What do you guys think? Is there a right answer? I keep trying to figure out if I should say the 47 million uninsured or the monopolies and unproductive level of control the insurance companies have on physicians and patients choices. The problem with the former is that there is no reasoning behind it other than, it's bad. The problem with the latter is I'm not informed enough to know everything about it. I'm trying to pick my poison so to speak. Which do you guys think is a better answer?
The Biggest Problem in healthcare question... What do they want to hear?
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We want to hear a genuine opinion
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and that you have a clue what's going on in healthcare, I imagine.
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So mention them both. I've given an answer like "Well, there isn't just one thing, but some problems include... " and they seemed satisfied with it.
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There is a triad to the health care system's flaws
1) Access 2) Cost 3) Quality
- We all know overall quality is good, though not everyone receives perfect care. PLUS, I wouldnt tell an interview that there is poor quality in medicine; though there can be.
- Focus on Access and Cost. We pay more than any other industrialized nation on hospital stay, drugs, outpatient care, etc. and because of that 47 million remain uninsured.
1) Access 2) Cost 3) Quality
- We all know overall quality is good, though not everyone receives perfect care. PLUS, I wouldnt tell an interview that there is poor quality in medicine; though there can be.
- Focus on Access and Cost. We pay more than any other industrialized nation on hospital stay, drugs, outpatient care, etc. and because of that 47 million remain uninsured.
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Not to nitpick, what you said above is great in reference to the question. But the 47 million number is complete inaccurate. I doubt you have actually looked at that statistic and the people who were included in it and what the criteria were. Please dont quote numbers until you actually look them up. Hearing them in a political campagin or on the news at night is not a good way to get information. Everyone has sort of taken that number as 'fact' without actually doing their own investigation, Google is your friend.
With that out of the way. Access&Cost are great. You could also touch on regulation and government intervention and how it has negative effects on healthcare, such as the HMO Act chartered by Congress. Probably should do some investigation into healthcare policy and it's history in order to better understand a question like that. I'd also try to stay as politically neutral as possible.
Ouch...
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it wasn't an insult. they really do want to know if you have any idea what's going on in healthcare. some kids go to class, take the MCAT, and decide to apply to med school without really understanding what medicine is like.
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Um, top 5 results on google for "uninsured americans" all say about 47 million, all cite the most recent census, 2005. CDC says 43-44. Please enlighten us if that is not an accurate number. Are you referring to those who can buy health insurance but choose not to?
But you are implying that I'm one of those people right? Or am I completely mistaken?
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lol, I think you're mistaken, I read no such intent.
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Thats what im guessing, what ive heard...no data to back this up..about 1/3 of those make over 50K so they should be able to afford some..1/3 are eligible for Govt programs but choose not to enroll, and the other 1/3 are legit.
What I usually say when asked that is talk about how the obesity epidemic is putting a burden on the system and we need to alllocate more resources towards preventative medicine.
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Answer: That people like you are going into medicine.
[/catty]
Seriously? What are *they* looking for?
There are so many things that could be covered with this question. The answer will be different for everyone. What is important to me (coverage) is different from chubby chaser (obesity) is different from you. As long as you let your interviewer know that you have at least thought about these issues and are aware of what is going on, you can mention just about anything.
[/catty]
Seriously? What are *they* looking for?
There are so many things that could be covered with this question. The answer will be different for everyone. What is important to me (coverage) is different from chubby chaser (obesity) is different from you. As long as you let your interviewer know that you have at least thought about these issues and are aware of what is going on, you can mention just about anything.
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no, I wasn't saying you were one of them. from your initial post, I'd say you know a good bit more than the people I'm referring to.
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the obesity thing is a good response as well. I generally give one big, tied-together response that talks about how poor personal decisions that lead to expensive healthcare, like obesity, lack of preventive medicine, and abuse of the ER cause high healthcare costs, which raise insurance costs (in addition to the ridiculous overhead), causing more people to be uninsured, etc.
the solution is for more preventive medicine and cutting down on insurance overhead to make healthcare cheaper and more readily available to people.
