UF Medical students have created a small but efficient health-care network that relies on health professionals and premedical students working with UF faculty and staff to provide multiple types of services for the underserved in the Gainesville community.
Student leaders from the College of Medicine include, from left, P. J. Lynn, Sonja Boulware, Parin Chheda, Alex Green, Grant Harrell, Adam Mecca, Josh Solano, Paige Comstock, Robert Seifert and Alex Mathai.
The days dawn early for second-year medical student Paige Comstock. On a recent Monday, she rises at 6 a.m. and is out of the house by 7:15, heading for the library at the UF Health Science Center where she will spend the next 10 hours studying for step 1 of the U.S. Medical Licensing Exam, with only a 40-minute break for lunch.
At 5:15 p.m., she rushes home for 10 minutes to let her dog, Wylie, out and change her clothes before leaving again for the College of Medicine mobile clinic parked at the Tower Road Branch Library, where she is co-director along with classmate Josh Solano. The two prepare for their patients as an attending physician, a social worker and undergraduate students arrive. At 6 p.m. the clinic is off to a busy start.
By 9 p.m. they finish with their last patient, a single woman who has been unemployed for several months but recently found a job. She is very concerned about a mole on her leg and is examined by the students and the attending physician. The medical students supply her with valuable information about affordable options for cancer screening in Alachua County. She leaves the clinic in better spirits than when she arrived and thanks her “doctors.”
Every Monday night, the student-run clinic and its all-volunteer staff see approximately eight patients, using a converted recreational vehicle as an exam room. Their services include free screening for hypertension, obesity, diabetes, STDs and pregnancy. They offer treatment plans and referrals to social agencies, and they write prescriptions.
For Adam Mecca, a student in the College of Medicine’s MD/PhD program, Thursdays are similar to Comstock’s Mondays. He’s in the lab at 6 a.m. to run experiments until noon. After a quick lunch he spends a few hours on administrative duties for the lab, such as working on a presentation or planning experiments. Then he tackles more administrative work, this time for the UF Equal Access Clinic, before leaving the Health Science Center at 5:30.
Clinics, Mecca and Schneider implemented changes to the clinic’s organizational structure that led to improved operations, expanded programs and an explosion of student involvement.
Today three UF student-run free clinics each provide health-care services one night a week. The expansions have increased the number of patients the students see each month from about 60 to between 120 and 130.
The original clinic, the EAC, is held from 6 p.m. to 9:30 p.m. on Thursdays at the Family Practice Medical Group and provides care to some of the area’s most disadvantaged. The new by-appointment clinic is held Tuesday evenings at the Gainesville Community Ministry beginning at 5:30, providing more follow-up care and chronic disease management, which has eased some of the patient load for the EAC, meaning fewer patients are turned away.
The latest addition is the Monday night mobile clinic that serves the west side of Gainesville in the Tower Hill area. With all three clinics, attending physicians and residents supervise the students’ work, but a unique team of interdisciplinary students in medicine, pharmacy and psychology manage the operations.
David Feller, MD, is the faculty adviser for the clinics.
“It is amazing how much energy some of the students put into their job (of running the clinic),” he said. “They’re wonderful, forward-thinking. You know, they’re here for a limited period of time, but they’re so motivated to make things work better.”
The Advent of a Student-Run Clinic
The EAC can be traced back to a humble beginnings but high aspirations. In 1989, a few students, including Helga Rippen, MD ’93, and William Slayton, MD ’92, organized a health fair held in east Gainesville at Lincoln Middle School.
“At that time there was no community outreach by medical students,” explains Rippen, a second-year student at the time. “We checked blood sugar, blood pressure; we were even able to provide limited cancer screening. Basically, it was our chance to assess the community’s needs, and eventually it evolved into the free clinic.”
Rippen, who took time off from medical school to earn a PhD and later earned an MPH, understands the broader issues of health care. As chief information officer and vice president for the Center for Health Information Technology in Rockville, Md., and a former senior adviser in the Department of Health and Human Services, Rippen’s career has focused on meeting the needs of society – whether as a young medical student organizing a community health fair or working to transform health care through the appropriate use of health information technology.
