Student-run Clinic Participation and Likelihood of Practicing Primary Care: A Meta-Analysis

ABSTRACT Importance The United States is facing a projected shortage of 40,000 primary care physicians by 2034. Student-run clinics (SRCs) are widely regarded as service-learning environments that may encourage students to enter a primary care specialty, but prior studies have yielded conflicting results and are limited to non-generalizable, single site analyses. Objective To compare likelihood of practice in a primary care specialty between students who did and did not participate in an SRC via pooled meta-analysis of U.S.-based studies. Study Selection Studies were first identified through a comprehensive library of U.S.-based SRC literature. The inclusion criteria were publications on SRCs in the United States with MD/DO students, from all time until March 1, 2024. Exclusion criteria were: full text not available; published abstract/textbook/dissertation/thesis; not in English. Two authors independently screened the database for publications on SRC participation and practice in primary care specialties. To identify relevant literature after March 1, 2024, the authors performed iterative snowball sampling of the bibliographies of included studies and their Google Scholar “cited by” lists until saturation. Finally, we included original data from the single largest study on this topic. Data Extraction and Synthesis We evaluated study quality using the NIH Study Quality Appraisal Tool. We used a random-effects model to account for heterogeneity. Main Outcomes and Measures The primary outcome was the relative likelihood (risk ratio) of pursuing a primary care specialty among SRC volunteers versus non-volunteers. We used a funnel plot and sensitivity analysis to assess for bias. Results Seven studies met inclusion criteria with a cumulative sample size of 7,468 students. SRC volunteers pursued primary care at 102% to 160% the rate of non-volunteers. The pooled risk ratio was 1.25 (95% CI: 1.09–1.44). Funnel plot and multiple sensitivity analyses did not suggest publication bias or undue influence from included studies. Conclusions and Relevance SRC participation is associated with a statistically-significant 25% increased likelihood of practicing in a primary care specialty. These findings may inform national and institutional strategies to support service-learning and address the national primary care workforce shortage. KEY POINTS Question Is participation in a student-run clinic during medical school associated with increased likelihood of practicing in a primary care specialty? Findings Despite conflicting results in the literature among small and single-site studies, in this meta-analysis of 7,468 medical students, participation in a student-run clinic was associated with a statistically significant 25% increased likelihood of practicing in a primary care specialty. Meaning Student-run clinics may be a potential strategy for strengthening the pipeline into primary care and reducing the projected shortage of 40,000 primary care physicians.