Rural Virginia Clinic Relies on Barter System, Cash for Medical Services

The Roanoke Times/Richmond Times-Dispatch on March 19 profiles an "unorthodox" doctor in Floyd County, Va., who employs a barter system through which patients can "work off their bills or trade almost anything" in return for treatment. Since 1997, Dr. Susan Osborne has operated the Floyd County clinic, which she has financed by using credit cards. Typically, she treats no more than eight patients per day and is willing to make house calls. Although she accepts cash, patients have also traded firewood, clothing, meat, milk, butter, eggs, vegetables, beer, horses and homemade soap for treatment. Patients can also receive "credit" if they work at the clinic or volunteer elsewhere in the community. Osborne, who also works as a Floyd County medical examiner, started the clinic after she found she was unwilling to work in a corporate health care setting, where she would be expected to see about 40 patients per day. Osborne said that although she is "earning less than most of [her] patients" and the clinic is losing money, she thinks she can "make it work." She added, "You can do this in a practice. You won't make any money, but it is possible" (Angleberger, Roanoke Times/Richmond Times-Dispatch, 3/19).