Academic Medicine, Vol. 87, No. 5 / May 2012 651 Student Education in Outpatient Clinics The Crimson Care Collaborative: A Student– Faculty Initiative to Increase Medical Students’ Early Exposure to Primary Care Abstract Rebecca Berman, MD, Camille Powe, MD, Julia Carnevale, MD, Andrew Chao, MD, Janine Knudsen, Anthony Nguyen, and Susan Edgman-Levitan The current shortage of primary care physicians (PCPs), particularly as more individuals obtain health insurance and seek primary care services, is a growing national concern. The Crimson Care Collaborative (CCC) is a joint student–faculty initiative in post-health- care-reform Massachusetts that was started with the explicit goal of attracting medical students to primary care careers. It fills a niche for student-run clinics, providing evening access to primary care services for patients without a PCP and urgent care services for patients of a Massachusetts General Hospital–affiliated internal medicine clinic, with the aim of decreasing emergency department use in both groups. Unlike other student- run clinics, CCC is integrated into the mainstream health care structure of an existing primary care clinic and, because of universal health insurance coverage in Massachusetts, can bill for its services. In addition to the clinical services offered, the student-run research team evaluates the quality of care and the patients’ experiences at the clinic. This article describes the creation and development of CCC, including a brief overview of clinic operations, social services, research, laboratory services, student and patient education programs, and finance. In the wake of the Patient Protection and Affordable Care Act of 2010, CCC is an example of how students can aid the transition to universal health care in the United States and how medical schools can expose students early in their training to primary care and clinic operations. I plan to train and practice in primary care. Crimson Care Collaborative has reminded me how much I enjoy seeing a wide variety of patients with diverse problems and has bolstered my decision to pursue this field. —Student participant, Crimson Care Collaborative Like many states, Massachusetts is faced with a profound shortage of primary care providers. In 2006, the Massachusetts health care insurance reform bill passed, and although subsequent studies have shown that 97% of state residents are now insured, access to primary care remains a major barrier for these newly insured individuals. Residents with MassHealth or Commonwealth Care, the state’s two publicly subsidized insurance plans, are more likely to report difficulty obtaining a primary care physician (PCP) than those with traditional commercial health insurance. 1 In addition, wait times for an appointment with a PCP have tripled compared with those for specialists since the health care reform legislation passed in 2006, and many internal medicine and family medicine physicians are closing their panels entirely to new patients. 2 The Crisis in Primary Care These changes to the health care delivery system, along with a decrease in the number of trainees pursuing primary care careers, have contributed to the developing primary care crisis in Massachusetts. 3 Although many students plan for careers in primary care when they enroll in medical school, their interest wanes during training—very few students pursue primary care residencies, and fewer still become primary care providers. 4 Applications to primary care residencies have decreased in number since the mid-90s when primary care was at the height of its popularity. 2 Inspiring a new generation of primary care leaders, then, is critical—both to replace those practitioners who are retiring or closing their panels to new patients and to reinvigorate and reinvent primary care in the new health care landscape. Unfortunately, research has shown that it is difficult to predict which medical students will pursue careers in primary care. Some studies have focused on the personal traits of students (e.g., age, marital status, rural hometown) and others on the overall medical school characteristics (e.g., public schools, family medicine departments) that lead students to choose primary care careers. 5 Yet, these characteristics are often not factors that students or faculty are in a position to change. Other studies, however, have shown that early mentorship, longitudinal patient relationships, and participation in community-based programs increase the likelihood that students will pursue careers in primary care. 6–8 Although we have found no definitive recipe for educational programs that are sure to steer medical students into primary care, we have collected anecdotal evidence from our primary care residents who cited their experiences in a student-run clinic as a major factor in their choice of careers in primary care. Such student-run clinics have become a popular means to provide hands-on medical experience to health professional students while also offering access to health care services for patients who do not have health insurance. As of 2005, 49 different U.S. medical schools had student-run clinics—some boasting up to five clinics. 9 A national team from the Society of Student-Run Free Clinics is in the process of tabulating current statistics on the student-run clinics in the United States today; their preliminary data, Please see the end of this article for information about the authors. Correspondence should be addressed to Dr. Berman, John D. Stoeckle Center for Primary Care Innovation, General Medicine Division, 50 Staniford St., Ninth Floor, Boston, MA 02114; telephone: (617) 726- 7930; e-mail: raberman@partners.org. Acad Med. 2012:87;651–655. First published online March 23, 2012 doi: 10.1097/ACM.0b013e31824d5269