“Addressing the wellness and illness of our communities is the key to being a doctor,” she says. “And we were lucky because we had a great Health Science Center, a great dean and a great opportunity to give back. It is gratifying to hear that there is still an environment at the College of Medicine that allows students to do things that impact the world around them.”
Later, in the fall of 1991, a late-night study session in Kyle Morsch’s off-campus apartment led to a discussion on how to provide health care for people in Gainesville who had no access.
“That night we planned out a free clinic, and we even came up with the name – Equal Access Clinic,” says Marci (Hartog) Slayton, MD ’94. “We asked Bob Watson (former senior associate dean for educational affairs) if we could do it, and he said if we get support from faculty, we could do it.”
The students received commitments from faculty, including Eloise Harman, MD, and Linda Lanier, MD ’85, and by January 1992, the EAC opened for business in the Salvation Army’s community center on University Avenue, while people came to the center for a free meal.
“The first night we went down there with our white coats and stethoscopes and hung up our ‘open for business’ sign, the people in line for food just looked at us,” Slayton recalls. “I think they thought ‘who are these kids?’ but after a while, they started getting out of the line and coming over to us.”
As Slayton explains, they didn’t know their small clinic would be maintained for 18 years, and that medical students behind them would take their idea, expand it, enlist students from the other UF health colleges and eventually create a health system that the community’s disadvantaged population could rely on.
It’s students like Slayton, now a Gainesville pediatrician, her husband Bill Slayton, an associate professor of pediatrics at UF, and current clinic leaders like Adam Mecca and Grant Harrell who inspire others to follow their lead, ensuring the future of the EAC and its impact on the community.
Back at the Gainesville Community Ministry one Tuesday night, Harrell, who started the clinic in 2008 as part of his summer Area Health Education Center project, admits he will miss working at the clinic when he leaves in June for an internal medicine residency at the University of Kentucky in Lexington.
“But I know it is in good hands,” he says, referring to the students who have begun to take over its leadership. One of those is Alex Mathai, who will enter his third year of medical school this summer.
“The reason I got involved with the clinics is because of people like Grant,” he says while overseeing the evening’s student volunteers. “He is really a role model and setting the stage for us to follow his example.”
Harrell’s objective when he launched the project was to explore the best way to create a primary care clinic that offers a medical home for patients coping with chronic health problems such as hypertension, diabetes, pulmonary and cardiac problems, explains Rhondda Waddell, associate director of Programs for Interdisciplinary Education at the Health Science Center.
“These were needy patients who were using up valuable space at the EAC and other area health clinics,” says Waddell, who serves as an adviser in the clinic.
Eventually patients found the care they needed at GCM and the practice began to grow with other health profession students and faculty volunteering their time.
“The first year we just tried to build our patient population,” Harrell explains. “Then Sonja Boulware, a third-year medical student, got involved, and she came up with the plan to form a partnership with the EAC and it was taken to a new level.”
Kathy Sanford has been coming to the Gainesville Community Ministry for more than a year. She first heard about its services through the EAC, where she sought treatment for an asthma attack.
“This place is helping me control my asthma,” she says. “Before I came here I was going to the emergency room all the time, and the people here found a program that gets me Advair for free.
“I haven’t been to the ER in almost two years.”
The goal of the Gainesville Community Ministry clinic and the mobile clinic in west Gainesville is to provide continuity of care, to focus on prevention and help keep people out of the hospital and emergency room.
“Everyone has an opinion about health-care reform, but the point is 30 million people have no health insurance, and those are the people we see every week,” says Mathai, a clinic coordinator.
Adam Mecca is another leader who inspires his fellow medical students. His tireless effort over the last two years to overhaul the operations of not just the EAC, but the entire structure of UF’s student-run free clinic enterprise, has led to a network of programs that will most likely be sustained for years.
“Our free clinics have to two major goals,” Mecca explains one Thursday evening between patients. “Our first goal is to provide health care for the underserved in the county, and the second goal is to provide an educational experience for professional students in the different health-care disciplines.
“I think in the process, we have developed this network that can actually provide higher quality and more access to many people,” he says. “By investing our time and by providing care the way we’ve been trained to do, we are improving the system of care.”
