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From Readiness to Resilience: Strengthening Student-Run Clinics Through Data and Connections

Julie Darnell, PhD, Associate Professor of Public Health Sciences

Loyola University Chicago

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Society of Student-Run Free Clinics 2025 Annual Conference

Chicago, IL

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October 4, 2025

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Important Themes Raised in JAMA Exchange

Growth and unmet need

“Incontrovertible good”

Quality

Oversight

Sources: Peoples, N., & Ubel, P. A. (2025). Are students ready to run student-run clinics?. JAMA Internal Medicine, 185(1), 14-15. Lee, D., Chen, K., & Kruger, J. (2025). Nurturing Future Health Care Leadership With Student-Run Clinics. JAMA Internal Medicine, 185(6), 746-747. Peoples, N., & Ubel, P. A. (2025). Nurturing Future Health Care Leadership With Student-Run Clinics—Reply. JAMA Internal Medicine, 185(6), 747-747

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Quality

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Problem: “We do not have a good concept of the quality of care at SRCs.”

Solution: “[M]andatory annual national survey and data repository”

Concerns: “Lacks incentives for participation” “Real data safety, validity, and compliance risks”

Peoples, N., & Ubel, P. A. (2025). Are students ready to run student-run clinics?. JAMA Internal Medicine, 185(1), 14-15.

Lee, D., Chen, K., & Kruger, J. (2025). Nurturing Future Health Care Leadership With Student-Run Clinics. JAMA Internal Medicine, 185(6), 746-747.

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Problem: “We do not have a good concept of the quality of care at SRCs.”

Solution: “[M]andatory annual national survey and data repository”

Concerns: “Lacks incentives for participation” “Real data safety, validity, and compliance risks”

Peoples, N., & Ubel, P. A. (2025). Are students ready to run student-run clinics?. JAMA Internal Medicine, 185(1), 14-15.

Lee, D., Chen, K., & Kruger, J. (2025). Nurturing Future Health Care Leadership With Student-Run Clinics. JAMA Internal Medicine, 185(6), 746-747.

Roadmap

​

to

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Health

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Equity

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Roadmap to Health Equity

In 2017, Americares, the National Association of Free and Charitable Clinics (NAFC), Loyola University Chicago, and a consortium of stakeholders including state-level free and charitable clinic associations and individual free and charitable clinics from across the country, launched Roadmap to Health Equity (Roadmap).

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Roadmap to Health Equity

Data

Repository

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Roadmap to Health Equity

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> 120 Roadmap Clinics, 2025

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Roadmap Today

A first of its kind national partnership supporting the delivery of data-driven, equitable care in free and charitable clinics.

120+ Clinics in

27 states

15 Clinical Quality Measures

Stratified by REaL

Quality Improvement and Shared Learning

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Data Collected

Clinic

Characteristics

Patient Demographics

Clinical

Quality

REaL +

Biological Sex

15* Core Measures

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*All clinics must

report on at least 3

Type + Size

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Prevention/ Screening

    • Cervical Cancer Screening
    • Colorectal Cancer Screening
    • Breast Cancer Screening
    • Body Mass Index Screening & Follow-up
    • Screening for High Blood Pressure & Follow-up Documented
    • Screening for Clinical Depression & Follow-up Plan
    • Tobacco Use: Screening and Cessation Intervention
    • Unhealthy Alcohol Use Screening and Brief Counseling

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High-Risk/ Complex Care

    • Diabetes: Hemoglobin A1c Testing
    • Diabetes: Hemoglobin A1c Poor Control 
    • Controlling High Blood Pressure
    • Hypertension: Improvement in Blood Pressure

Core Clinical Measure Set

Care Coordination/ Patient Safety

    • Documentation of current medication in medical record

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Community Partnerships/ Population Health

    • Influenza Immunization

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Acute Care

    • Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis

Required for all clinics

Priority measure - highly encouraged

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Clinic and Patient Growth

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Roadmap Benchmark Report

YOUR CLINIC

ALL OTHER REPORTING CLINICS

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Roadmap Benchmark Report, Continued

YOUR CLINIC

ALL OTHER REPORTING CLINICS

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Roadmap Benchmark Report, Continued

YOUR CLINIC

ALL OTHER REPORTING CLINICS

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Example Clinic Graph with �National Benchmark Comparisons

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2024 Highlights

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  • Roadmap gives free and charitable clinics an opportunity to assess their individual performance on clinical quality outcomes and reveal any disparities.

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  • Clinics have access to benchmark reports to compare their performance with that of their Roadmap peers and external benchmarks (UDS, Medicaid HMO, Healthy People etc.).

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  • Clinics utilize Roadmap data for internal QI, funding proposals and reports, advocacy efforts, and more.

