Medical students eager for clinical experience in primary care have taken proactive learning to a whole new level. The student-designed Crimson Care Collaborative, based at Massachusetts General Hospital, has a twofold mission: to enrich medical education in primary care and expand access to primary-care services for both insured and uninsured patients in the Bay State, which since 2006 has mandated health insurance coverage by law. Having completed a seven-week pilot program last spring, students and their preceptors will open the collaborative’s doors in October.
“The idea that students could be mobilized to address a crisis in terms of lack of access to primary care is very appealing,” said Camille Powe, a fourth-year MD candidate whose ideas helped lay the groundwork in September 2009. “It was very easy to recruit students; we were inundated right from the start.”
The student–faculty collaborative practice aims to nurture enduring relationships, said fourth-year David Bayne, with students following their patients over time. “Our strategy is to see patients who don’t have doctors, then link them up with a more permanent primary-care provider,” Bayne said. “That’s a big part of our mission: providing a bridge to care.”
The Crimson Care Collaborative was conceived by Rebecca Berman, an HMS instructor in medicine at MGH and an internist at the hospital’s John D. Stoeckle Center for Primary Care Innovation. Enlisted by the center to promote student interest in primary care, Berman said that candidates for internal medicine residency who have been exposed to student clinics at other schools rave about them. HMS has never had a clinic that engaged students in weaving a healthcare safety net for patients. But in the era of healthcare reform, Berman said, an influx of newly insured patients was overwhelming Massachusetts’ primary-care providers, and HMS students are eager to address the shortage of practitioners.
Under Berman’s guidance, a nucleus of students—among them Powe, Julia Carnevale, David Bayne, Andrew Chao and Erika Pabo—shaped the clinic’s practice model. Space and staff support came from Internal Medicine Associates, Inc. (IMA), a flagship practice at MGH. Roughly 40 students have been involved since planning began last fall; their numbers have since swelled to 55.
Patients are seen initially by first- or second-year students, who take the patients’ vital signs; third- or fourth-year students complete their history and conduct a physical exam. Berman and the students then meet with each patient to develop a treatment plan.
The clinic provides social services, and everyone is seen by a physician. “The clinic will cater to both IMA urgent-care patients and those who lack a primary-care doctor,” Berman said. Meanwhile, the students have an eye on the bigger picture. “Primary care can help solve the problems we have with our healthcare system,” Powe said. “If people have good relationships with their primary-care providers, they’re less likely to get a lot of unnecessary tests and specialty treatment, and they won’t go to the emergency department as often. Better access to primary care is economical, and it’s also better for patients’ health.”
“Our students are designing a model to increase access to primary care across the country,” Berman said. “Harvard creates leaders, and we need leaders in primary care.”