Community leaders agree. While not their sole supporter, the Alachua County Commission has been a champion of the UF free clinics for years – most recently through its CHOICES program, which provides access to health care for the county’s working uninsured through a voter-approved sales surtax.
“About three years ago the County Commission allocated $10,000 a year for the Equal Access Clinic from the CHOICES funding as a reward for the wonderful job the volunteers do in providing such a valuable service,” said Alachua County Commission Chair Cynthia Moore Chestnut. “Since then, the commission has more than doubled its support due to the outcome-based performance that has been measured by the students.”
The student-run clinics receive funding from several other sources, including a recent $20,000 grant from the Association of American Medical Colleges, $2,000 from the American Medical Association and annual funding from the UF Medical College Council.
Student education is a principal objective at all clinics. Young students work side-by-side with seasoned medical faculty, take patients’ vitals, get their histories and present to their attending physician.
“I have learned a lot about the management of hypertension and the kinds of medications to prescribe,” said third-year medical student Mrunal Shah. “You also learn more practical things like how to network with other professionals and how to find resources to get help for people.”
Joh Hu, another third-year student about to enter his fourth, says they also gain valuable insight into the “reality of our health-care system.”
“We’re trying to do the best for our patients within the confines of the current health system,” he explains. “For example, trying to find medications that they can afford, versus the standard drugs we learned in class.”
The one thing the student-run clinics cannot operate without is College of Medicine faculty. The students need doctors to volunteer as attending physicians or the clinics can’t open.
Dr. Miguel Tepedino is a family practice physician in Lake City and an adjunct professor at the College of Medicine. He is a reliable volunteer for the mobile unit that operates every Monday in west Gainesville.
Dr. Matthew Gray is a recent UF medical graduate who, as a busy first-year resident, volunteers at the EAC on Thursdays.
Dr. Phillip Barkley is the director of the UF Student Health Care Center and a regular volunteer physician at the Gainesville Community Ministry.
“We have our regular doctors who come often and we have some who volunteer every few months,” explains Mecca. “We are grateful to all of them for allowing us to maintain our clinics and for sharing our vision.”
Support from the administration has been key to reinvigorating the student-run clinics. It was Dr. Nancy Hardt, senior associate dean for external affairs, who got the wheels on the mobile clinic moving. She reached out to area resources and gained support from CHOICES, the Alachua County Health Department, Florida Department of Health and Florida Area Health Education Centers for funding and volunteers.
Hardt says the students’ approach to management of the clinics has been very entrepreneurial.
“They understand the needs of the population they serve, and they will go to great lengths to meet those needs,” she says. “For example, they realized many of the people who need services don’t have transportation, so they brought a mobile unit to the west side of town.”
Passing the Torch
With a sustainable model in place, the current leadership of UF’s free clinics are preparing for a smooth transition to new student officers who will bring their own creative ideas and approaches. Mecca plans to stay involved, although he’s not certain how his career will take shape.
“I’m having a hard time deciding how I’m going to balance my two interests,” he admits. “On the one hand I have a strong interest in basic science and research in neuroscience and neurophysiology, but then on the other hand I have this drive to improve health-care systems and student-run free clinics.”
As for Harrell, his commitment to service and outreach will continue – it will just take place in a different community. He begins a primary care residency at the University of Kentucky this summer. Although his academic record probably could have scored him a slot at Harvard or a Johns Hopkins, Harrell chose Kentucky because it offers a rural medicine track, says Harrell’s sister, Heather Harrell, MD ’95.
“Grant has had a passion for helping disadvantaged people since he was young,” she says.
The young physician, who once spent a summer working with the Harlem Children’s Zone, traveled to Nairobi, Kenya, to help set up education programs in the Mukuru slums and tutored at-risk high school boys every Monday during medical school, isn’t likely to give up his ideals or his influence now that he is a full-fledged physician.
As for Comstock and many of the other clinic coordinators, they donned new white coats May 23 signaling their own transition into clinical rotations with its unpredictable work hours and sleepless nights. Nevertheless, as students who have continually gone beyond what is expected of them they are certain to have their own impact on the next generation of students behind them.
“The compassion and generosity of these students is profoundly evident,” says Waddell. “They bring forth the best of what we can hope for in our future medical profession.”