Like many large U.S. cities, sun-kissed San Diego faces enormous unmet needs in terms of access to health care for certain portions of its population. But, since 1997, a good many of the city's medically disadvantaged men, women and children have been blessed with a health care safety net woven of physicians and medical students who harbor a passion for caring for the underserved.
As one of the clinic site managers at the downtown San Diego clinic, student Aaron Lee arrives early to ready the clinic "headquarters" for an influx of students and physician preceptors.
Student Adam Behroozian reviews his patient's chart before he heads downstairs for the initial patient intake/interview process.
This evening's warm, dry weather allows medical students at the downtown clinic site to do the initial intake interview with their patients on the patio of the church that houses the clinic.
Attending physician Sunny Smith, M.D., left, helps assess a health concern that brought patient Juan Lombera to the clinic tonight, as Sarah Fang, a medical student visiting from Western University of Health Sciences in Pomona, Calif., listens and learns.
Attending physician Kristin Brownell, M.D., right, reviews a patient's chart with pharmacy student Crystal Zhou and medical student Randall Baldassarre. Brownell, an FP, was part of the student team that initiated the clinic project in 1996 and has been a part-time staff member since 2004.
Medical student Ryan Huerto touches base with his patient, Arnulfo Aguilar, one last time to make sure he understands follow-up care instructions. Empowering patients to take charge of their health is a role clinic staff members take seriously.
Each of the four clinic sites relies on a "promotora" -- or health promoter -- to serve as a "trust bridge" from the clinic to members of the community. Isabel Dominguez, one of three promotoras at the Baker clinic, pauses in her work to pose for a photo.
For 16 years, the University of California-San Diego (UCSD) School of Medicine's Student-Run Free Clinic Project(meded.ucsd.edu) has provided a powerful and eye-opening immersion experience for many young medical students. Back in 1997, Sunny Smith, M.D., was one of them.
"I did not go into medical school with a commitment to family medicine or a passion for the underserved," says Smith. "But being exposed to this clinic in my first year of medical school changed my career trajectory."
- The University of California-San Diego (UCSD) School of Medicine's Student-Run Free Clinic Project operates four clinic sites in San Diego and helps ensure that patients without health insurance receive quality health care.
- The clinics provide primary care services, dental care, acupuncture treatment, ophthalmology services, pharmacy services, and access to social services and legal aid volunteers.
- The free clinic project's co-founder, the top leadership team and many of the volunteer preceptors are family physicians, which provides medical students with a good look at family medicine in action.
Smith ultimately completed her family medicine residency, returned to UCSD to complete a two-year fellowship in underserved health care and then became co-medical director of the student-run clinic. "I'm committed to staying here for the rest of my career," she says.
In July, AAFP News Now visited two of the four San Diego free clinic sites to see firsthand a project so successful and highly respected that it has served as the model for 15 student-run clinics operating nationwide. The project has drawn health care visionaries from the Mayo Clinic system in Minneapolis and Harvard Medical School in Boston and from as far away as Frankfurt, Germany.
The clinic's co-founder and executive director Ellen Beck, M.D., also a family physician, notes that even though the clinic was not the country's first student-run free clinic, the project has become one of the country's largest and best-run operations. The combined clinic sites have provided more than 34,000 medical and dental visits to patients, and they serve as a medical home to about 2,000 uninsured patients each year.
According to Beck, the free health care services, which are provided almost entirely by volunteer physicians and UCSD medical students, are valued at upwards of $4 million annually. The clinic receives funding from a variety of sources, including federal grants and state, corporate and private donors.
"What we do here provides high-quality health care to people with no access to care even as we're inspiring the next generation of health care professionals to be healers and teachers," says Beck, who emphasizes the clinic's focus on social justice and social responsibility. "It's very moving for me to see the transformation in patients' lives, but it's equally exciting to see these remarkable young people giving their hearts and souls to the clinic."
San Diego Student-Run Free Clinic Project
Compassionate Care at Crunch Time
It's late Monday afternoon and the First Lutheran Church on Third Avenue in downtown San Diego is rapidly taking on the look of a "crazy busy" primary care clinic.
A second-floor classroom is swimming with medical students hovering over patient charts they've just received from one of the clinic's student managers. He stands in front of a pair of large white boards, colored markers in hand, recording patient names and matching students with their physician preceptors.
