Student-run free clinics fill gaps for patients in need, as medical students find meaning in service

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A few months ago, a mother brought her young son to a clinic run by the Commitment to Underserved People (CUP) Program - through which the University of Arizona College of Medicine - Tucson provides free care to underserved populations - for routine vaccinations. But an examination by medical students found signs of anemia, and a physician on-site confirmed the diagnosis.

The boy was whisked to a hospital, where he began successful treatment for a condition that could have stunted his development and damaged his heart and brain.

"He had been getting more anemic very slowly," making it difficult for the mother to notice the symptoms, explains Kanita Olson, a first-year medical student and clinic leader for the CUP Kid's Clinic. "Because we were able to examine him, we were able to catch it before it got too severe."

Treating illnesses and injuries that might otherwise go undetected or get addressed later than they should is the primary aim of student-run free clinics (SRFCs), which provide free or low-cost care to people in underserved communities. There are not precise counts on the number of such clinics, but the most recent comprehensive estimate (published in JAMA in 2014) found that 75% of AAMC-member medical schools offer SRFCs.

There's an educational benefit as well. Studies and student feedback show that the initiatives accelerate clinical education, giving students hands-on experience interacting with patients right from their first days in school, under the supervision of physicians.

"When I first got started, I was really nervous" working directly with patients, says Desha Perera, a first-year student who serves as director of administration at the CommunityCares Clinics in Ohio, staffed by students from the University of Toledo College of Medicine and Life Sciences. "Approaching the patient interview now, it's not so daunting. The biggest change [in her approach] is knowing how to get to the root of what I need to ask" about everything from medical conditions to lifestyle habits to support networks.

On a broader scale, the work inspires many students to become advocates for better resources for underserved populations.

A 2022 literature review in Academic Medicine summarized the payoffs:

"Student-run free clinics act as primary care providers that bring health care to populations in need and are an important source of undergraduate medical education, guiding trainees through the art of history taking and physical examination.

"They are also social justice and advocacy initiatives - addressing disparity in access to care and educating medical trainees with firsthand exposure to socioeconomic determinants of health as well as language and medical illiteracy barriers."

Yet studies have noted significant challenges to operating the clinics. Chief among them are limitations on resources such as space, lab tests, language interpreters, and physician availability. The constant turnover of student volunteers disrupts patients' continuity of care with specific providers. And there is little data on long-term patient outcomes. A 2022 review in The Journal of Multidisciplinary Healthcare found that "research on the health benefits and/or outcomes of such clinics is fragmented."

"With a free clinic, it's a delicate balance between being an educational experience and providing a service," says Noah Baltrushes, a board member of the Coachella Valley Free Clinic, which runs with professional oversight and student leadership from the University of California, Riverside, School of Medicine, where Baltrushes is entering his fourth year.

How they work

Students are the foundation of the clinics, which are supported by professional administrators and an array of caregivers, including physicians and nurses. On the back end, students run the overall operations, overseeing budgets, patient scheduling, supplies, and support services (including language translators, community resources, and lab test arrangements). On the front end, first- and second-year students see patients for initial screening, like gleaning the immediate medical conditions and taking histories, under the supervision of third- and fourth-year students with clinical experience from clerkship rotations.

Physicians are on hand to consult on the patient visits, review the student summaries, and make or confirm decisions about diagnoses, prescriptions, referrals to specialists, and other courses of action.

The clinics generally do not exist as permanent, stand-alone entities. Typically, they operate on specified dates in shared, borrowed, and transient spaces, including mobile units that resemble buses or part of other organizations' offices. In Ohio, CommunityCares Clinics provide services at numerous sites each month, including in a church and a school parking lot, says Executive Director Benjamin Theis, a first-year medical student. (CUP is an exception, offering numerous clinics from one building in the University of Arizona medical complex, as well as at external sites.)

Medical schools often support a network of clinics that focus on different issues. Some home in on people with specific health needs, such as women and people who are unhoused. The cadence of their schedules varies as well: a pediatric clinic might run once a month, while an adult primary care clinic might run every two weeks.

Students say they are motivated to work in the clinics not just to practice clinical skills, but to fulfill a desire to work with underserved populations.

"I'm from Sedona, Arizona, which is a small town, and I grew up without a primary care [doctor]; urgent care was our doctor," Olson says. "I was really excited to get involved in a program for patients who don't have access and don't have insurance."

In California, the Coachella Valley Free Clinic sits about 90 minutes from the medical school, Baltrushes notes. It's close to the Mexican border, primarily serving local residents of Mexican descent.

