Abstract
BackgroundRelatively little is known about American medical student’s attitudes toward caring for the uninsured, limiting physician reimbursement and the role of cost-effectiveness data in medical decision-making. We assessed American medical student’s attitudes regarding these topics as well as demographic predictors of those attitudes, and compared them to practicing physicians.Methods and FindingsA survey instrument was explicitly designed to compare medical student attitudes with those previously reported by physicians. Between December 1st 2010 and March 27th 2011 survey responses were collected from more than 2% of the total estimated 2010–2011 US medical student population enrolled at 111 of 159 accredited US medical schools within the 50 United States (n = 2414 of possible 98197). Medical students were more likely to object to reimbursement cuts, and more likely to object to the use of cost effectiveness data in medical decision making than current physicians according to the literature. Specialty preference, political persuasion, and medical student debt were significant predictors of health policy attitudes. Medical students with anticipated debt in excess of $200,000 were significantly less willing to favor limiting reimbursement to improve patient access (OR: 0.73 [95% confidence interval (CI): 0.59–0.89]), and significantly more likely to object to using cost effectiveness data to limit treatments (OR 1.30, 95% CI 1.05–1.60) when compared to respondents with anticipated debt less than $200,000.ConclusionsWhen compared to physicians in the literature, future physicians may be less willing to favor cuts to physician reimbursements and may be more likely to object to the use of cost effectiveness data. Political orientation, specialty preference and anticipated debt may be important predictors of health policy attitudes among medical students. Early career medical providers with primary care ambitions and those who anticipate less debt may be more likely to support healthcare cost containment.
Highlights
Physicians are important stakeholders in American healthcare [1]
Medical students were more likely to object to reimbursement cuts, and more likely to object to the use of cost effectiveness data in medical decision making than current physicians according to the literature
When compared to physicians in the literature, future physicians may be less willing to favor cuts to physician reimbursements and may be more likely to object to the use of cost effectiveness data
Summary
Physicians are important stakeholders in American healthcare [1]. In that respect, their attitudes toward important healthcare policy questions, such as the obligation to care for the uninsured, support for expanding patient access via limiting physician reimbursement, and the role of cost-effectiveness data in medical decision-making, may have important implications for national health policy decisions. Prior to the enactment of the Patient Protection and Affordable Care Act, which was forecasted to decrease substantially the proportion of uninsured Americans, a majority of surveyed American physicians supported the expansion of healthcare coverage to the under- and uninsured at the expense of physician reimbursements. This suggests that a majority of physicians were willing to receive less compensation for their services if that translated into greater patient access to health care [2]. We assessed American medical student’s attitudes regarding these topics as well as demographic predictors of those attitudes, and compared them to practicing physicians
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