At an Institute for Family Health center near Union Square in New York City, medical student Sara Stream asks a new patient named Alicia what brings her in. The 34-year-old woman arrived last summer from Guatemala, and says she hasn't been seen by a doctor in many years.
Her list of ailments is long.
"I have trouble seeing, headaches, problems with my stomach," says Alicia, who declined to use her full name, because she is in the country illegally. "I feel depressed."
Stream takes the problems one by one, carefully asking follow-up questions about when symptoms started, when they recur, where they're felt, and what Alicia thinks the causes might be. Stream is using a translator, who also happens to be her supervisor, Dr. Amarilys Cortijo. As the symptoms pile up, Cortijo steps in.
"We'll have to deal with the complaints, and try to get to the root, which is probably all the emotional turbulence that is taking place," she says.
Cortijo works for the Institute for Family Health and is co-director of two student free clinics — one in the Bronx with volunteer students from Albert Einstein College of Medicine and this one, downtown, which the Institute runs with volunteer students from NYU School of Medicine.
Many other medical schools around the country run similar clinics that treat the uninsured for free. The clinics typically are open once a week. They take in a few dozen patients per session and treat several hundred patients over the course of a year.
The programs are among the most popular extracurricular activities at medical schools and, at some institutions, the lion's share of students volunteer at one point or another.
Students do everything. First- and second-year students perform more administrative tasks, such as running the reception desk, fundraising, and coordinating lab tests and follow-up treatment. Third- and fourth-year students see patients, with faculty physicians overseeing all formal diagnoses and prescriptions.
At the NYU clinic, students increasingly have had to help drum up business. Many of the core patients in the Union Square area signed up for Obamacare coverage, leading to a 25 percent decline in visits to the free clinic last year.
"A lot of our patients had been freelance [workers], who were the most likely to benefit from the changes in health coverage," says Dr. Sarah Nosal, a family medicine practitioner and co-director of the program.
So NYU students have had to go recruit patients in a way they never needed to before, heading to churches and community centers in neighborhoods farther away, letting undocumented people like Alicia know about the free healthcare they could get if they came to the clinic.
The student-run free clinics are not major venues for taking care of the uninsured. Most of the close to 2 million uninsured residents of New York state — 1 million of them in New York City — get health care in emergency rooms, city hospitals or community health centers, if they get care at all.
Still, Dr. Neil Calman, head of the Institute for Family Health, says the clinics perform a valuable service, both for patients and for future physicians.
"This is an opportunity for medical students to get involved in the business-end of seeing what health care is like for people who don't have the same kind of access that they have to it," Calman says. "It's really a learning experience."
Stream and Cortijo quickly realize Alicia has too many problems for student trainees to take on, so Alicia will become Cortijo's patient at one of her offices in Harlem or the Bronx.
That's one less patient for the free clinic, though there are plenty of others in line behind Alicia.
For Stream, there's a satisfying difference between treating patients at the flagship NYU hospital versus at the free clinic.
"Here, a patient may not have seen a doctor in the past 10 years," Stream says. "Patients may not have ever have seen a doctor. While they're here, I want to figure out what's wrong and how I can help them the most, because we don't know when they're going to see a doctor again."
Stream is in her last semester. After that, whether she keeps seeing uninsured patients will depend on where she does her residency, and where sets up shop.
This story is part of NPR's reporting partnership with WNYC and Kaiser Health News.
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