement. Even though their disease needs long-term attention and careful monitoring, many patients with HIV or AIDS are not referred to a private physician when they are discharged from the hospital.

Hodge struggled to fill this void. By the time he accepted that it would be impossible for him to serve only this population and to survive financially, he had become frustrated and sad. He could not forget those patients who needed him but could not afford to pay him for his services. He sought a way to take care of his family of patients and still be able to maintain himself and his practice.