Every clinic, including mine, will do some degree of charitable work. Look at your numbers, decide what your clinic can absorb, and how much of that you want to do. This decision affects all of your clinic, such as employee salary and benefits, upgrades to equipment and so forth, not just your own salary. Once you have made the decision, stick with it and stop worrying about it. You can re-evaluate this every quarter or year, and if you want to increase charity work after these evaluations, then go ahead. You also decide under what circumstances you would provide unpaid services (severity of illness, financial hardship issues...). You can budget this on a monthly basis, to help keep track. Any patients you cannot accommodate can be provided printed information or info by phone about community/county resources. If there is a like-minded pediatrician or two in your area you might take a team approach on this to spread out the load. This policy should allow you to see a number of patients who cannot pay at the time of service, and as you have noted some will be able to pay later. The important thing is that patients (in your case, parents) understand explicitly up front what is expected.
For example, if you want to provide care to a patient that cannot pay their individual responsibility at time of service, give them a payment plan that is fair and reasonable, even 10 dollars a month, and if they stick to it great, but if not they need to know ahead of time that they will be discharged from the clinic, again with referral to community/county resources. Try to anticipate the cost of included necessary follow up visits in the payment plan. If you decide to provide free care in a case due to the circumstances, then agree to that up front.
Note that in your case truly impoverished families should qualify for MaineCare, so should not be a problem in this issue. It has been my experience that the lower middle class gets pinched the most in these situations, unable to qualify for aid, but cannot afford insurance or deductibles.
As a last resort, you can always reach into your own pocket (literally, not figuratively) and pay for a patient's visit. This way only your own income is affected when that happens, and you always have a safety net for your soul when that heart-melting case is brought in by their desperate parent at the end of the month and you have used up your budgeted charity allowance.
I have done that myself, telling my office manager, "I had to do that or I would have gone straight to Hell".
So, budget so you know what you might do, plan so you know how you will do, and then you may be surprised what you can do.
