I will start off by saying that no healthcare system is perfect. When you think about healthcare being free and completely covered by the government [such as the National health services in UK or Canada], you hear about the long waiting times, difficulty being able to see a specialist and so forth. Then when you consider a healthcare system like in US where you wish to do your residency training, you hear a lot about costs of healthcare and that the rising costs are not sustainable.
While this can be a very long drawn political discussion, let us focus on this question that may be asked at your interview on US healthcare.
"What are the problems in the US health care system that you have come across and its solutions?"
Now the list of TEN problems in the US healthcare can be long and daunting, but remember we need to answer from the point of the applicant who is getting ready to train for independent practice. Here are the problems that one may face practicing in the US healthcare system and FOUR solutions for the problems that I feel are practical and feasible:
1. High drug costs: There is a lot of debate as to how to control the drug prices in this free market. Sadly, it is the patient who suffers the most. I really do not know how to address this by myself.
2. Costs of care. Again the reasons are numerous and no one knows whether the drug prices by the pharmaceutical companies, rising number of administrators who are turning healthcare into a business or growing complexity of medical care are the reasons behind this. Again this is something that I myself would not be able to resolve.
3. Access to care. This is with regards to the long waiting times that some communities may face in trying to get to see a physician or healthcare provider [physician assistant/nurse practitioners].
How can I help improve access to care? Without going into the details of which insurances my practice would accept, the way I try to improve access to care is that when a primary care physician or the patient themselves call and request to be seen urgently, I always make room in my clinic and accommodate them as best as I can. This is especially important in a place of practice that has limited physicians. Being available to meet with the patient's and/or their families in my opinion resolves prevents any conflicts and at the very least shows that you are putting an effort to listening to the patient and addressing their concerns. I agree this is not a sustainable option, but at the very least you are trying.
Another method that I believe can help access to care is telemedicine. I really think there is a lot of potential and telemedicine can reach out to patient's quickly and efficiently and also interact with other physicians especially in rural hospitals. A lot of work still needs to be done with regards to regulation, reimbursement and malpractice coverage but imagine how great it would be if a Dr. can check you out with available technology at the comfort of your own home. This is one area that if you read up a little bit more about you can actually identify specific strategies to help the healthcare system. In this day and age, I would also encourage young physicians like you to take up creative projects and embrace the use of telemedicine to improve access to medicine.
Having more physicians is going to be tough especially with the high tuition cost of medical school and salary to pay the attending physician. More PA/NP is another attractive option, but I don't like the fact that hospitals are 'replacing' physicians and the administrators are loving this idea. I still think there needs to be regulation/supervision of PA/NP providers, so instead of improving access by just hiring more PA/NP, you could say that you would like to be in a setup where you can supervise them and see more patients in a day. I think that would be a great idea.
4. Fear of being sued. The fear of being sued dictates some of the decisions that we physicians make while providing medical care. Some have an approach of CYA [cover your bottom] that can sometimes lead to superfluous and extraneous care. Where to draw the line on medical care is difficult to know though some states have a limit as to how much the physician can be sued for. Again this is not something that I can fix by myself.
5. Abuse of the healthcare system. There are situations where a person may ask to be in the rehab center if they have minimal support at home. This is a rare occurrence though. Things like opioid abuse really strain the healthcare system.
6. Lower focus on preventive (and patient education) rather than curative care. It certainly makes a lot of sense that focusing our efforts on prevention such as with vaccination, cancer screening, screening for cardiovascular disease, healthy lifestyle choices to prevent obesity will yield much higher returns in population health than curative care. This is something that a physician can strive to implement in his or her clinical practice. For example, in the field of nephrology, a lot of important work has been done with regards to patient education before dialysis and her chances of getting a kidney transplantation, vascular access and some studies have even shown an improved survival with patient education after that patient starts dialysis. I think this is a growing field and the hospitals are really starting to use social media to improve patient awareness of health conditions. Diabetes care diabetes care is improved a lot after having diabetes educators and other chronic health conditions should also follow this trend.
7. Healthcare wastage. Every physician witnesses provision of care that is futile such as an elderly patient with terminal cancer getting a tracheostomy, tube feeds and being on dialysis. Again, better patient communication, research in these complex areas of medical care can help address this problem.
8. Patient safety. Because of the growing number of teams taking care of different parts of the patient's medical care, patient safety has become an important concern especially when there is breakdown of communication. This is something that you as a physician can fix by being a better communicator, talking with patients, families, other physicians and being more collegial and collaborative with other providers of the care that can help improve patient safety along with better documentation. Having safety systems in the hospital, AI will be employed in the near future to catch the near-misses. You can also participate in the hospital safety committees and strive to improve overall patient safety.
9. Reimbursement of care. Physician practices suffer a lot financially because of inconsistencies in how practices are reimbursed for care. There is a lot of unhappiness about this and some practices even tried to game the system to increase reimbursement. Sometimes these practices can be unethical. Again this is something that I do not know how to fix by myself. Some physicians are looking to practice " concierge medicine" that might avoid these problems but it is not perfect and is still evolving.
10. Last and my favorite is physician burnout. Yes you heard me right 'physician burnout'. About half of the medical doctors across-the-board [residents, attending physicians] in US report symptoms of burnout. These physicians feel exhausted emotionally in their ability to take care of the patient and sometimes have reported feeling callous about the patient's concerns. A lot of research is actively being done to study causes and Rx of physician burnout. There are a host of personal (compulsive behavior, striving for perfection, lack of social support) and workplace related factors (workload, lack of control over schedule, non-clinical work) that lead to burnout. You may have also read in the news about physician self-harm and suicide. It is felt that the rising nonclinical workload such as documentation in the electronic medical records have added and contribute to the menace of burnout.
This is an area that you can actively intervene upon and make changes. It is no surprise that if you are in the best mental and emotional state, you will do a better job taking care of your patients. The solutions can range from personal [better lifestyle choices, exercise, yoga, meditation, mindfulness], trying to achieve better work life balance [this often means refusing to take on additional responsibilities when your plate is already full], better electronic medical records training, use of scribes [if possible], extracurricular activities such as music, art or community service, or cutting down on part of the work that makes you unhappy such as night calls/weekend calls especially when financially independent, improving collegiality with your other team members at work are very possible strategies to improve the joy of clinical practice.
Photo credit for image in post: http://www.us-immigration-news.com/wp-content/uploads/2017/09/US-Health-Care-System.jpg
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