Blog | Thursday, September 27, 2012

QD: News Every Day--Don't know much about health care reform


Medical students don't know much about the environment they'll practice in under health care reform, a study found.

To characterize medical students' knowledge of and attitudes toward the Affordable Care Act and the variables of political affiliation, medical school year, specialty choice, and financial considerations, researchers e-mailed an online survey to all 1,235 Minnesota medical students at in January 2011.

Students were asked to indicate their level of agreement to three questions using a 5-point Likert scale: "I understand the basic components of the Patient Protection and Affordable Care Act (the national health care reform bill passed in March 2010)"; "I support the Patient Protection and Affordable Care Act"; and "Physicians are not professionally obligated to play a role in implementing the new healthcare reform bill."

Results appeared in a research letter in the Sept. 24 issue of Archives of Internal Medicine.

There were 843 respondents (68%), of whom 55% identified themselves as liberal and 52% expected to go into primary care.

The study found that less than half of the respondents (48%) agreed with the statement, "I understand the basic components of the Patient Protection and Affordable Care Act." A large minority (41%) of students had no opinion regarding support for the ACA, and only 13% of students did not support the legislation. Most respondents agreed that physicians are professionally obligated to play a role in implementing the ACA (69%). Most students also indicated that monetary considerations influenced their choice of specialty (53%).

Among the respondents, 72% who understood the ACA supported it, while 20% who did not understand the ACA did so. Most students who did not understand the ACA indicated no opinion (72%) regarding support, while only 11% of students who understood the ACA had no opinion about support.

Liberal students compared to conservatives were significantly more likely to understand (odds ratio [OR], 15.1; 95% confidence interval [CI], 8.6 to 26.8]), support (OR, 2.2; 95% CI, 1.4 to 3.3) and have a sense of obligation to implement health care reform (OR, 3.3; 95% CI, 2.1 to 5.1).

Students who responded that their choice of specialty was or would be influenced by medical school debt or future earnings were significantly less likely to agree that they supported (OR, 0.5; 95% CI, 0.4 to 0.7), understood (OR, 0.7; 95% CI, 0.5 to 0.9) or felt a sense of obligation to implement health care reform (OR, 0.6; 95% CI, 0.4 to 0.8).

Compared with students who anticipate a primary care specialty, students were significantly less likely to support health care reform if their future specialty was surgical (OR, 0.6; 95% CI, 0.3 to 0.9) or undecided (OR, 0.6; 95% CI, 0.4 to 0.99).

Third-year students, compared with first-year students, were less likely to agree that physicians are obligated to play a role in implementation of the legislation (OR, 0.6; 95% CI, 0.3 to 0.9).

Researchers noted that "future physicians remain largely ignorant and indecisive about the ACA, with a minority of respondents indicating understanding and 41% of students indicating no opinion regarding their support of the legislation."

Still, 69% of students endorse a professional obligation to implement the ACA.

"While future physicians believe they have a responsibility to participate in implementing the ACA, these data raise concerns that they may not possess the knowledge necessary to implement reform measures in the coming years," researchers wrote. "Our data reflect previous research demonstrating insufficient policy education in medical school and suggest that increasing such efforts may be required for successful implementation of the ACA and future health care reform initiatives."