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  • Roadmap has been a significant tool for clinics wishing to improve data quality and standardize documentation for systems improvement.

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Value + Impact

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Visit the Roadmap website to complete the clinic application.

Learn More + Join

roadmap@americares.org

healthroadmap.org/join/

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Oversight

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Problem: “Students are inexperienced in clinic administration;” “no such standards exist for supervising students”; turnover

Solution: “clear standards for faculty oversight and include faculty experienced in clinic administration”

Peoples, N., & Ubel, P. A. (2025). Are students ready to run student-run clinics?. JAMA Internal Medicine, 185(1), 14-15.

Lee, D., Chen, K., & Kruger, J. (2025). Nurturing Future Health Care Leadership With Student-Run Clinics. JAMA Internal Medicine, 185(6), 746-747.

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Problem: “Students are inexperienced in clinic administration;” “no such standards exist for supervising students”; turnover

Solution: “clear standards for faculty oversight and include faculty experienced in clinic administration”

Peoples, N., & Ubel, P. A. (2025). Are students ready to run student-run clinics?. JAMA Internal Medicine, 185(1), 14-15.

Lee, D., Chen, K., & Kruger, J. (2025). Nurturing Future Health Care Leadership With Student-Run Clinics. JAMA Internal Medicine, 185(6), 746-747.

Quality Standards

from

National/ State Association

of Free & Charitable Clinics

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Problem: “Students are inexperienced in clinic administration;” “no such standards exist for supervising students”; turnover

Solution: “clear standards for faculty oversight and include faculty experienced in clinic administration”

Peoples, N., & Ubel, P. A. (2025). Are students ready to run student-run clinics?. JAMA Internal Medicine, 185(1), 14-15.

Lee, D., Chen, K., & Kruger, J. (2025). Nurturing Future Health Care Leadership With Student-Run Clinics. JAMA Internal Medicine, 185(6), 746-747.

Quality Standards

from

National/ State Association

of Free & Charitable Clinics

Yes, and…

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https://nafcclinics.org/our-impact/quality-standards/

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NAFC Quality Standards

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NAFC Quality Standard Example

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WAFCC = Wisconsin Association of Free & Charitable Clinics

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WAFCC Example Standard

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WAFCC: Standards & Accountability

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Growth & Unmet Need

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Growth & Unmet Need

Doubling of clinics from 2005-2014, and a doubling again from 2014-2025: ~400 student-run clinics

“Paucity of alternatives”

“may otherwise might go without care”

Peoples, N., & Ubel, P. A. (2025). Are students ready to run student-run clinics?. JAMA Internal Medicine, 185(1), 14-15.

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Why do free clinics exist? Or, Why do some geographic areas have more clinics than others? �

  • There are NOT more free clinics in areas with higher #s of uninsured
  • There are more free clinics where Medicaid is less generous
  • There are more free clinics where there are fewer FQHCs
  • There are more free clinics where there are more medical school graduates

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Source: Darnell, J. (2011). What is the role of free clinics in the safety net? Medical Care, 49(11), 978-984.

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2005-2007 U.S. Census Survey of Free Clinics�(N=~1,000)

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All Known Free Clinics by State, 2005 (N=1,002)

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Nearly 3 out of 4 Clinics Survive

  • 184 clinics permanently closed, w/ documentation
  • 3 clinics temporarily closed, w/ documentation
  • 74 clinics “most likely” closed

261 clinics coded as “closed”*

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Percentage and Number of Clinics Closed �by State (N=261)

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Percentage and Number of Clinics �Open by State (N=725)

Treats 16 clinics whose operating status is unknown as closed.

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Status of Student-Run Clinics from 2005 Survey (N=57)

Open

Closed

51 (89%)

6 (11%)

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Reasons for Closure (%)

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Clinic Longevity as a Protective Factor

Mean

(Median)

Organizational Age

Open Free Clinics

Closed Free Clinics

31 years

(28 years)

19 years

(17 years)

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Closure Timing in relation to Medicaid Expansion�(N=165)

Before Medicaid Expansion or in Absence of Medicaid Expansion

After Medicaid Expansion

72%

28%

Notes: Missing Year of Closure for 22 clinics. Omits “most likely” closed clinics because lacking documentation of closure.

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2015 Census Survey of Free & Charitable Clinics (N=~1,400)

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“Incontrovertible Good”

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Peoples, N., & Ubel, P. A. (2025). Are students ready to run student-run clinics? JAMA Internal Medicine, 185(1), 14-15. Lee, D., Chen, K., & Kruger, J. (2025).

Nurturing Future Health Care Leadership With Student-Run Clinics. JAMA Internal Medicine, 185(6), 746-747.