"It provides [medical] services in a place that doesn't have services" for much of the local population, he says. "There is this space between the [social] safety net and regular health insurance, where a lot of people fall." For them, getting care "is not a choice between [the clinic] and a better option. It's a choice between [the clinic] and nothing."

The patients who show up often demonstrate significant need. The Academic Medicine review notes that "SRFCs primarily serve patients of low socioeconomic status, targeting communities where up to 45% of the population falls below the federal poverty line … These underserved populations disproportionately represent Black, Latinx, and/or immigrant communities who speak English as a second language.

"SRFC patients are more likely to have multiple diagnoses and suffer from chronic conditions, such as hypertension, obesity, and diabetes."

In Arizona, the students working at CUP see many patents "who should have been seen more regularly in primary care or seen specialists," says Sarah Teeman, clinical leader for CUP's women's program. Many of their illnesses "are more progressed" than they would have been if the patients had earlier access to care, she says.

Students benefit as well. In Toledo, Theis says that working with patients under the guidance of senior students and physicians has accelerated the depth and quality of his patient interactions. Thinking back to the beginning of the academic year, Theis says he's more able "to get to the root of what might be contributing to the patient's condition."

That means knowing how to talk with patients about more than strictly medicine, in order to understand other factors that affect their health and treatment. "If we're going to refer them to [another provider], we need to ask [about] their transportation situation. If we're going to give them therapy for diabetes, we need to check on the nutrition side, to make sure they have access to the right food."

Too few resources are a common challenge

SRFCs face several consistent challenges, according to student leaders and studies. "Resource limitation is a big factor," notes Teeman at CUP. Those limitations include:

• Physician availability. Physicians from medical schools or the community who volunteer to work at the clinics find that patient appointments fill up fast, sometimes beyond what the day's schedule allows. A study of a student-run free clinic at the University of Central Florida College of Medicine found that clinicians were often overbooked, leading to long wait times for patients. Sometimes, physicians are not available on the scheduled dates of the clinics for a particular month, leading the clinic to have to change the dates, says Olson at CUP.
• Specialty resources. Clinics often have access to outside labs for blood and urine collection and analysis, but with a set number of tests within certain time frames. "That might mean [patients] have to come back for a second appointment to get the rest of the labs," Teeman says. Access to other specialty services, such as ultrasound exams for pregnant patients, are also sometimes limited by the availability of equipment and specialists.
• Translators. Language translators are precious commodities. Ideally, the clinics have on hand a volunteer student who can speak a language other than English. In Toledo, Perera serves that role for Spanish-speaking patients at CommunityCares Clinics, but sometimes the patients speak other languages. The clinics recruit students (who might or might not be in the medical school) to serve as standbys to provide translation remotely over the phone or on a virtual call, she says.
• Continuity of care. The churn of students working at clinics as they enter and move through medical school, along with the variety of physicians whose schedules allow them to volunteer at the clinics, makes it unlikely that patients will see the same providers over the years. A 2024 article in the Patient Experience Journal noted that "Maintaining a continuity of care can be challenging in a free clinic because providers are volunteers, and a patient cannot be guaranteed to have the same provider for every consecutive visit.

"A lack of continuity of care could cause challenges such as diagnoses being miscommunicated, inconsistent notes from consecutive patient visits, medication histories not being reviewed before the appointment, leading to an increased potential for critical changes in patient assessment and after-care intervention planning."

But patients "understand that we are students, and that students progress and move on," says Theis in Toledo.

What patients want, says Baltrushes at the Coachella Valley Free Clinic, is continuity in the quality and availability of services. He notes that patients are geographically unstable as well, moving to other communities because of job changes, evictions, and other factors related to poverty.

"I don't think anybody thinks, 'I'm going to be coming here for 10 years,'" he says. "Continuity of presence is the only thing that you can manifest."

Providing that consistency with genuine caring pays off. One of the most consistent findings in academic articles and student recollections is that patients appreciate the student work at the clinics. A review of SRFC experiences published last year in the Journal of Community Health includes this representative quote from a patient about the student providers:

"They're very friendly. … They will sit there and talk to you, actually talk to you, and not just be like, 'Oh, I'm just here to work.' They actually talk and sit there and figure things out."

The students know they are making a difference on a case-by-case basis. On one recent Tuesday, Olson says, "I started my [school] day at 6 a.m., and the CUP clinic runs from 5 p.m. to 10 p.m. At the end of the day, I got home and I was like, 'Wow, I'm not exhausted at all. I actually feel really good.'"