Three surveys, conducted from 2004 to 2014 have provided valuable insight into the structure and function of SRC’s across the US. All three relate to medical SRCs and no studies were identified that focus on IP SRCs. Lung (2004) provides limited information as the survey was published in the form of a research abstract. It provides information on thirty- three SRCs established between 1968 and 2003 that responded to a mailed survey. The clinics provided care to the uninsured and a third of the clinics specifically focused on individuals experiencing homelessness. They provided a range of medical specialties including, adult medicine, obstetrics and gynaecology, and paediatrics. The most commonly
provided services included, urinalysis, serum chemistries, CBC count, serum lipid levels, glucose testing, Papanicolaou test, pregnancy tests, and gonorrhoea and chlamydia testing (Lung, 2004).
Simpson and Long (2007) provided a more comprehensive report of the state of US SRCs reporting the results of a national web-based survey of medical SRCs administered to 124 colleges that were members of the American Association of Medical Colleges (AAMC). Ninety- four schools responded and 111 medical SRCs were identified, located within 49 medical schools and spread across 25 states. The survey showed a significant increase in the establishment of SRC’s from the late 1990’s to the early 2000’s, with an average length of clinic operation being just 7.4 yrs.
Clinics were located at homeless shelters or community agencies, hospitals, churches, rented buildings, state-run health clinics, mobile units, and other unspecified locations. The majority of clinics operated once a week providing free care to uninsured patients primarily from minority populations, (Hispanic 31%, Black 31%, White 25%, Asian 11%, Native American and other 3%). Clinics saw an average of 15 patients per week with around a third of the patients presenting with acute or emergent complaints, a third for monitoring of chronic health problems, and the remainder for check-ups, physicals, or to pick up their repeat medications. The clinics referred patients for services they could not provide, including referrals to the emergency department, local public health centres, associated academic medical centres, and public hospitals. Laboratory tests were performed onsite or through partnerships with outside organizations at 81% of the responding SRCs and 79% dispensed a range of prescribed drugs. Students managed the clinics and were also responsible for establishing partnerships with clinic sites, laboratory service providers, medication sources, and for seeking funds to support clinic operations.
With regards to the SRC manpower, Simpson and Long (2007) reported volunteer students, supervised by volunteer physicians, staffed the clinics. The majority of student volunteers were medical students, including preclinical medical students, (this term is used in the US for medical students who are in their first 2 years of medical school and who have not yet been on clinical placement), plus clinical medical students (medical students in the 3rd and 4th of their studies and who are in clinical placements). A third of the responding clinics reported they also had volunteer students from health-related graduate programmes, and a third reported using undergraduate students. Non-health related graduate students and high school students were also present at a small number of clinics.
Physicians on the faculty at the university were present at all of the responding clinics, with half of the clinics supplemented by non-faculty volunteer physicians. Around a quarter of clinics also reported having volunteer nurses and social workers, with a fifth identifying other professional health workers as supporting the SRC. Although faculty was present in the
clinics, Simpson and Long (2007) stated that most of the teaching within the SRCs was reported as being led by students, primarily by the senior medical students. They were not able to make an assessment regarding the quality of clinical education occurring within the SRCs and their survey did not evaluate the impact of the SRC.
Lung (2004) described a large variation in the reported clinic annual operating budgets, ranging from $200 to $100,000, with a mean annual operating budget of $17,352. Simpson and Long (2007) reported similar findings with the annual operating budgets of responding clinics ranging from $500 to $95,000, with a mean operating budget of $18,889 (median $12,000). The major sources of clinic funds being private or community grants and student fundraising, with some supplemental funds coming from the medical school or university associated with the SRC, and government grants.
Smith et al. (2014) attempted to update Simpson and Long's survey but using a different approach to survey dissemination. On this occasion, SRCs were identified through the Society of Student-Run Clinics. The Society was established in 2010 with the aim of drawing together SRCs across the nation to collectively advocate for policy and resources to support SRCs and the needs of those individuals they serve
(www.studentrunfreeclinics.org). The survey was emailed to student leaders of SRCs that were housed at member organizations of the AAMC. The results relate to 86 institutions that reported having at least one SRC, with a total of 208 SRC sites identified. Smith et al. (2014) reported the number of AAMC member institutions with an SRC had more than doubled in the 9 years since Simpson and Long’s (2007) survey, with 75% of medical schools in the US reporting to have a least one SRC (mean of 2.4 SRCs per school). As with the previous surveys, the majority of patients attending the clinic (90%) were uninsured. Smith et al. (2014) provided additional information on the population being served, reporting that for more than half of the clinics, over 80% of their patients were under the federal poverty level, with the most commonly treated conditions being diabetes and hypertension.
Some differences between the results reported by Simpson and Long (2007) and those reported by Smith et al. (2014) could suggest that during the intervening years between surveys, SRCs had become mainstream which is reflected in changes in the location of clinics, inclusion of clinics as curricular components and the introduction of paid faculty and administrative staff at some SRCs. When Simpson and Long (2007) conducted their study, the greatest number of SRCs were located in homeless shelters (32%) while Smith et al. (2014) reported around 80% of SRCs being housed at community clinics (51%), or medical office buildings (28.2%).
With regards to the educational component of the SRC, a shift was apparent from SRCs being a student-driven volunteer service opportunity, to SRCs becoming a medical
curricular component, either as an elective (35.8%) or as a component of the core
curriculum (11.1%). While Smith et al. (2014) reported that student volunteers remained the main workforce at the clinics, almost half of the clinics identified that recruiting and retaining sufficient faculty volunteers had become a major clinic concern and clinics were beginning to report the inclusion of paid staff, including faculty (12 clinics) and administrative staff (20 clinics).
As for funding, although the mean clinic budget had risen over the intervening 9 years between surveys, from $18, 889 to $48,653, the range and median showed no real change (median $12,000, range $0 -$100,000), and funding was identified as a major challenge by a third of SRCs.
A limitation of all 3 surveys (Lung, 2004; Simpson and Long 2007; Smith et al. 2014) was their sole focus on medical school SRCs, as such they did not include SRCs hosted by other professional schools, nor did they focus on programmes that reported to be interdisciplinary, multi-professional, or interprofessional in focus. However, Smith et al. (2014) did address the representation of other professions within the responding SRCs. Of the 86 medical schools that responded, 62 (72.9%) reported having interprofessional partners involved in the SRC. Table 6 shows the reported interprofessional partners, both students and faculty/clinicians from professions other than medicine, as reported by Smith et al. (2014).
While the representation of other professions within the clinic may be considered to provide opportunity for IPE within the SRC the nature of the relationship between professions was not described, raising the question of whether these clinics were operating as
interprofessional or multi-professional clinics.
Students No of clinics
(%)
Clinicians / Faculty No of clinics (%)
Pharmacy students 36 (43.9) Pharmacists 34 (41.5)
Nursing students 25 (30.5) Nurses 36 (43.9)
Social work students 23 (28.1) Social workers 34 (41.5)
Physician assistant students 20 (24.4) Physician assistants 8 (9.8)
Dental students 19 (23.2) Dentists 15 (18.3)
Legal students 6 (7.3) Lawyers 5 (6.1)
Pre-health professional a 45 (54)
Public health students 31 (37.8)
Community volunteers 33 (40.2)
a Undergraduate, post baccalaureate, master’s, or PhD students who wish to enter health professional school Table 6: Reported interprofessional partners at SRCs (adapted from Smith et al. 2014)