UR students serve the uninsured 

About two dozen men and women fought through an early March snowstorm to get something that many people take for granted: medical care.

They filed downstairs to the basement of Asbury First United Methodist Church in southeast Rochester, where the University of Rochester and church officials have set up a small health clinic. The examination room — previously a storage area — reeked of rubbing alcohol and latex.

The Asbury clinic on East Avenue is one of three UR Well Student Outreach clinics in Rochester operated by medical students. The patients — students saw more than 900 last year — usually don't have health insurance and can't afford to pay for services.

The clinics — the others are at St. Joseph's Neighborhood Center and St. Luke Tabernacle Community Church — coordinate their services, most of which are free. Together, they provide a much-needed triage for the area's uninsured, while also giving students an important learning experience.

Deondre Coakley, a marine biology student at Monroe Community College, recently used the Asbury clinic. He says that he wanted to work in the child care field so badly that he took a volunteer position, without health insurance.

"I feel like I'm in good health, but I need the annual physical because it's a requirement for my job," he says. "And this is convenient for me instead of paying to go somewhere else."

Many patients visit the Asbury UR Well clinic on the first Tuesday of the month when the students offer physical exams, says Ida Hickman, a church volunteer who coordinates clinic staffing.

"Used to be that that you got the job and the employer did their own physicals," Hickman says. "Now they make people handle that on their own and it costs about $200. That's a lot of money that many people just can't afford."

UR medical students volunteer at the clinics, which are usually open one evening a week for about three hours. The students do not receive course credit or compensation, but many say that the experience is unlike any they might encounter in a classroom or hospital setting.

The first- and second-year med students are paired with third- and fourth-year students, and all are closely supervised by UR physicians, who also volunteer their time and expertise.

Ted Ryser, a fourth-year med student, has volunteered at the clinics since his first year. He is clinic manager at Asbury, making sure that the facility is fully stocked and runs smoothly.

The experience of working in a neighborhood clinic is completely different from working at a hospital, he says.

"It's a much more formal environment at the hospital," Ryser says.

At the clinic, students learn from pros in a less stressful setting, he says. And they learn whether medicine is a good career match before running up a huge tuition tab for medical school, he says.

"I think it's real important to know what you're getting yourself into," Ryser says. "In the first and second year in med school you study a lot, but after that, you spend a lot of time in the hospital and you have to be able to work with a lot of different types of people in different situations."

At the clinics, students meet with their patients and then present their findings to the doctors on duty. Ryser says that students treat mostly minor trauma, concussions, urinary tract infections, flu and colds, STD's, and a lot of skin infections.

"It's everything you see in urgent care clinics," he says.

The clinics don't have many repeat patients, he says. Patients who need more in-depth care are referred to resources better equipped to handle their needs, Ryser says.

Patients are often sent to St. Joseph's Neighborhood Center, a sprawling South Avenue complex that offers a comprehensive list of health services ranging from physical therapy to cancer screenings. A UR Well clinic operates within St. Joseph's well-established clinic, says the UR's Dr. Marc Berliant, a nine-year volunteer at the UR clinic inside St. Joseph's.

St. Joseph's has access to many resources and technologies, Berliant says, but the UR clinic operates on an extremely limited budget. He says that helps him teach students to be resourceful.

"It's amazing how much you can still diagnose with an old-fashioned, time-honored physical," he says.

The students at the UR Well clinics say that they've seen a slight decrease in patients this year, and on some nights only a couple of patients show up. Some of the students and doctors speculate that the drop may be the result of the Affordable Care Act.

Armed with little more than her laptop, Laurie Adjivon, a health insurance enrollment navigator with Coordinated Care Services, says that she can often collect information from clinic patients while they wait to be seen. She says that she can get them enrolled and insured within a day or two.

Getting an exact count of the Rochester region's uninsured isn't easy. According to Excellus BlueCross BlueShield, Upstate New York's uninsured rate was roughly 8.4 percent from 2010 to 2012. That was considerably lower than the national rate of 15.1 percent.

But neither Berliant nor Michael Brennan, clinical coordinator at St. Joseph's, are convinced that the health care system has improved to the point that free or low-cost medical services are no longer needed.

"The costs are still prohibitive," Berliant says. "Between the co-pays and deductibles, it allows people to have insurance that they can't afford to use."

Brennan says that he hates to think of what would happen if the UR Well clinics or places like St. Joseph's weren't available.

"St. Joe's is the safety net for the safety net," he says.

Brennan frequently sees patients whose health is compromised because they receive care intermittently, which leads to health crises that are more costly to treat, he says.

One patient, a diabetic who lost his health insurance, stopped taking his medication, which resulted in losing a toe, Brennan says. Another, a woman, had a foot ulcer about the size of a quarter before she received care.

The patients who come to the clinics are generally not the extremely poor or homeless, Brennan says. More often they're the working poor, he says.

"They're service workers, restaurant owners, and small business people," he says. "The very poor are generally covered by Medicaid. Our people are working. That's the amazing thing about this."

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