Jay's Anatomy

"Imagine a system where a doc could charge $20 for 15 minutes and make a significant amount more than the average family practitioner — $200K," Umbehr wrote in the e-mail debate. "Or, even better, the same doc could charge $10 for 15 minutes and make $100K. Those prices are near 'free clinic' prices. By doing so, this empowers the people and utilizes the forces of a free market to drive the prices lower via competition."

Thedinger wasn't impressed. "While I wholly support their recognition of the fact that private insurance companies are an inefficient middle man that sucks cash out of health care," he shot back in an e-mail, "believing that the health care system can be fixed by simply removing all regulations and allowing doctors to practice in the paradise of free-market policy is a little naïve ... Again, one must ask what this plan does to address the lack of access to healthcare for millions of Americans. Nothing! It provides a way for well-to-do people to get their checkups without the fuss of dealing with an insurance company. It is an inventive way for the SimpleCare folks to make money in the suburbs, but is hardly a model for addressing our nation's healthcare woes."

Umbehr says the often impassioned exchange petered out before the end of the semester. But at the Jay Doc clinic, many of the students say they're inclined to side with Thedinger.

"I find it absolutely unconscionable that we persist in a health care system where the suffering and ill health of others is translated into profit for hospitals, insurance companies and drug manufacturers," Obley says.

He goes a step further, adding that medical schools fail future doctors by not preparing them for political advocacy. Physicians, he says, should be at their city council meetings and lobbying at the statehouse. For Obley, that's familiar ground; he worked on health care policy for Kansas Governor Kathleen Sebelius for two years before going back to med school.

But most of the students at Jay Doc admit that the longer they train, the harder it is to find time or inspiration to do anything outside their studies.

Even Thedinger had to step back this year from his organizing role in SNHP and the Jay Doc clinic so that he could devote his time to clinical rotations in trauma surgery at KU Med. He says he sees rising frustration among both doctors and students. "But people are not taking a unified stance and saying, 'Well, we need to move to this better system,'" he says. "They're just dealing with the status quo on a day-to-day basis."

Which is one reason that scores of patients spend hours in a clinic waiting room just to see someone who doesn't even have a degree yet.

s the Lexapro clock inches toward closing time, it looks like the Jay Docs will have turned away fewer than half a dozen patients this evening.

"So are you going to get us out of here before, like, really, really late tonight?" volunteer doctor Adam Leight asks student co-director Zeigler.

"9:15, Dr. Leight, 9:15," she assures him.

From the other side of the room, Obley plays down Zeigler's confidence.

"Make no promises," he says.

Leight doesn't much care. He gulped down a can of Pepsi and a snack bag of peanuts during the first deluge of patients, and he's still wisecracking his way through diagnoses. Leight is the clinic's most reliable physician; even after a full day at his own clinic, he calls another six-hour shift with the Jay Docs "refreshing."

He says he is inspired by their enthusiasm and enjoys the opportunity to work in an environment divorced from any profit motive.

"Most of them [the students] still have no clue how broken the system can be," he says. "Or, if they do know, they haven't really lived within it yet. They haven't watched themselves become a functioning part of it on a daily basis, metamorphosize like Kafka's worker, as we all do to a greater or lesser extent."

Tonight, Lase Ajayi is looking for a syringe — and advice on how to administer her first butt injection.

"It's probably best to reconstitute the stuff out of the room," Leight tells her. "The more people see you play with needles, the more nervous they get. It's best to just walk in there and, you know, whip it out of your back pocket when they're not even looking."

"This'll be a night of a lot of firsts for me," she quips. "First gluteal injection, first urethral swab ..."

"Male urethral swab?" Leight asks. "You used the blue ones, right?"

"Yeah," she says.

"The other ones are like Q-tips," he says, causing the men in the room to cringe.

"What does it feel like?" Ajayi says in a tone that sounds like a set-up to a joke. "Like, how painful?"

"I've never personally been swabbed," Leight says. "But it wouldn't feel good."

"Hey, Adam, you get swabbed every day," Ajayi says, turning to Obley.

"Ask him," Obley says, pointing at an unsuspecting student who walks into the back office at the wrong moment.

"And another thing," Leight continues. "If you like the guy, you should probably reconstitute it with Lidocaine instead of water."