Help a budding doctor and save

By Karen Aho

More than 150 million Americans lack dental insurance. I'm one of them.

But rather than put off care for my aching tooth, I found relief for about half the price from a source you might not have thought of: students.

In fact, students represent a ready cadre of health-care workers to soothe many types of ailments, not just bad teeth. Dentists, optometrists, psychological counselors and practitioners of alternative therapies -- from naturopathic doctors to massage therapists -- routinely do their practicums in designated student-training clinics.

This is treatment at licensed health centers run by universities and professional schools for student training. The centers provide thorough evaluations to the public at half the price, or less, of a standard clinic and guarantee high-quality care overseen by licensed supervisors.

These clinics give faculty the opportunity to oversee training, expose students to a diverse clientele and further the educational mission to serve the community, often filling a gap in services for the underinsured.

Time is money

In every field of health care, student trainees are eager listeners and observers. They are constantly being evaluated and are required to do lengthy medical histories and meticulous physical or psychological exams. Their work is double-checked -- and the patient re-examined -- by a doctor, who discusses the case with the trainee and, at times, additional trainees and faculty experts.

If pain is a concern, don't worry. Dental students have to put in hundreds of hours on mannequins and other students before they are allowed to hold a metal instrument anywhere near patients.

So, you ask, with all this, and at half the price, what's the catch? Well, there are some limitations, and they depend on the field.

With dental work, the most significant drawback is time. A cleaning and exam could take three hours instead of one ($50 instead of $100). A crown might require a commitment of nine hours instead of two or three ($600 instead of $1,200). These are samples; times and prices vary.

In any case, dental schools are not the place for a quick fix. To prevent any irreversible mistakes, students are required to get the instructor's approval before each step. Because instructors circulate among students, it makes for a lot of downtime in the chair.

That said, the waiting isn't all bad. Your mouth need not remain open. And the dental student is there with you, a captive prisoner to any and all questions.

I became a patient at the Tufts University School of Dental Medicine in Boston. On my first day, I got tips on preventing tea stains, learned that I had two extra bones in my mouth and discovered in detail why, despite a mouthful of fillings, I am not destined for an old age in dentures.

On the second day, though, I was forced to calculate the exact value of my own time. My student dentist informed me that the two crowns and a root canal I needed would require 15 three-hour appointments. She started to list each of the steps on a piece of paper but ran out of room. It became clear why many of the people in the lobby looked like retirees or students.

I did a quick analysis. The student clinic would cost me 39 hours more and $1,600 less than a private dentist, for a savings of $41 per hour. So it pays. It's just difficult to fit into a work schedule.

Your body is a textbook

The time discrepancy is far less stark in other health-care fields.

A comprehensive eye exam at one of the nation's 15 optometry schools might take 90 minutes, as opposed to 45 at a private clinic, and still offer a significantly reduced rate.

Edward Revelli, the University of California, Berkeley, School of Optometry associate dean of patient care, said most of the patients are insured and could go anywhere. They come to the student clinic for the multiple layers of care. Patients are seen by a student, and again by an instructor, sometimes more than once.

This is a unifying trait of training clinics. While your confidentiality is always protected by law, your file -- your body -- is an open educational text. Depending on your comfort level, this can be seen as either a great bonus or one very long awkward moment.

Cradle to grave

At psychology clinics, the extra eyes are hidden. Counseling sessions are one-on-one, but are observed through audiotape, videotape and one-way glass. Patients legally agree to this at the outset, but can ask permission later for some private sessions.

These clinics tend to have sliding-fee scales that offer mental health services for a fraction of the hourly rates seen in private practice. Low-income patients might pay several dollars, while middle-income workers still benefit at slightly higher rates.

The care can be less critical. Need some Swedish therapy? Massage schools offer half-price hours in their student clinics, say $30 instead of $60. Or want a doula for information and emotional support during childbirth? Dona International refers people to doulas-in-training willing to provide free services.

This is by no means a conclusive list of available services. It's merely a reminder that students are out there and need bodies. Sometimes literally. How do you think mortuary-science students hone their embalming skills? Yup, they embalm bodies of the indigent and the poor referred by funeral homes. At some schools, students even conduct the funeral services.

How to find a school

The trick, in every case, is to find the service. Without a national health-care system, we don't have a one-stop listing of providers. The nearest university is your best starting point.

The U.S. Department of Education does have a search engine to help locate schools by ZIP code and type. National professional and educational associations also list schools by location. University psychology departments can tell you where their graduate students do their clinical training. State and city departments of health and human services will post information about community health centers.

It doesn't hurt to check medical schools, too, even if you're some distance away. Medical students sometimes staff modest clinics in targeted communities and do outreach in rural areas.

Don't forget that second prong of health education: research. University medical researchers need volunteers for clinical trials. While trials do pay a modest fee, the real benefit is the potential for treatment. The qualification standards are rigorous. Researchers typically need people who have a medical condition but are otherwise healthy.

The U.S. National Institutes of Health maintains a list of upcoming trials at ClinicalTrials.gov that's searchable by location and condition. It also has a place to register for future trials.

"Usually you get the latest treatment and the best treatment, usually by the best doctors in the field," said Mali Einen, a clinical research coordinator at Stanford University. By participating in a trial, she received a drug for narcolepsy seven years before its FDA approval.

In the end, if you do benefit from educational training or research, it's possible to continue the cycle of giving: Bodies donated to science can be embalmed by mortuary-science students, then used as anatomy cadavers for medical school students.

Updated Sept. 2, 2008