When Megan Sandel, M.D., M.P.H., first entered pediatrics training at Boston Medical Center, the first medical-legal partnership was only a few years old, and she had the opportunity to learn side-by-side with lawyers.

“After that, I didn’t want to go back,” said Sandel, now the national center’s medical director and an associate professor of pediatrics at the Boston University School of Medicine and an associate professor at the Boston University School of Public Health. “In many ways, we still see that among our residents.” Today, Boston medical students can participate in the BU Advocacy Training Program, a four-year scholarly concentration where they are exposed to the medical-legal partnership model and gain a deeper understanding of the social determinants of health. When screening patients, students are taught to incorporate the I-HELP mnemonic, which stands for income supports, housing, employment/ education, legal status, and personal stability. Sandel said that about 20 percent of medical students participate in at least one advocacy activity.

“We want to help medical students understand that many social determinants of health have legal underpinnings,” she said. “Understanding both systems inside and outside of health care is really crucial.” Such partnerships not only serve patients individually but also can change systems. For example, many patients facing a utility shut-off have a serious illness that qualifies them for an exemption with a physician letter verifying their health status. It used to take hours to generate those letters, Sandel said. In response, the Medical-Legal Partnership-Boston created a legal template for utility letters to integrate into Boston Medical Center’s electronic health records system. Now, it takes only minutes to create a physician utility letter. The system change coupled with training health providers to screen for utility assistance needs made a big impact. Between 2005–2006 and 2008–2009, the number of utility protection letters generated for patients grew by 350 percent, according to a 2010 Health Affairs article.