Students bring their own computers and are adjusting to a recently implemented and still "in-process" electronic health record system.
All the UCSD medical students here tonight have completed one or two quarters of elective coursework that is required to participate in the project, and, eventually, all students will assume roles in helping to run the day-to-day clinic operations.
Medical student Sean DeWolf, who speaks fluent Spanish, shares a light moment with his patient, Gloria Sedano, with whom he has built a good rapport -- and ensured continuity of care -- during the past year.
A pharmacy services area, supervised by UCSD faculty pharmacist Eduardo Friscovsky, Pharm.D., and staffed by pharmacy students, is set up and ready to dispense everything from insulin to antibiotics, inhalers, steroids and OTC medications. The free clinic project receives a voluminous supply of free medications, minus controlled substances, from pharmaceutical company patient assistance programs.
In fact, the four clinic sites combined dispense more than 1,000 free prescriptions every month.
Beck estimates that some 60 patients will be ushered through the clinic tonight. Of those, 25-30 patients will receive primary care services, another 10 will get dental care and as many as 15 patients will be treated at the acupuncture clinic downstairs. Other patients will be guided to social services and legal aid volunteers from the California Western School of Law in San Diego. An ophthalmology clinic is set up in the church kitchen, the darkest room in the building.
Attending physicians, the majority of whom are family physicians, may oversee care for as many as eight patients tonight, but the pace is more deliberate for students.
A medical student is assigned no more than two patients. On occasion, a student may spend an entire clinic session taking care of a single patient's needs. "The patient comes in with a list of problems, and we address every problem at every visit," says student Dylan Mann. "We say to patients, 'We're here, we want to see you and we want to get this taken care of tonight.'"
Clinic Integrates Into Community
It's Tuesday morning, and clinic operations have moved across town to Baker Elementary School. Setup and protocol mirror last night's clinic experience, and some physician and student faces look familiar. The school, in recess for the summer, is nestled in a neighborhood of small but well-kept homes filled with people who rely on the clinic for their health care.
As a preceptor and mentor, Michelle Johnson, M.D., right, listens carefully as student Marsha-Gail Davis discusses treatment plans for her patient.
Here, the clinic has become a neighborhood fixture.
Beck calls the women in this community "the heart and soul of the clinic." She describes how they created, of their own accord, an "empowerment" group that raises money selling baked goods and homemade crafts to purchase health-related items, such as walkers and canes, for neighbors in need.
Local residents' gratitude to the clinic staff often is on display. Today, a grandmother, with her young grandson in tow, delivers a tin pan full of sliced watermelon for the doctors and students to enjoy.
UCSD graduate Michelle Johnson, M.D., shares the co-medical director title with Smith, and, like Smith, she helped build the clinic as a student volunteer and completed the underserved fellowship after residency. Today, this family physician points out the important role that volunteer interpreters play in a clinic where nearly 80 percent of patients speak Spanish as their primary language. In fact, only physicians and students deemed fluent in Spanish work without a translator at their sides.
Johnson also stresses the high quality of care patients receive. "The first point person in a patient's care can be a first- or second-year student, but it never ever stops there. Every single patient also is seen by an attending physician," says Johnson.
Today, medical student Ryan Huerto approaches Johnson to discuss his patient's concern about a slow-to-heal surgical incision. Together, they review the patient's chart, conduct a physical exam and craft a follow-up plan for the patient.
The physicians mentor the medical students, but also have an obligation to chart their progress as aspiring physicians. "I work with the same medical students over time so I can evaluate the clinical skills of the third- and fourth-year students," says Johnson.
Priming the Family Medicine Pipeline
"Students go to medical school wanting to help people -- spend time and listen to their stories -- and then they find there are not a lot of arenas in medical school to do that," says Smith. "When students come here, they feel like they make a difference."
The free clinic teaches students leadership and responsibility, she adds. Serving the underserved also teaches aspiring physicians the importance of relationships, community partnerships and preventive care.
What Smith describes sounds a lot like family medicine, and with luck and hard work, many of these students ultimately will claim the specialty as their own.
More From AAFP
Society of Student-Run Free Clinics(www.studentrunfreeclinics.org)