“Additional high-quality research into the tangible value of an SRC”

“…we have seen the SRCs do incontrovertible good for their communities”

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Value of Care

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Value of Care: Monetary

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= Quantity of Services X $ Value

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Value of Care

Total Service Value:

Formula: Sum of all services X equivalent reimbursement rate used by FQHCs

Meaning: The total dollar $ value of care clinic delivered

Example: If your total service value is $500,000, then you can say: Our clinic delivered the equivalent of $500,000 in reimbursable care. Or Our clinic provided $500,000 worth of care.

Return Value:

Formula: Total Service Value / Total Cash Operating Expenditures

Meaning: How much care you provide for every dollar spent

Example: If your expenditures are $250,000, then you can say: For every $1 invested in our clinic, we return $2.00 in patient care value.

    • To donors: Your $100 gift provides $200 in care to patients.
    • In a grant: We delivered $500,000 in services on a $250,000 budget.

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NAFC Value of Care Toolkit: �Reductions in ER Utilization/Savings

Coming Soon!

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“Impact” of Volunteering at a Free Clinic on Career Outcomes

  • Learn systems-based care
  • More satisfied and perceived to be better prepared to work in low-resourced settings
  • More positive attitudes toward working with the underserved
  • Practice in underserved areas
  • Choose primary care specialties

Sources: Colbert, Ogden, Lowe et al. 2010, Students learn systems-based care and facilitate system change as stakeholders in a free clinic experience. Advances in Health Sciences Education. 25, 4: 533-545; Meah, Smith and Thomas. 2009. Student-Run Health Clinic: Novel Arena to Educate Medical Students on Systems-Based Practice. Mount Sinai Journal of Medicine. 76: 344-356. Pincavage, Razi, Arora et al. 2013. “Resident Education in Free Clinics: An Internal Medicine Continuity Clinic Experience. Journal of Graduate Medical Education, 327-330. Beck, E. 2005. “The UCSD Student-Run Free Clinic Project: Transdisciplinary Health Professional Education. Journal of Health Care for the Poor and Underserved. 16, 2:207-219. Beck, Wingard, Zuniga et al. 2008. Addressing the health needs of the underserved: A national faculty development program. Academic Medicine. 83, 1094-1102: Campos-Outcalt, DE 1985. “Specialties chosen by medical students who participated in a student-run, community-based free clinic. American Journal of Preventive Medicine. 1, 4:50-51. Smith, S. D., Yoon, R., Johnson, M. L., Natarajan, L., & Beck, E. (2014). The effect of involvement in a student-run free clinic project on attitudes toward the underserved and interest in primary care. Journal of health care for the poor and underserved, 25(2), 877-889. Rupert, D. D., Alvarez, G. V., Burdge, E. J., Nahvi, R. J., Schell, S. M., & Faustino, F. L. (2022). Student-run free clinics stand at a critical junction between undergraduate medical education, clinical care, and advocacy. Academic Medicine, 97(6), 824-831. Wilson, O. W., Broman, P., Tokolahi, E., Andersen, P., & Brownie, S. (2023). Learning outcomes from participation in student-run health clinics: a systematic review. Journal of multidisciplinary healthcare, 143-157. Ng, E., Hu, T., McNaughton, N., & Martimianakis, M. A. (2021). Transformative learning in an interprofessional student-run clinic: a qualitative study. Journal of interprofessional care, 35(5), 701-709. Hu, T., Cox, K. A., & Nyhof-Young, J. (2018). Investigating student perceptions at an interprofessional student-run free clinic serving marginalised populations. Journal of Interprofessional Care, 32(1), 75-79. Lie, D. A., Forest, C. P., Walsh, A., Banzali, Y., & Lohenry, K. (2016). What and how do students learn in an interprofessional student-run clinic? An educational framework for team-based care. Medical education online, 21(1), 31900. Schutte, T., Tichelaar, J., Dekker, R. S., van Agtmael, M. A., de Vries, T. P., & Richir, M. C. (2015). Learning in student‐run clinics: a systematic review. Medical education, 49(3), 249-263. Thomson, K. B., Mirpuri, P., & Chen, M. (2022). The impact of volunteering with a student-run free clinic on medical student specialty selection. BMC Medical Education, 22(1), 714.

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Final Reflections

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Free & Charitable Clinic Sector

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CASE Method: Copy and Steal Everything

ROADMAP TO HEALTH EQUITY

FCC QUALITY STANDARDS

SECOND OPINIONS IAFCC/WAFCC VALUE OF CARE

NAFC VALUE OF CARE: ED REDUCTIONS TOOLKIT

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Get out of your silos!

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State Associations Supporting Free/Charitable Clinics

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Acknowledgment

  • Noor Arfeen, Loyola University Chicago BSPH Student

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Thank you!

  • Julie S. Darnell, jdarnell1@luc.edu

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Questions?��Comments?