Student-run health clinics are widespread among U.S. medical schools. This study provides the first census and description of these clinics, whose operation now involves thousands of students, tens of thousands of patients, and hundreds of thousands of dollars annually. Respondents reported nearly 37,000 annual patient visits at the student-run clinics described here. These clinics provide free access to a variety of services—including blood pressure screening, vaccinations, HIV testing, medications, laboratory work, and even minor surgical care—and provide low cost acute care and chronic case management.
In several ways, student-run clinics stand to play a unique role among safety net providers. Student-run clinics possess great operating flexibility—as demonstrated by a variety of nontraditional clinical sites including churches, homeless shelters, and mobile vans—potentially improving access to care for marginalized patient populations. For medical schools, student-run clinics represent an appealing academic–community partnership: clinics bridge the school with local community agencies, students have unique educational experiences, and patients receive low cost medical services. By operating in different, nontraditional settings, student-run clinics may appeal to patients in a way other providers do not. One school shared the story of their own clinic growing so large that it was later subsumed by their medical system, and we identified three clinics treating more than 50 patients a week. But even small clinics deliver valuable care and provide vital treatment options for patients.
Some have questioned the quality of care delivered by these clinics, given their limited resources, restricted operating times, and high turnover of students and physicians relative to traditional, professional clinics.22
The effectiveness of care likely depends on the individual clinic, and assessing patient outcomes lies beyond our methodology. Quality assessment here is more important in light of the high proportion of student-run clinic patients reported to consistently and repeatedly access care there. Our findings suggest that most student-run clinics do have the infrastructure to address many chronic and acute complaints, including hypertension, diabetes, and common infections. Most clinics also offer laboratory services and a spectrum of medications, provisions (e.g., condoms), and referral services. Even as the verdict on quality of care is pending, student-run clinics provide free health care to highly vulnerable persons whose few sources of care are often overwhelmed by demand.
Clinic leaders described widespread involvement with these programs among medical students who volunteer for a variety of reasons. Most often taught by their peers, students learn many new skills in this setting, including taking patient histories and making presentations; indeed, the opportunity to learn such skills may motivate many students to volunteer. This study cannot assess the quality of clinical education in this setting or the adequacy of faculty oversight of teaching at these programs. Regardless, these extracurricular programs are clearly a common and potentially influential venue for students’ acquisition of clinical skills and attitudes. Further study in this regard is warranted.
There are limitations to this study. While we provided a strict definition of student-run health clinics, the interpretation of that definition was left to study participants. It appears to us that this definition was strict yet not burdensome; we did not find a program considering itself to be a student-run health clinic that did not meet our inclusion criteria. Also, we achieved a good response rate (76%) from schools but had difficulty eliciting information from multiple clinics at the same school. Because survey respondents remained anonymous, we could not pursue further contact information for those clinics, and it appears our invitations were not always forwarded as requested, risking possible sample bias. Consequently and certainly, our study underestimates the frequency and patient volume of student-run clinics nationwide. Most respondents were medical student coordinators, whose perspective on their clinic’s operation is subject to bias or inaccurate reporting. There are no other data on student-run clinics to which we can compare these reported findings, but we believe our methodology provides an accurate initial assessment of student-run clinic services and volume. Finally, our study excludes osteopathic medical schools and schools in U.S. territories.
Our findings demonstrate student-run clinics to be both significant educational programs and also an important health care service for many patients nationwide. Building on this work, future investigation should further elucidate these roles of medical student-run health clinics.