Is Presence of a Student-Run Clinic During Medical School Associated with Future Primary Care Practice? Sebastian Tong, MPH, Boston University School of Medicine Bob Phillips, MD, MSPH, The Robert Graham Center Rebecca Berman, MD, Harvard Medical School

Background: Student Run Clinic First SRCs opened in 1960s Few studies completed to measure either patient or student outcomes from SRCs Simpson and Long1 – first attempt to categorize all SRCs nationally, 49 SRCs identified Meah et al2 – systematic review of 20 articles; identifying areas of needed research Campos-Outcalt 3 – family medicine and primary care match after participation in SRC at UCD 1978-82; significant increase in both! JGIM 2007;22:352-6. Mt Sinai J Med 2009:76;344-356. Am J Prev Med 1985;1(4):50-1.

Background: Primary Care COGME’s 20th report: Advancing Primary Care Current PCP to all physician ratio 32% Recommendation: 40% 28.1% in 2002 to 23.8% in 2006 Graham Center Report: Specialty and Geographic Distribution of the Physician Workforce – What Influences Medical Student & Resident Choices? AAMC Graduation Questionnaire AMA Physician Masterfile

Background: Primary Care Interest

Objective To determine whether there is an association between: presence of a student-run clinic at a medical school AND future practice of medical student graduates in a primary care specialty

Methods Data sets FM Match Data from AAFP (2000-2010) AMA Physician Masterfile (current practice characteristics of all US physicians) Simpson and Long data (47 schools with SRCs in 2005)

Methods (continued) 80 schools with missing data Puerto Rico schools eliminated (4 schools) Survey of 76 Medical School Deans/Directors of Student Affairs to ask if had SRC in 2005 Response rate 69/76 with 1 dean refusing to participate Total sample = 115/123 (93.5%) Exemption Status obtained from Harvard School of Public Health IRB

Methods (continued) Linear regression analysis of: Current primary care practice vs. student-run clinic presence at medical school FM match vs. student-run clinic presence at medical school Confounding factors added to multiple linear regression Public vs. private (OR 1.27) Rural vs. urban (OR 1.38) Presence or absence of FM dept (OR 2.62)

Results Student-Run Clinics 72 schools have at least 1 SRC 43 schools do not have a SRC

p = 0.207

p = 0.396

p = 0.132

p = 0.286

Conclusion No difference in family medicine match rate OR future practice in a primary care specialty based on presence or absence of a student-run clinic at a medical school

Limitations Inconsistent definition of Student-Run Clinic Service-learning student driven outreach project in any discipline that strives to enhance the health and well-being of a community A health care delivery program in which medical students take primary responsibility for logistics and operational management and which is capable of prescribing disease-specific treatment to patients Varying vision and philosophies of SRC % of students at school participating 2005 grads in practice yet? Other unaccounted confounders – ex. other service-learning activities

Next Steps Clarification of SRC definition School(s) specific survey of students participating vs. not participating in SRC Community involvement and family medicine!

Thank you Stoeckle Center for Primary Care Innovation Susan Edgman-Levitan, Executive Director Rebecca Berman, Fellow Robert Graham Center Bob Phillips, Director Stephen Patterson, Research Director Meiying Han, Health Economist AAFP