Can student run free clinics help the health care safety net?

While interviewing for medical schools last fall, I observed a strange phenomenon: every institution I encountered would underscore its student-run free clinic as a major highlight of the medical education they could offer. First- and second-year students would speak rapturously about the experience they gained from clinic. Working there, they said, reminded them of why they wanted to become doctors in the first place.

Today, the majority of all U.S. medical schools have at least one student-run free clinic under their auspices. Some, such as the University of California, San Diego School of Medicine, have up to four.

The proliferation of these clinics can partially be attributed to a growing desire among the medical community to provide care to those who lack health insurance. Though the Patient Protection and Affordable Care Act is projected to extend healthcare coverage to 32 million more U.S. residents starting January 1 of next year, this still leaves about 30 million individuals uninsured and unable to pay for health services. What has increasingly begun to emerge is a healthcare safety net, a complex web of hospitals and community health centers that provide low-cost medical services to individuals regardless of their ability to pay.

The student-run free clinic plays a small but vital role in the healthcare safety net. The clinic can help uninsured patients, many of whom suffer from complicated chronic diseases, secure care they otherwise would not be able to afford. And because a medical school affiliation gives student-run clinics a steady source of funding and supplies student volunteers eager to work, the student-run model may be more sustainable than its non-profit counterpart.

Yet the “student-led, student run” philosophy has drawn ire from some individuals who are invested long-term in alleviating health disparities. The idea that students, not M.D.-holding physicians, are chiefly responsible for a patient’s healthcare might compromise the care the patient ultimately receives, according to Dr. David Buchanan, who wrote an article in the Journal for the Poor and Underserved dealing with the ethical implications of student-run clinics.

Most students who volunteer at the clinic are in their first and second years of medical school, a time traditionally dominated by very little patient contact. The majority of their clinical experience thus far has consisted of practicing on “standardized patients” — a cast of actors pretending to suffer from a repertoire of minor medical maladies. For many of these volunteers, the student-run clinic marks the first time they ever conduct a physical examination on a real patient.

Though students are prohibited from writing prescriptions and are strictly overseen by a presiding physician, the autonomy associated with student-run clinics might promote the harmful stereotype that poorer individuals ought to receive lower quality healthcare than those who have health insurance. Patients who can afford to pay for healthcare can refuse care they see as inadequate. But those who receive free care from student-run clinics don’t have as much flexibility.

Proponents of the student-run free clinic argue that patient care and student education can coexist. Studies have been published comparing patient outcomes at student-run free clinics with those at staffed, insurance-accepting facilities, many of which have revealed no significant gap in quality.

Advocates see the student-run clinic as a win-win situation: individuals without regular healthcare receive much-needed attention, and medical students get the opportunity to flex their clinical muscles and gain firsthand exposure to health disparities.

As long as volunteers have enough oversight to learn from their mistakes and adjust, there’s no reason why the student-run free clinic shouldn’t continue to flourish. Compared to the alternative, which is nothing, communities served by student-run clinics are still better off than they had started out.

Jennifer Xu is a medical student.

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