Creating a medical clinic at your church

By Mark Blpcher  ·  Dec 21, 2023

Fourth in the series "Disrupting health care to redeem it." Earlier installments can be found here, here, and here.

The advantages of church-based medical clinics were outlined in “A medical challenge to local churches” in our December newsletter.

This month, we look at the practical side of things, outlining what a church needs to take into consideration for hosting such a clinic and how to prepare for it.

Taking care of details

Scope of services: Church-based clinics can provide basic primary care services such as annual physicals, sports physicals, sick visits, well-child checks, vision and hearing screenings, pre-surgery exams, treatments for various infections, post-hospital follow-up care, X-rays (depending on state and facility), wellness planning, and management of some chronic conditions. For example, blood pressure, diabetes, anxiety/depression, and asthma are conditions commonly cared for in a primary care doctor’s office. All of these services can be provided in a church building. Some medical needs might even be triaged on Sundays, adding more convenience for patients.

Facility: A clinic can function with as little space as

  • two 10-by-12-foot exam rooms.
  • a small waiting room.
  • a rest room.
  • a small area to perform basic labs such as rapid strep testing, urinalysis, and pregnancy testing.
  • a check in/check out desk.

In many states, a portable X-ray machine can be used without having to be stationed in a lead-lined environment. Overall, a fully functional primary care clinic needs only 1,000 to 2,000 square feet of space. In some cases, even less.

Equipment/supplies: A small clinic can function with

  • two exam tables—one adjustable, one with stirrups.
  • a vitals monitor.
  • adult and infant scales.
  • urinalysis machine.
  • pulse oximeter.
  • infant length measurement mat.
  • ECG (electrocardiogram) with accessories.
  • crash cart with AED (automatic external defibrillator).
  • vision and hearing testing devices.
  • standard examination instruments.
  • the medical supplies used in primary care.

These items are easy to acquire and not expensive. A good exam table with stirrups can be bought for a few thousand dollars or less. Vitals monitors cost between $500 and $1,000. A refurbished ECG can be purchased for between $600 and $900. A refurbished X-ray machine suitable for primary care can be acquired for as little as $20,000 or even less. Other needed equipment includes computers, phones, a fax machine, and a copy machine.

Days/hours of operation

Hours of operation will vary but will likely be limited. In the beginning, some clinics may be open only two half-days per week. Telemedicine/virtual visits can be arranged when the office is closed, and a clinician may even make an occasional house call. As the patient volume grows, more clinic hours will be necessary.

Electronic medical records (EMR) platform

Christian Healthcare Centers uses an EMR designed for direct primary care practices, i.e., practices that do not bill insurance but use a subscription payment model. It is not tied into a national database, which means patient information cannot be accessed by non-CHC personnel. The cost for this system is based on how many prescribing clinicians within the practice use it. Generally, the EMR for a full-time prescribing clinician costs $250 to $275 per month.

Liability

The most frequent objection I hear to opening a medical clinic is liability, but it isn’t a problem. Despite our litigious society, primary care doctors are rarely sued, which means they enjoy some of the least expensive professional liability costs. On average, full-time primary care doctors pay about $4,000 per year for malpractice coverage. A doctor working in a church-based clinic is likely to be part time, which would reduce the cost of liability coverage by about 50 percent. In some instances, the coverage from the doctor’s private practice or an employer may cover them at the clinic as well. The other forms of liability insurance (premises, fire, furnishings, etc.) are relatively easy and inexpensive to secure.

Personnel

Depending on patient volume, the clinic can operate with a part-time staff:

  • one family medicine or internal medicine/pediatrics physician (male or female).
  • one advanced practice provider (male or female).
  • one medical assistant.
  • one person to answer phones, do check in/check out, and perform other office functions.

Generally, a part-time staff can provide care for 400 to 600 patients.

Some providers may choose to volunteer in lieu of being paid. Although such generosity is appreciated, utilizing unpaid volunteers can create a budget problem down the road if that volunteer leaves the clinic and their replacement needs compensation. I recommend paying everyone. They can always donate their pay back to the clinic. The rate of compensation will vary by region and the particular needs of each staff member. CHC uses the 50th percentile of national average, adjusted according to the state average.

Another personnel issue is whether the staff are church employees (not recommended) or clinic employees (assuming the clinic is set up as a separate organization, which is recommended). If most or all the staff are part time, especially in the beginning, it may be best to treat everyone as a 1099 independent contractor instead of a W-2 employee. This can save money on withholding taxes, workers' compensation, and other expenses.

Funding

There are two funding needs—startup and sustaining. Charitable, tax-deductible contributions will be needed to pay the lease, acquire furnishings, equipment, and supplies, and fund operations in the initial stages.

Startup funding

A rough estimate of startup costs is between $20,000 and $100,000. A variety of methods can be used to raise startup funding, including contributions from the church budget, fundraising events, individual and business contributions, church special offerings, and applying for grants from foundations. Another option is inviting the church family to fast for two meals one day per month and donate the money saved to the clinic fund.

Sustainable funding

The funding model common to direct primary care offices, i.e., small monthly fees, will produce sustainable revenue. Funding clinic operations in this manner provides a consistent cash flow versus the roller coaster cash flow of the typical fee-for-service/insurance-dependent doctor’s office. The clinic will draw patients from the congregation and the surrounding community. As a rule of thumb, 500 patients at $50 per month will generate $25,000 per month, or $300,000 per year.

How long it takes for the clinic to be completely self-sustaining depends on several factors, including the population surrounding the clinic, the effectiveness of the clinic’s patient recruitment strategies, and the number of children who join with their parents. At CHC, the fee for a child is considerably less than an adult, so the monthly income per member per month is impacted. CHC grew from 122 patients when it opened in July 2017 to 1,000 by the end of January 2018. As of this writing, CHC has over 3,200 patients and consistently grows an average of 2 percent per month.

Coaching for new clinics

Anyone thinking of starting a church-based clinic will have many questions I have not addressed in this article. Most will want coaching. Christian Healthcare Centers recently established an affiliate program to assist in the startup and growth of new clinics. Information about the affiliate program can be obtained by emailing me at [email protected].

Broadly speaking, this is a modified, low-cost “franchise” model designed to help churches establish and operate clinics without losing organizational autonomy or the community “feel” unique to every local church. CHC does not own affiliates because church-based clinics need to be grassroots entities. However, we all will benefit from collaboration, learning best practices from one another and enjoying the collegiality/fellowship that comes with shared ministry experience.

Conclusion

On its face, opening a medical clinic in a church might seem like an overwhelmingly complicated and expensive undertaking. I will not say it is easy, but it is very doable, especially with the counsel and coaching of those who know how.

What is most important is this question: Is a church-based clinic strategic to a local church’s mission? When this question is considered in light of the model of ministry practiced by the Lord Jesus Christ, the answer seems obvious. I invite local church leaders to prayerfully consider taking a bold step of faith in this direction.

The requirements of your own state should be checked when considering starting a clinic.

Mark Blocher is co-founder of Christian Healthcare Centers and a member of the Samaritan Ministries Board of Directors.