By Dr. Ellen Beck
San Diego’s safety net is in tatters. There is no county hospital and no school of dentistry. In order to receive County Medical Services, the health care program for indigent adults, people have to sign a lien against any future property they might own. And so, a “student-run” program has become part of the safety net.
The University of California at San Diego’s Student-Run Free Clinic Project provides comprehensive health care for people who do not qualify for government aid and cannot afford private insurance.
The Project was founded in 1997 by myself, a group of committed medical students and dedicated community partners. Since our inception, we have looked to medical students to be the main drivers in this model of high-quality care for the underserved.
We started in a church basement one night a week. Now we serve more than 2,000 people a year, providing high-quality health care on each day of the week. We operate out of two churches and a school, and serve those who do not qualify for access to care. The doctors-in-training — supervised by licensed physicians — even make house calls to the homeless, reaching out to people on the street.
The majority of our patients have chronic illnesses such as diabetes and hypertension, diseases that could lead to disability and death if left untreated. Our students provide much-needed care to these patients, helping to prevent blindness, amputation, heart disease and stroke. Student doctors are taught a humanistic approach, spending considerably more time with each patient than is common in traditional practices. And our dental clinic makes a point of doing restorative dentistry — not just poverty dentistry, which is essentially pulling teeth — so that toothlessness does not lead to joblessness.
Contributions of time, services and goods from an extensive network of volunteers and donors allow the clinics to run at the low average cost of $800 per patient per year. The project not only offers high-quality care, but trains and inspires the students who provide it. The students are learning not only to be physicians and scientists, but to be healers and teachers. Future health professionals arrive at medical school with passion, compassion and a desire to make a difference. Programs like ours help to keep those passions alive. Indeed, many graduates of the program return to the clinic as volunteer supervisors or start their own practices in underserved communities.
Students not only learn to be junior clinicians, but also all the elements of managing and coordinating patient services. Under supervision and with training, they are in charge of all aspects of the functioning of the clinic, including environmental waste management, supplies inventory, specialty services coordination and preventive services.
Through our patient-centered approach, we create an environment of respect and trust where people without access to care can take charge of their health. Patients are also provided the tools to achieve well-being for themselves as a whole, both mind and body, because of our trans-disciplinary model with health professionals and students across myriad specialties, which can include medicine, dentistry, pharmacy, mental health and acupuncture.
Although we are not the first student-run free clinic project, we are the first to “take the show on the road.” As a result of the national faculty training program we created, called Addressing the Health Needs of the Underserved, and numerous site visits and consultations, more than 15 other locations across the country have started student-run free clinic projects, in locations as diverse as Milani, Hawaii; Houston, Texas; Jackson, Mississippi; Orlando, Florida; and Kansas City, Missouri.
And recently, students from around the country held the inaugural meeting of a new student organization, the Society of Student-Run Free Clinics. More than 200 attendees from several countries attended the meeting in Jacksonville, Florida. We see ourselves as the midwife for the birth of this new organization. We have also created the first year-long fellowship in underserved health care in the country, where former students return after residency and licensure to devote their careers to this work.
The need for access to care is infinite, but there is also a need for health care that is humanistic and respectful: that builds trust over time and looks to the community to be the teacher. This kind of care does not simply bandage a wound, but helps to transform lives, both of patients, students and physicians. This is what we aim to achieve.
Dr. Ellen Beck is the director of the UCSD Student-Run Free Clinic Project in San Diego and a 2010 recipient of the James Irvine Foundation Leadership Awards.
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