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Reaching the underserved through free clinics
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On the first Monday of every month, I volunteer at the University of California, San Diego, Student-Run Free Clinic Project located in downtown San Diego. Each time, I come away with a renewed sense of hope and appreciation for the benefits of a free clinic: reaching an underserved community; giving students hands-on experience and teaching them how to be doctors; and minimizing high expenses of care.
According to the National Association of Free Clinics, “Free clinics are volunteer-based, safety-net health care organizations that provide a range of medical, dental, pharmacy and/or behavioral health services to economically disadvantaged individuals who are predominantly uninsured.”
In San Diego County, an estimated 460,000 individuals, or more than 15% of the approximate 3 million residents, do not have adequate health insurance. As Sunny Smith, MD, one of the co-directors of the Student-Run Free Clinic Project, once said, “Where else would the underserved go if we weren’t there?”
Personal experience
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On a typical day at the free clinic, medical students, pharmacy students, undergraduates and volunteer attendings converge. Under the tutelage of Smith and co-director Michelle Johnson, MD, the clinic is run by the medical students, known as the clinic managers, who do everything from taking vital signs at check-in to assigning patients to students to drawing. In the clinic, students learn from their peers. First-year medical students are paired with fourth-year students to interview, examine and then present to attendings.
Although the clinic is busy, an atmosphere of energy is apparent. On a single day, I may discuss a variety of endocrinology clinic patients with the students: a woman whose HbA1c is 8% and who is having difficulty with medications and dietary changes; or a 50-year-old man with chronic abdominal pain over the last 2 years that was extensively worked up, including a negative EGD, who was found to have primary hyperparathyroidism.
Founded in 1997 by Ellen Beck, MD, this endeavor began in a church space and saw 10 patients in the first night. Today, the clinic offers primary care and specialty clinics in endocrinology, cardiology, neurology and podiatry. Dental and legal services, as well as acupuncture, are also available. UCSD medical students, and those in pharmacy, social work, public health and other pre-health professions, volunteer.
This clinic is one of approximately 24 student-run clinics in the United States. The clinics currently serve 2,500 patients and have helped more than 75,000 people in this country.
“This work is important to me,” Johnson said. She and Smith oversee the three clinic locations full-time; they lead seven clinics during the week, including two evening sessions. “I worked at the clinic as a medical student at UCSD. Returning as a physician, I am looking forward to being a listener, healer and teacher in this special environment. It’s refreshing for me to see the enthusiasm and warmth of the students — one of my former students was so excited that her patient’s HbA1c decreased into the goal range.”
Challenges in a free clinic
Providing quality, innovative care while educating a new generation of physicians at a free clinic in an underserved community is not without challenges.
Using the Student-Run Free Clinic Project as an example, the clinic plans on opening a fourth site soon. Johnson pointed out that glucose test strips alone cost an astounding $25,000 per year. The larger problems of the health care system are accentuated here, as many patients fall into the working-poor category — those who earn too much to qualify for assistance but too little to pay for insurance out-of-pocket.
Challenges aside, perhaps former UCSD medical student, Mary Richards-Moya, MD, said it best from the future physician’s perspective: “The free clinic has been the most special part of medical school for me — it’s the part when I think about medical school 20 years from now that I’ll always remember.”
Edward C. Chao, DO, is assistant clinical professor of medicine at University of California, San Diego, and staff physician at VA Medical Center, San Diego.
For more information:
- UCSD Free Clinic, meded.ucsd.edu/freeclinic
- Project Access, sdcmsf.org/project-access-san-diego-pasd
- National Association of Free Clinics, freeclinics.us
Disclosure: Dr. Chao is a volunteer at the University of California, San Diego, Student-Run Free Clinic Project.