Med School Students Chip in to Help Uninsured Left Behind by Obamacare

At an Institute for Family Health center near Union Square, medical student Sara Stream asks a new patient named Alicia what brings her in. It's been many years since the 34-year-old patient, who arrived last summer from Guatemala, has seen a doctor.

Her list of ailments is long.

"I have trouble seeing, headaches, problems with my stomach," said 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. She's using a translator, who also happens to be Stream's supervisor, Dr. Amarilys Cortijo, and as the symptoms pile up, Cortijo steps in.

"A lot of the symptoms she has are somatic," said Cortijo. "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."

Cortijo works for the Institute for Family Health and is co-director of two student free clinics — one the Institute runs 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. Mt. Sinai, Columbia, Cornell and SUNY-Downstate all run similar clinics that treat the uninsured for free. They typically meet once a week, taking in a few dozen patients per session, and treating several hundred patients over the course of a year.

The programs are among the most popular extracurricular activities at medical schools, and at some places the lion's share of students volunteer at one point or another.

Students do everything. First- and second-year students do more administrative tasks, such as running the reception desk, coordinating lab tests and follow-up treatment and fund-raising. 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 picked up Obamacare coverage, leading to a 25 percent decline in visits last year.

"A lot of our patients had been freelance people, who were the most likely to benefit from the changes in health coverage," said Dr. Sarah Nosal, co-director of the program.   

So NYU students have had to go out recruiting in a way they didn’t need to before, heading to churches and community centers in neighborhoods farther away, to let people like Alicia know about the free healthcare they could get if they come to the clinic.

"[They've] reached out to communities where undocumented people were and made them aware of our resources," Nosal said.

The student free clinics are not major venues for taking care of the uninsured. Most of the close to 2 million uninsured people in New York and 1 million in the city get health care in emergency rooms, city hospitals or community health centers — if they get it at all.

Still, Dr. Neil Calman, head of the Institute for Family Health, said the clinics perform a valuable service for both patients and 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," he said. "It’s really a learning experience."

For Calman, it's an unfortunate irony that he is getting volunteers from NYU and Albert Einstein medical schools, when their base hospitals, NYU Langone Medical Center and Montefiore Hospital, have a record of taking relatively few low-income patients.

"Both of them are a block away from a city hospital [Bellevue and Jacobi medical centers], and so they’ve really been able to put off the responsibility for the care of people on Medicaid and the people who are uninsured to the city hospitals," Calman said.

Those people also become Institute for Family Health patients. Alicia became one of them, after Cortijo quickly realized Alicia had too many problems for student trainees to take on. Alicia will become Cortijo's patient at one of her offices in Harlem or the Bronx. 

"It’s a lot to take on, but we take it on," Cortijo said. "Somebody’s got to do it."

That's one less patient for the free clinic, though there are plenty of others on line behind Alicia, for Stream and her fellow medical students to take on.

Whether they continue to see the uninsured, after they complete medical school and finish volunteering at this program, will depend on what they choose to do next —  where they do their residency and where they set up shop.