Doctors Treating Prison Inmates: How Would You Feel Doing It?

Shelly Reese

Disclosures

May 30, 2019

Although the American Osteopathic Association and the National Commission on Correctional Health Care both offer certifications in correctional medicine, many doctors say they came to practice correctional medicine by happenstance.

Keith Ivens, MD, president of the American College of Correctional Physicians, began caring for prisoners in an Indiana prison in 1995 as part of a locum tenens assignment. "The people running the prison liked me, I liked them, and after 3 months they asked me to become an employee of the state of Indiana." Since then he's worked in jails and prisons run by local, state, and federal governments as well as private prison operators.

Correctional doctors like Ivens give a laundry list of reasons for their career choice: They don't have to bill or code or shuffle insurance forms; the pay is decent; the hours are good, and when they clock out, they leave work at the office. While physicians have a lot of patients to see, no one is pressuring them to limit visits to 10 or 15 minutes, and they don't have to schedule vacations months in advance or arrange call coverage.

I really think that I am serving an underserved population. I am taking care of a group of people that nobody wants to take care of.

But Ivens says the primary reason for practicing correctional medicine is the ability to make a difference. "I really think that I am serving an underserved population. I am taking care of a group of people that nobody wants to take care of."

The Challenges of Treating Inmates

That said, correctional medicine isn't for everyone. Some say it can be professionally isolating, particularly because many facilities are in remote locations, and that the job demands flexibility.

"Every day is going to be a little different," Ivens says. "There are going to be lockdowns because of fights. Bad weather can determine how you access your patients. Sometimes you have to leave your nice, comfortable clinic and go out into the prison."

For some doctors accustomed to working in institutions devoted to healthcare, recognizing that healthcare is secondary to a correctional facility's primary mission of maintaining public safety can be the biggest challenge.

"As a prison doctor, I'm in a secondary role," Allred says. He tells a story about wanting to transfer a patient who was experiencing a cardiac event to a local hospital. "The warden told me, 'Doc, this gentleman is a very, very dangerous individual. Do the best you can tonight, and when we are comfortable sending him out, we will.'"

Allred spent the night with the prisoner, who was transferred to the hospital the next day without incident. "Because of my army experience, when the warden said that, I understood. But I've worked with other doctors who come in off the streets, and they don't get that public safety is paramount."

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