Student-Run Free Clinic Celebrates Major Milestone

This year Columbia Student Medical Outreach (CoSMO) is celebrating a major milestone—20 years operating as a free clinic serving uninsured patients in Washington Heights and Northern Harlem. The first and largest student-run free clinic at Columbia University Vagelos College of Physicians and Surgeons, CoSMO is a team effort, staffed by volunteer medical and physical therapy students and faculty from VP&S, and students from the School of Social Work, Mailman School of Public Health, and School of Nursing. NewYork-Presbyterian provides the physical space for the clinic and provides medical staff while the free clinic is in operation.

CoSMO served as a model for additional student-run free clinics at VP&S: Columbia-Harlem Health and Medical Partnership, Columbia Human Rights Initiative Asylum Clinic, Columbia University Care Access Project, and the Q Clinic, which also celebrates its 10th anniversary this year. The five free clinics offer an opportunity for medical students to get hands-on experience in patient care in an interdisciplinary setting and work as care coordinators, scheduling appointments and follow up with patients.

“The pre-clinical curriculum is a lot of memorization of facts, and when I walk into the CoSMO clinic, I really see why I'm learning everything,” says Abigail Marx, events chair at CoSMO and second year medical student at VP&S. “It adds a lot of depth to my pre-clinical learning.”

The extra experience helps students advance their skills during medical school and prepare for their future as health care providers.

“The CoSMO students are better prepared to interview patients, to do exams, and to really think about how to manage the medical problems of the clinic’s patients,” says Heather Paladine, a family medicine physician at VP&S and an attending physician at CoSMO. “Being at a student-run free clinic like CoSMO, the students learn things that I never learned in medical school about the cost of care and how to get resources for patients who have a lot fewer resources than most of the people we see at the medical center.”

Serving our community

The student-run free clinics help to fill a gap in the local community of Washington Heights, which has the second-highest rate of uninsured adults  in New York City. More than 20% of adults in Washington Heights lack health insurance, compared to the citywide average of around 12%. The clinic offers a wide array of services, including checkups, chronic condition self-management education, nutritional care, behavioral health care, and physical therapy.

In a small clinic setting, the student volunteers are able to provide one of the most valuable and scarce resources of all in health care—time.

“For many of our patients, there just hasn't been someone to sit down and explain what's going on, why they feel ill, and what they can do to help,” says Kishan Bhatt, CoSMO co-chair and fourth year medical student at VP&S. “As medical students, we have the time. I think it fills a niche for those patients, and it makes them really motivated to help themselves and continue to come back to the clinic.”

The patients at CoSMO tend to have numerous chronic health issues, with diabetes being one of the most common. Through fundraising efforts, the clinic covers the full cost of lab tests, health monitoring equipment, and prescription medications that the uninsured patients would otherwise have to pay for out of pocket.

“CoSMO is a way for vulnerable patients to plug in to a whole system of enthusiastic students who are committed to providing a safety net to help patients navigate health care,” says Cyrus Boquín, a Columbia internal medicine specialist and medical director at CoSMO. “Challenging limitations will always exist, but in cooperation with physician volunteers and supervisors, we use our connections, expertise, and creativity to ensure that our patients get the top-quality care that they need.”

By providing primary care to uninsured patients, CoSMO helps ensure that fewer patients experience major health incidents that require a visit to local emergency departments.

“Anybody who's worked in an emergency room or clinic understands that many emergencies stem from challenges that should have been taken care of in a primary care setting,” says Boquín. “The asthma attack that results in fatal danger could have been prevented had the patient had access to medication. They could avoid hospitalization and avoid life-changing health complications. With CoSMO, our patients can get their medications, and they have a place to call and not have to be afraid.”

CoSMO is constantly innovating, piloting new programs and partnerships to better serve the needs of the community. In the past year, CoSMO held its first ever gynecology clinic, expanding access to reproductive health services such as pap smears. The clinic also piloted new initiatives to screen patients for food insecurity and connect them with community resources, and expanded access to cutting-edge diabetes medications through partnerships with prescription assistance programs.

For the clinic’s volunteer physicians, each year, too, can feel like a reinvention.

“Caring for these patients and these communities is what drove me to become a medical student,” Boquín says. “With every new crop of students, I’m inspired again to do my daily work and reminded why I went into primary care medicine.”