Abstract
The attitudes of medical students toward the current United States healthcare system are not well described in the literature. A graded survey was developed to assess awareness and motivation toward the care of the uninsured and underinsured as well as the impact of a video intervention on these attitudes. The survey, which showed good internal consistency (Cronbach’s alpha = 0.85), was administered before and after viewing a collection of videotaped patient stories. Although a spectrum of beliefs emerged from the analysis of survey responses, some common attitudes were identified. Eighty-five percent of respondents either agreed or strongly agreed that medical care should be provided to everyone, regardless of their ability to pay. In addition, 66% indicated they would be willing to forgo a portion of their income to provide care to those who do not have access to healthcare services. These values were strongly correlated with increasing respondent age and primary care specialty choice (p<0.01). The video intervention did not heavily influence student responses, perhaps due to a ceiling effect created by the large number of students who were already sympathetic toward the underserved. Overall, this data reflects that United States medical students recognize a need to provide care to the underserved and are willing to make personal sacrifices to meet that need.
Highlights
In a United States policy climate dominated by the continuing debate over the Patient Protection and Affordable Care Act (PPACA), even after the Supreme Court upholding its major provisions, one of the most controversial areas is the provision of health services to the underserved
In addition to these survey findings, qualitative data revealed several themes: (1) the choice to enter the medical profession was guided by a desire to help those in need; (2) commitment to the underserved is often borne out of prior personal adversity or experiences volunteering with those in need; (3) student debt was a significant barrier to deepening commitment to the underserved, due to the opportunity cost of foregone wages and personal time; (4) there is a need for reform of the current healthcare system, there is little agreement on any single change needing to be made
Medical students tend to agree that all patients deserve access to care, they tend to differ in their preferences for how best to provide and pay for uncompensated care
Summary
In a United States policy climate dominated by the continuing debate over the Patient Protection and Affordable Care Act (PPACA), even after the Supreme Court upholding its major provisions, one of the most controversial areas is the provision of health services to the underserved. Et al found that a large percentage of medical students support universal access to health care and believe that physicians have a responsibility to care for all patients regardless of their ability to pay; this support was found to decline with years of medical education. [3] Another study demonstrated that medical students are more likely to be committed to caring for medically underserved patients when they enter medical school than when they graduate. Research on empathy demonstrates a decline throughout medical school and some authors propose engaging medical students in workshops and role-playing to maintain empathy. [5]
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