Another Type of Consultation: Free public health consultations by medical students.

Since 2015, groups of medical students at the Northwestern School of Medicine. Feinberg in Chicago are hard at work answering one question: how can we improve health care at a systemic level?

Medical students should and always will provide personalized, high-quality care to their patients. But among all the study, rotations, research, and clinical volunteering, there is another area of ​​professional growth and activism in the healthcare field that allows students to contribute to broader changes in the healthcare system: community health counseling.

A group of students at Feinberg, now over 50 in any given year, have been providing free policy advice to community clinics and nonprofit health organizations for more than six years as members of Second Opinions, 501(c). )(3) a non-profit student organization founded by three management consultants turned physicians. Second Opinions aims to promote change in healthcare at a systemic level by connecting medical students with local healthcare organizations to support a variety of administrative and policy initiatives.

Teams of four to five members of Second Opinions work together on individual projects for four months, solving problems in areas ranging from clinical workflow analysis to healthcare and the nonprofit economy. Ongoing projects include helping one local community clinic improve its breast referral network and helping a second clinic create a fair sliding scale payment system for uninsured patients. While our projects are based on set deadlines, we establish follow-up procedures in which we continue to work with clients on emerging issues. This continuity of care approach is critical at all levels of healthcare, and is what attracted many of us to medicine in the first place.

Second Opinions shines brightest in its work to improve outcomes for the underprivileged. With rising costs and volatile health care laws, free and charitable clinics (FCCs) and federally qualified health centers (FQHCs) are leading the way in providing affordable care to underinsured or uninsured Americans. To help them overcome their biggest obstacles, quantify the impact on the community, and secure funding, our group recently created a reimbursement assessment tool to determine the monetary and quality-adjusted life years (QALYs) of services provided by free clinics, as well as the cost of related services. services. preventing emergency room visits.

The impact of our assessment tool began at the local level, but soon took on a national dimension. First, we presented the Illinois Association of Free and Charity Clinics with a cluster of just over 40 FCCs. Soon our team introduced the National Association of Free and Charitable Clinics, an organization of more than 1,400 FCCs, to the board members. This information has important implications for how healthcare resources are allocated, and our work to quantify subsequent costs and illness averted has strengthened the case for investing in these providers.

Changes at the system level do not have to take place on a national scale. The work could start by helping a local women’s health clinic transition from paper documents to an efficient electronic health record system so that more underrepresented Chicagoans can be seen every day. It could be assessing community health needs for neighborhood clinics that operate in west and south Chicago, or even helping our own facility expand its pediatric mHealth program.

Through this experience, our medical students learn how to make a difference in health care problems at the system level and are able to help both individual patients and a system prepared for the care of the forest and trees. The challenges we face are complex and open-ended, and our members are challenged to find ways to measure system performance and make changes through policies, workflow improvements, and clinical protocols that benefit all patient groups, especially those that are underserved. . It is a difficult task, but our advantage as medical students is that we always closely observe from the inside with fresh eyes and a passion for creative innovation.

Our members grew up in an era marked by inequity and inefficiency in health care. The dysfunction of our American health care system is being broadcast to us throughout medical school. We are ready to innovate and we believe that physicians should always have a place at the same table when it comes to improving the healthcare system and doing business in the healthcare industry. Our members are committed to providing practical advice and finding solutions to problems that burden the same underrepresented patients we hope to care for in clinics and hospitals throughout our careers. We also understand that we have a lot to learn. Our members remain humble, ready to start each project, listening for as long as it takes to adequately understand the scope of the problem. First of all, our members are creative people who are not afraid to invent solutions where there is no precedent to guide them.

We encourage medical trainees across the country to join our efforts to improve public health through strategy development. Everyone involved in public health can help, and we are happy to support others in this important work. System-level changes are complex but powerful, so help where you’re needed and be creative. And if you need Second Opinions advice, you know who to turn to.

Dr. Cecil Qiu, Liz Nguyen and Benjamin Papert contributed to this article. All of them graduated from Northwestern University’s Feinberg School of Medicine. Qiu is a resident of the Johns Hopkins University School of Medicine, Nguyen is a resident of the Stanford University School of Medicine, and Pipert is a resident of the Duke University School of Medicine.

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