A different kind of consult: pro-bono community health consulting by med students


Since 2015, groups of medical students at the Northwestern Feinberg School of Medicine in Chicago have been working diligently to answer a single question: How can we improve healthcare at the system level?

Medical students have and always will be expected to provide personalized, high-quality care to their patients. But amid all the studying, rotations, research and clinical volunteering, there is another area of professional growth and healthcare activism emerging that allows students to promote broader change across the healthcare system: community health consulting.

A group of students at Feinberg, now more than 50 in any given year, have been providing pro-bono strategy consulting services to community clinics and healthcare not-for-profits for more than six years as members of Second Opinions, a 501(c)(3) not-for-profit student organization founded by a trio of management consultants-turned-physicians. Second Opinions aims to promote system-level change in healthcare by pairing medical students with local healthcare organizations to support a variety of administrative and strategic initiatives.

Groups of four to five Second Opinions members work together on discrete projects for four months at a time, tackling problems in areas ranging from clinical workflow analysis to healthcare and not-for-profit economics. Current projects include helping one local community clinic improve its mammogram referral network and assisting a second clinic in the creation of an equitable sliding scale payment system for uninsured patients. While our projects are based on set timelines, we establish follow-up procedures in which we continue working with clients on emerging issues. This continuity-of-care approach is crucial across all levels of healthcare and is what drew many of us to medicine in the first place.

Second Opinions shines brightest in its work to improve outcomes for underserved populations. Amid rising costs and legislative volatility in healthcare, Free and Charitable Clinics (FCCs) as well as Federally Qualified Health Centers (FQHCs) have led the way in providing accessible care to underinsured or uninsured Americans. To help them overcome their greatest obstacles, quantifying community impact and obtaining funding, our group recently created a reimbursement valuation tool to determine the monetary and quality-adjusted life years (QALY) values of services provided by free clinics as well as the value of appropriately averted emergency department visits.

The impact of our valuation tool started locally but soon gained national traction. First, we presented to the Illinois Association of Free and Charitable Clinics, a cluster of just over 40 FCCs. Soon, our team was presenting to board members of the National Association of Free and Charitable Clinics, an organization of over 1,400 FCCs. This information has important implications for how healthcare resources get distributed, and our work quantifying averted downstream costs and disease strengthened the case for investing in these providers.

System-level change does not have to occur on a national scale. The work can start by aiding a local women’s health clinic in the transition from paper records to an efficient electronic health record system so that more underrepresented Chicagoans can be seen each day. It can be performing community health needs assessments for neighboring clinics that operate in Chicago’s West and South Sides, or even helping our own institution expand the reach of its pediatrics mobile health program.

Through experiences like this, our medical student members learn how to effect change on system-level healthcare issues and leave empowered to help both individual patients and the system—equipped to care for the forest and the trees. The problems we face are complex and open-ended, and our members are challenged to find ways to measure system performance and enact change through policy, workflow improvements, and clinical protocols that benefit entire patient populations, particularly underserved ones. This is a tall order, but as medical students, our advantage is that we are always intimately observing from the inside with a fresh perspective and a passion for creative innovation.

Our members grew up in an era marked by healthcare disparities and inefficiencies. The dysfunction of our American healthcare system is broadcast to us throughout medical school. We are ready to innovate, and we believe physicians should always have a seat at the table when it comes to improving the healthcare system and operating the business of healthcare. Our members are eager to provide actionable recommendations and create solutions to problems that burden the same underrepresented patients we hope to care for in clinics and hospitals throughout our careers. We also realize we have much to learn. Our members remain humble, ready to begin each project by listening for as long as it takes to adequately understand the scope of the issue at hand. Most of all, our members are creative—unafraid to invent solutions where there is no precedent to guide them.

We encourage medical trainees across the country to join in our efforts to promote community health through strategy work. There is space for anyone who is dedicated to community health to help, and we are excited to support others with this important work. System-level change is difficult but powerful, so help where you are needed and get creative. And if you need a Second Opinions consult, you know who to page.

Drs. Cecil Qiu, Liz Nguyen and Benjamin Peipert contributed to this article. All graduated from Northwestern University Feinberg School of Medicine. Qiu is a resident at Johns Hopkins University School of Medicine, Nguyen is a resident at Stanford University School of Medicine, and Peipert is a resident at Duke University School of Medicine.



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