1. 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

2. 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 ; significant increase in both!
JGIM 2007;22:352-6.
Mt Sinai J Med 2009:76;
Am J Prev Med 1985;1(4):50-1.

3. 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

4. Background: Primary Care Interest

5. 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

6. 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)

7. 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

8. 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)

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

10. p = 0.207

11. p = 0.396

12. p = 0.132

13. p = 0.286

14. 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

15. 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

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

17. 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