MADISON, Wis. — After the Benevolent Specialists Project Free Clinic in Middleton canceled patient visits in March and then provided a trickle of virtual care, the clinic opened again recently with COVID-19 precautions.

But another challenge emerged. The clinic, staffed by volunteer doctors and nurses, most of them retired, is having a hard time finding providers because many fear exposure to the coronavirus.

Among 50 regular doctors, a third said they wouldn't return. Of 30 nurses, more than half said they wouldn't come back, even as new safety procedures call for more nurses than before, the Wisconsin State Journal reported.

"Many are in that higher-risk age bracket," said Tricia Levenhagen, manager of the clinic, known as BSP. "We are challenged right now with finding enough volunteers to provide patient care when we do have the inpatient visits."

An estimated 5.4 million American workers lost health insurance between February and May, including 62,000 in Wisconsin, according to a new report. Free clinics, a safety net for the uninsured, are encountering pent-up demand even as many struggle with staffing and other hurdles, such paying for protective equipment and not being equipped to do telemedicine.

Wisconsin's 90 or so free clinics are "starting to see the wave" of people who are newly unemployed and uninsured, said Dennis Skrajewski, executive director of the Wisconsin Association of Free and Charitable Clinics.

"There are many patients out there delaying care currently and many more unemployed lacking insurance and access to care," Skrajewski said.

An estimated 343,000 adults in Wisconsin had no insurance in May, up from 281,000 in 2018 — a 22% increase that ranks 20th highest among states, according to a recent report from Families USA, a nonpartisan consumer advocacy group.

Democratic Gov. Tony Evers in May suspended rules so people wouldn't lose coverage during the pandemic through BadgerCare, the state's main Medicaid program. But some copays for childless adults on the program, adopted by previous Republican Gov. Scott Walker and the GOP-controlled Legislature, have begun.

Wisconsin remains one of 13 states that haven't expanded Medicaid as allowed under the Affordable Care Act. It's the only such state with no coverage gap, however, because Medicaid covers people up to the poverty level and people who make more can get subsidized private insurance on the federal exchange — though advocates say such coverage can be unaffordable.

Student volunteers gone

Our Lady of Hope Clinic, a free clinic on Madison's West Side, faces a shortage of volunteers but for a different reason than BSP. It has relied on college students for behind-the-scenes tasks such as scheduling, charting and getting patients to their rooms. Now most are gone.

"Once the schools closed down, many were not able to stay in town or they had to bring in money on their own outside of this opportunity," said Blaine Hechimovich, the clinic's development director. "I think it's going to continue to be a challenge."

The clinic, supported by members who can afford to pay for care, has seen a decline in paying patients and a slight increase in those who need free care, Hechimovich said.

The clinic's two doctors — one full time and one part time — are paid staff, unlike at many free clinics.

Good Neighbor Clinic, a free clinic in Prairie du Sac, has mostly closed during COVID-19 except for renewing prescriptions for ongoing patients, providing some care by phone and administrating monthly Vivitrol injections for addiction patients through a local program, said Joyce Evers, a volunteer social worker.

Many of the clinic's regular volunteer providers are older and concerned about COVID-19 risk, Evers said. "We are operating with a small number of volunteers who have no in-person patient contact," she said.

Community Connections Free Clinic in Dodgeville is seeing patients, in person and by telemedicine, by appointment only instead of its usual walk-in model.

A program started by the clinic in 2018 that brings a bus to area farms to provide free care, mostly to Hispanic workers, halted in March because of the pandemic, said Dr. Emily Jewell, one of the volunteer providers.

"I think recruiting has been harder and harder because most physicians are working the same or more than before Covid with less staff," said Jewell, whose regular job is at SSM Health clinic in Dodgeville.

MEDiC clinics, which offering care in the Madison area by volunteer students at the UW School of Medicine and Public Health, closed for in-person medical care in mid-March but have continued to do prescription refills over the phone and begun telehealth visits, said Dr. Christine Seibert, faculty advisor.

Dental care changes

More Smiles Wisconsin, which runs a free dental clinic in Madison, closed in late March and reopened in early June with reduced capacity. It is treating one patient at a time, instead of up to three, as a COVID-19 precaution, said Stacy Nehmer, executive director. Demand for emergency care has not declined but new patient visits are down.

"We are hopeful that this is only due to the current messaging patients are publicly receiving that they should postpone any non-emergency care," she said.

Statewide, most free clinics have reopened to some degree but many struggle to find volunteers, Skrajewski said.

"The shortage of volunteers is a real challenge and some clinics are increasing the hours of paid staff to fill the gap and provide needed services," he said.

Some free clinics haven't been equipped to provide telemedicine, he said. But the free clinic association got a $246,000 grant from the Advancing a Healthier Wisconsin Endowment at the Medical College of Wisconsin to provide the technology to free clinics throughout the state.

At the BSP clinic, care was provided only by telehealth until last week, when the clinic opened again Tuesdays through Thursdays.

Unlike most free clinics, which provide primary care or dental care, BSP offers specialty medical care, including ophthalmology, psychiatry, rheumatology, orthopedics, neurology, dermatology and cardiology.

The clinic hopes to find more doctor and nurse volunteers so 150 regular patients whose appointments were cancelled in March can resume care, said Levenhagen, the manager. Many have chronic diseases, which can get worse if left unmonitored.

"We're working on that backlog," she said.