Letting Medical Students Run the Clinic

Though some feel they compromise quality, student-run clinics are an option to provide care for the uninsured.
(Matt Rourke/AP)

Every Saturday from 1:30 p.m. to 5:30 p.m., the abandoned Pinckney Community Public Library in the rural town of Pinckney, Michigan flickers to life. Two caravans bearing young professionals in white coats roll up to the parking lot. Once inside, they loop stethoscopes around their necks, shuffle color-coded forms around the front desk, and smooth out paper bed covers on mattresses. One of them swings a sign stamped with the words “Clinic Open” toward the front door.

In the cramped back room, a senior medical student is giving a crash course to a second-year on the essentials of heart pharmacology. “What do statins do?” the senior student asks, pointing to a small square of text on a patient’s intake form. The younger student pauses, sifting mentally through facts learned by rote memorization from textbooks and lectures. “They lower cholesterol,” she says, hesitating. “I think I remember that from cardiology.”

This is the University of Michigan Student-Run Free Clinic, a satellite medical operation that provides primary and preventive health services to uninsured patients in a low-income area of southeast Michigan. A student-run clinic is similar to a standard clinic in that it provides basic tests like urinalysis, bloodwork, and mammography free of charge, except it is almost completely staffed, operated, and led by medical students.

“I think this is where they teach medical students to be late,” Ron, a grizzled convenience store clerk, cheerfully jokes to me in the waiting room. He spent months on the waiting list of another free clinic before the staffers there referred him to an alternative, student-run option. This is his second visit to the University of Michigan clinic, and so far he has no complaints about the quality of care he’s been receiving.

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.

“I feel like medical school can be really about yourself—how much I can learn, how much I can do,” says Chelsea Reighard, one of the student directors at the University of Michigan Student-Run Free Health Clinic. “I really wanted to serve people and work with them to improve their health.”

The “student-run” modifier is not overstated. With the exceptions of official diagnoses and prescription signing, medical students are responsible for everything that goes on in clinic. They schedule patient appointments, take comprehensive health histories, and conduct physical examinations. Though M.D.-bearing physicians lurk in the background overseeing clinical decisions and assuaging liability concerns, the initiative remains a primarily autonomous affair.

Free clinics are by no means a novelty on the medical landscape, tracing their roots to the Haight-Ashbury Free Clinic movement of the 1960s. But historically, many of them have depended on religious institutions for funding and support. Then, in 1989, a group of first-year medical students in the UC Berkeley-UCSF Joint Medical Program began providing free blood draws and screenings to the uninsured individuals who frequented a homeless drop-in center, and the free clinic model seriously began considering medical students as potential staffers.

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.

Lauren Wozniak, another student director at the Michigan clinic, recalls an experience she had while teaching at a low-income middle school. A student approached Wozniak’s desk after class and asked Wozniak to look at her tooth. Before Wozniak could respond, the student pried back her jaw to reveal a large crevice in the back of her mouth. Her tooth had completely rotted away.The student had apparently never been to the dentist in her life.

Proponents see the student-run free clinic as playing 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 nonprofit counterpart.

“I don’t know where I’d be without this place,” Ron says to me before he is whisked away for his appointment. He’s waited close to an hour for these doctors-to-be to see him, but feels it’s a small price to pay for the time and attention he’ll be receiving for his healthcare needs.

Lately, “health disparities” have become the in-word among the medical community, defined as gaps in quality of healthcare among racial, ethnic, or socioeconomic groups. Though measurements like infant mortality and lifespan have improved across the nation as a whole, the medical community has increasingly begun to identify minority groups that bear a disproportionately greater burden of preventable disease, death, and disabilities compared to the rest of the population.

African Americans, for example, have an elevated likelihood of developing diabetes or hypertension that cannot be exclusively explained by their genetic makeup. Health experts believe that the reasons for these health differences lie within the medical system itself, whether it’s because factors in these patients’ lives prevent them from getting regular medical attention or because physicians are not asking the right questions during visits. People interested in eliminating health disparities do not just focus on diagnosing diseases and prescribing medications, opting to take more creative approaches to healthcare. For instance, the Mobile Clinic Project at UCLA is funding bus ticket vouchers to make sure patients do not miss appointments, while the Joy Southfield Clinic in Detroit is sponsoring community gardens to promote healthy eating habits.

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Jennifer Xu is a medical student based in Ann Arbor, Michigan.

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