On a Saturday morning in September 1999, Einstein students made history when they opened the doors to a free health clinic in the Bronx. Never had a medical school in New York City opened such a service, run by the students and supervised by physicians. 

Today the Einstein Community Health Outreach (ECHO) Free Clinic continues its work, deepening a legacy of learning and service that began 25 years ago.

Origin Story

Although no one quite recalls the exact moment when the planning for ECHO began, Dilip Madnani, M.D. ’01, has a guess; emails from the time show that an American Medical Student Association meeting was held on campus in September 1998, with an agenda listing a free clinic as a discussion topic.

“A bunch of us showed up to the meeting,” he says, “and none of us knew each other. It wasn’t as if I went in with friends.” Dr. Madnani, who was a third-year medical student at the time, recalls that he was the most senior person in the group. “I think I was appointed to be in charge by default. I may have had more time because I was on a research year. But we had a team of us working together.”

That team included Mark Russo, M.D. ’02, a first-year student who had expressed interest in the free clinic even before he started medical school. That summer, he learned about a developing opportunity for a free clinic in the Bronx’s Hunts Point neighborhood. After following up with an email to get more information, he was directed to a fourth-year student, Mona Karim, M.D. ’99, who had  been “working on it forever.”

Dr. Karim was entering her fourth year at Einstein, so she passed the planning torch to newer students such as Dr. Russo.

Dilip Madnani, M.D. ’01

“People had been trying to do it for a couple of years, or maybe longer,” says Dr. Russo, “but there were so many practical issues. Who’s responsible? Who’s going to fund this? What services could we offer? How would people get there? ”

Dr. Karim had been trying to answer those questions since 1994, when she was a first-year medical student. She had recently visited a friend in California who volunteered at the Haight Ashbury Free Clinic, and when Dr. Karim started school in the Bronx, she observed “a population that was really underserved and, in some ways, needy,” she says. “And I really felt, especially with the location of the medical college in the Bronx, that we could be of service to the community.”

Dr. Karim spent the next two years trying to establish a community clinic. While she successfully coordinated some health screenings, the logistics of opening a free clinic remained complex. “I had many, many meetings,” she says, “but we didn’t get anything off the ground.”

Mona Karim, M.D. ’99

By the time Dr. Russo got involved, Dr. Karim had identified Hunts Point in the South Bronx as an ideal location for the clinic. However, plans changed after a crucial conversation with Neil S. Calman, M.D., co-founder, president, and chief executive officer of the Institute for Family Health, then called the Institute for Urban Family Health.

“Dr. Calman was involved with Einstein,” says Dr. Russo. “He was a mentor for pediatric rotations, and when we met with him, he said, ‘Yeah, we’re going to do this.’”

Opening Year

Planning continued throughout the school year, and the clinic opened on Sept. 25, 1999.

“It was crazy,” Dr. Madnani says. “We did everything. We had to register patients, check them in, figure out the blood work, figure out the meds, figure out the referrals, figure out the doctors, and figure out everyone’s schedules.” As someone who now runs multiple practices of his own, he recalls that starting up ECHO took a similar amount of work: “We all put in so much sweat equity to build it,” he says.

Adds Dr. Russo: “I remember the first day, hoping maybe one or two patients might come through the door, and  expecting the session to last only a couple of hours. We ended up seeing at least a dozen patients over eight hours in the first session. At that point, the importance of this effort was clear.”

About 50 student volunteers were involved that first year, but it was a core group of five or 10 who showed up every Saturday. As the weeks went on, routine and infrastructure evolved. And by the spring of 2000, when Dr. Madnani and the other third- and fourth-year students were transitioning to some of the more time-sensitive training that medical school requires, a solid organizational structure was in place.

Rob Siegel, M.D. '03, reaches for patient charts at the ECHO clinic in the early 2000s. (Photo courtesy of Laura Kent, M.D. '03)

Laura Kent, M.D. ’03, was in her first semester when Einstein launched ECHO. “I immediately got super interested in it because the project was so dynamic,” she says. “It was just a wonderful way to get to know and interact with the community and to do something really meaningful while we were studying all the time.”

Dr. Kent, who was ECHO’s project director, also appreciated that the clinic involved students from all four years working closely together. In fact, the structure of ECHO leveraged student abilities accordingly: first- and second-year students, who did not yet have clinical experience, took most of the steering committee positions, handling aspects such as managing communications, fundraising, and community relations. The clinical roles were reserved for third- and fourth-year students, who had begun gaining experience in hospital and medical office settings. And for everyone, ECHO was an opportunity to be part of something genuinely innovative.

Laura Kent, M.D. '03

“Now there are clinics modeled like this everywhere,” says Sam Moghtaderi, M.D. ’02, who began volunteering at ECHO in the spring of its first year and went on to serve as clinical director for two years. “I’m a residency program director now, and I read hundreds of applications a year, and everybody’s medical school has something like ECHO, which is very pleasing for me to see. But it was not easy to establish back then.”

Because students were not licensed practitioners, they needed support from those who were. “We had one or two faculty members at Einstein in family medicine who would supervise us, but they would always do it totally on their own time. The Institute for Urban Family Health really took us under its wing,” Dr. Moghtaderi says.

An Einstein medical student takes a patient's blood pressure at the ECHO clinic.

A quarter century later, not only are student-run free clinics commonplace across the country, but ECHO is part of the Einstein curriculum.

“ECHO was completely extracurricular when we started it,” says Dr. Kent, “but now it has been folded into the curriculum for family medicine, for what’s called the family medicine clerkship.” ECHO is also an option for Einstein students who choose it as part of their service learning requirement.

Sam Moghtaderi, M.D. ’02

“I looked at this and thought, ‘OK, we are a clinic for people who have health issues and don’t have health insurance,’” says Dr. Siegel. “‘What’s the most important thing we can do? We can see if we can get them health insurance.’” Student volunteers handling front-desk administration began asking patients to fill out applications for Medicaid, with the social worker offering assistance with the process.

Dr. Siegel was a second-year student at the time, and he remained devoted to ECHO throughout his education. “I went every week I possibly could,” he says. “I loved it.” And in his fourth year, when he had a slow month, he decided to check on all those patients who’d applied for Medicaid two years earlier.

“Back then Medicaid was not computerized at all. To find out if somebody had it, you needed to call the New York State Medicaid hotline from a touchtone phone and push a bunch of buttons,” Dr. Siegel says. “I spent two days on this Medicaid hotline just punching in demographic info on a keypad for everybody. And every time Medicaid came back with, ‘Yes, this person has it; here’s their Medicaid number. It’s active,’ I’d say, ‘Yay!’” Dr. Siegel calculated that 15% of the approximately 600 patients had been enrolled.

Rob Siegel, M.D. ’03