University of Wisconsin–Madison Medical College of Wisconsin

Caution Urged Regarding Role of Free Clinics in US

John J. Frey, III, MD

WMJ. 2024;123(2):67

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Dear Editor:

The commentary in the latest issue of the WMJ by Zellmer et al1 discussing the possible role of free clinics in health care in the United States should raise a number of cautions. There are certainly free clinics, such as the St Clare Health Mission, which are staffed, designed for continuity of care and partnering with health systems in the region to provide referrals and follow-up. They do serve a useful, but limited role in health care. However, experience with free clinics, particularly those run or staffed by medical and other health sciences students who change frequently, may represent a failure of good intentions unless the clinic leadership takes responsibility to assure continuity of care and have guaranteed arrangements to get patients additional care as needed.

As the authors point out, chronic disease is a burden for many low-income Americans, and free clinics are often not helpful in treating chronic illnesses. They have records that are not available when patients show up in emergency departments or urgent care centers, and often confuse patients more than help them. A few centers, such as Bread of Life and Walker’s Point Health Center sponsored by Aurora Health Care in Milwaukee are examples of clinics that provide chronic care management and social services for uninsured patients. But they also strive to get patients insurance access and assignment to a primary care medical home as part of their mission.

Well-meaning free clinics that cannot assure continuity and arrange secure handoffs to community health centers or other sources of care or guarantee access to consultants and testing as needed do not help the safety net or patients. I worked as a student and resident in free clinics in Chicago, but the community itself ran the clinic and took responsibility for the process of care. We as volunteers played specific roles.

Many services for unhoused people, immigrants and refugees, and the working poor are embedded in public health or teaching programs but remain the responsibility of all health systems in a state as well-endowed as Wisconsin. In the end, working for universal coverage in our state and country is what is needed.

  1. Zellmer L, Mallick S, Larsen S, Shroff GR, Pasha M. The Safety Net’s Safety Net: Understanding the Crucial Role of Free Clinics in Cardiovascular Care. WMJ. 2024;123(1):7-8,4.

Author Affiliations: Emeritus Professor of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Corresponding Author: John J. Frey, III, MD; email
Financial Disclosures: None declared.
Funding/Support: None declared.
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