Medical Students Jump In To Help The Uninsured
At an Institute for Family Health center near Union Square in New York City, medical student Sara Stream asks a new patient named Alicia what brings her in. The 34-year-old woman arrived last summer from Guatemala, and says she hasn't been seen by a doctor in many years.
Her list of ailments is long.
"I have trouble seeing, headaches, problems with my stomach," says Alicia, who declined to use her full name, because she is in the country illegally. "I feel depressed."
Stream takes the problems one by one, carefully asking follow-up questions about when symptoms started, when they recur, where they're felt, and what Alicia thinks the causes might be. Stream is using a translator, who also happens to be her supervisor, Dr. Amarilys Cortijo. As the symptoms pile up, Cortijo steps in.
"We'll have to deal with the complaints, and try to get to the root, which is probably all the emotional turbulence that is taking place," she says.
Cortijo works for the Institute for Family Health and is co-director of two student free clinics — one in the Bronx with volunteer students from Albert Einstein College of Medicine and this one, downtown, which the Institute runs with volunteer students from NYU School of Medicine.
Many other medical schools around the country run similar clinics that treat the uninsured for free. The clinics typically are open once a week. They take in a few dozen patients per session and treat several hundred patients over the course of a year.
The programs are among the most popular extracurricular activities at medical schools and, at some institutions, the lion's share of students volunteer at one point or another.
Students do everything. First- and second-year students perform more administrative tasks, such as running the reception desk, fundraising, and coordinating lab tests and follow-up treatment. Third- and fourth-year students see patients, with faculty physicians overseeing all formal diagnoses and prescriptions.
At the NYU clinic, students increasingly have had to help drum up business. Many of the core patients in the Union Square area signed up for Obamacare coverage, leading to a 25 percent decline in visits to the free clinic last year.
"A lot of our patients had been freelance [workers], who were the most likely to benefit from the changes in health coverage," says Dr. Sarah Nosal, a family medicine practitioner and co-director of the program.
So NYU students have had to go recruit patients in a way they never needed to before, heading to churches and community centers in neighborhoods farther away, letting undocumented people like Alicia know about the free healthcare they could get if they came to the clinic.
The student-run free clinics are not major venues for taking care of the uninsured. Most of the close to 2 million uninsured residents of New York state — 1 million of them in New York City — get health care in emergency rooms, city hospitals or community health centers, if they get care at all.
Still, Dr. Neil Calman, head of the Institute for Family Health, says the clinics perform a valuable service, both for patients and for future physicians.
"This is an opportunity for medical students to get involved in the business-end of seeing what health care is like for people who don't have the same kind of access that they have to it," Calman says. "It's really a learning experience."
Stream and Cortijo quickly realize Alicia has too many problems for student trainees to take on, so Alicia will become Cortijo's patient at one of her offices in Harlem or the Bronx.
That's one less patient for the free clinic, though there are plenty of others in line behind Alicia.
For Stream, there's a satisfying difference between treating patients at the flagship NYU hospital versus at the free clinic.
"Here, a patient may not have seen a doctor in the past 10 years," Stream says. "Patients may not have ever have seen a doctor. While they're here, I want to figure out what's wrong and how I can help them the most, because we don't know when they're going to see a doctor again."
Stream is in her last semester. After that, whether she keeps seeing uninsured patients will depend on where she does her residency, and where sets up shop.
This story is part of NPR's reporting partnership with WNYC and Kaiser Health News.
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Transcript
AUDIE CORNISH, HOST:
The deadline for signing up for Obamacare is the end of this month, at least for those who would face a tax penalty without insurance. Regardless of how many people pick up health coverage, millions will still fall through the gaps. Fred Mogul of member station WNYC recently visited a clinic where medical students care for the uninsured.
FRED MOGUL: It's a busy day at a Manhattan clinic. A patient named Alicia meets Sara Stream.
SARA STREAM: I'm Sara and I'm a fourth-year medical student here at NYU.
AMARILYS CORTIJO: (Speaking Spanish).
MOGUL: Stream's supervisor translates as she takes a medical history from Alicia. Alicia asked not to use her full name because she's in the country illegally.
CORTIJO: So, she feels depressed. OK. She has eyesight problems and she has headaches.
MOGUL: Stream questions her thoroughly, tackling one problem at a time.
STREAM: So the burning in your stomach, can you describe more about when that happens?
MOGUL: Little by little Stream teases out the story of a life filled with domestic violence Alicia left behind in Guatemala last summer. Stream's translator is Dr Amarilys Cortijo, who helps with the diagnosis.
CORTIJO: A lot of the symptoms that she has are somatic.
MOGUL: Cortijo is co-director of NYU's student free clinic.
CORTIJO: We'll have to deal with some of the complaints and then try to get to the root, which is probably a lot of the emotional turbulence that's taking place.
MOGUL: Caring for the uninsured and their often complicated problems is just one of the things med school students do in the volunteer program. They fundraise, they staff the reception desk, they coordinate lab tests and follow-up care and, says co-director Dr. Sarah Nosal, they increasingly help drum-up business, which dropped off when Obamacare took effect.
SARAH NOSAL: A lot of our patients had been a lot of those sort of freelance people who were the most likely to benefit from the changes in health coverage.
MOGUL: So the NYU students have had to go out recruiting in a way they didn't before.
NOSAL: To places where there were patients who were left out of the benefits of these new health plans and reached out to communities where undocumented people were - churches and community centers - and made them aware of our resources.
MOGUL: Med schools all around the country operate free clinics like this one. They're typically open once a week to treat a few dozen patients. There are six of these clinics in New York City serving a small fraction of the city's estimated one million uninsured. At the NYU clinic, student Sara Stream quickly realizes Alicia will need a lot of help. Her supervisor Dr. Cortijo decides to take Alicia into her main practice up in Harlem in the Bronx. There, Alicia will be able to get ongoing primary care plus mental health counseling - all for free if she has no money to pay.
CORTIJO: I would like to have a magic wand and relieve her. I can see the suffering in her eyes. But the only thing we can do is basically walk hand-in-hand with her and try to show her that there is at least a little kindness in the world.
MOGUL: As Alicia walks out, she seems a little overwhelmed by all the follow-up tests and treatments that lie ahead.
CORTIJO: OK? (Speaking Spanish). Try to calm down a little bit, OK?
MOGUL: Later though, by phone, Alicia sounds more upbeat.
ALICIA: (Through interpreter) I have hope that with this help that they're giving me, my physical health will get better.
MOGUL: And for Sara Stream, there's a satisfying difference between treating patients at the flagship NYU hospital and at the free clinic.
STREAM: In here, I think, something that I'm always mindful of is that a patient may not have seen a doctor in the past 10 years. Patients may not have ever seen a doctor. While they're here, I want to treat them and figure out how I can help them the most, because we don't know when they're going to see a doctor again.
MOGUL: Stream is in her last semester. After that, whether she keeps seeing uninsured patients will depend on where she does her residency and where she sets up shop. For NPR News, I'm Fred Mogul in New York.
CORNISH: This story's part of a reporting partnership of NPR, WNYC and Kaiser Health News. Transcript provided by NPR, Copyright NPR.
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