I just realized I'm an idiot... I thought you said "and that you have" no "clue what's going on in healthcare, I imagine." I apologize... I'm probably fearing that the interviewer will say that to me. 🙁
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I think "it's bad" is an understatement. That's 47 million people who do not have access to health care. i.e. they are not being treated for their illnesses, they are not getting screened for serious medical conditions, they are not receiving medications that they might desperately need - all resulting in the fact that an uninsured person might die prematurely because he/she cannot get care. If the uninsured do seek medical care, they usually go to the ED and frequently not for actual emergencies. This costs the system a lot of money and eats up valuable medical energy that could be directed to more pressing cases. Therefore I don't think you should hesitate to say that the # of uninsured is the biggest healthcare issue, as long as that is YOUR opinion. I think interviewers will catch on if you are just reciting something you think is the right answer.
On top of naming the biggest problem in health care, you should be ready to answer HOW that problem may potentially be resolved.
Yeah, I was just being brief. I wasn't trying to make it seem unimportant, I was simply saying that it doesn't take an in-depth understanding of healthcare or insurance policies to have that response. So, in the eyes of a committee, they might look at that answer as a cop-out. On a personal note, my girlfriend, sadly, doesn't have health insurance. It kills me. We're working to try to get her loans so that she can have health insurance. Do you think that is something that is appropriate to mention in an interview?
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Would it be bad to mention declining Medicare reimbursements? That is a problem, but I'm worried that it will imply being greedy and wanting money.
And what about saying that health care should be a responsibility and not a right?
And what about saying that health care should be a responsibility and not a right?
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if you can explain why it's bad, it's probably a reasonable answer.
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another major issue is that because of managed care, docs are often forced to see a ton of patients a day, thus they can't spend an adequate amount of time with each patient, which leads to a. poor patient care, b. patient confusion, c. stressed out docs.
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What if your interviewer is in that category...?
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http://www.businessandmedia.org/printer/2007/20070718153509.aspx
Read that article...Also, the 47 million includes close to 10 million illegal aliens, people who illegally broke into this country. In addition, a large majority of that number CAN afford health insurance but CHOOSE not to purchase it. I hope you are not implying my tax dollars should goto pay for health insurance for people who can legitimately afford to purchase it on their own, but choose instead to buy a plasma TV.
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Interesting article. But to clarify, they say that 10 million of the 47 are non-Americans. A non-American does not mean someone who "illegally broke into this country." It could be someone born in a foreign country who moved over here for whatever reason, legally, but is not yet a citizen. Are they expected to go back home every time they need their health taken care of? Moreover, I wouldn't assume that all people who can but don't buy insurance are wasting their money on luxury items. That number includes people making 50K and up. 50K isn't a ton of income for someone who may need to raise multiple children by him/herself, put kids through college, pay for his/her own schooling, etc.
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Earlier you said
The problem with your article is that it comes from the Business and Media Institute. "The Business & Media Institute (BMI) was founded in 1992 as the Free Market Project by the conservative media watchdog group Media Research Group. It is predominately funded by larger right-wing foundations." Now for one, that is a source of news, so by your argument it is not a good way to get info, and secondly, it's a political group. So tell me, how is this a good way to get info...the logic doesn't follow...
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Where's Panda when you need him...
If you say declining Medicare reimbursments are the BIGGEST problem in healthcare, yes you sound greedy. And, you sound like an idiot, b/c medicare reimbursments aren't actually declining (except against inflation). There's a possibility that they will, but so far cuts have been blocked and there's no solid evidence to suggest that they won't be in the future, as well.
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Honestly, take your pick. Read a book on the health care crisis and find for yourself what you really see as unacceptable: uninsured, under-insured, fragmentation of care, HMOs. It doesn't matter, different doctors will think different things, but the attitude you definitely don't want to have is "what do they want to hear" for anything. I agree don't say doctors suck at what they do or medicine is messed up and needs to be fixed. Be measured and thoughtful in your replies, but they do want honesty and intelligence.
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There is a right answer, it wasn't either of the ones you gave. Two words: defensive medicine
Crazy malpractice lawyers force us to drive up costs by sending every patient with a headache through a $4000 radioloical workup. It hurts the patients (though higher costs) and makes all the doctors miserable because they've been turned into walking targets.
Not saying that that's really the biggest problem in medicine, but it's a respectable and safe answer. Everyone hates malpractice lawyers. Different doctors have different opinions on socialized healthcare, insurance companies, midlevels, Medicare, etc, but I've never met a single one that didn't hate John Edward's.
Obesity was another interesting 'safe' answer. Good suggestion whoever said that.
Crazy malpractice lawyers force us to drive up costs by sending every patient with a headache through a $4000 radioloical workup. It hurts the patients (though higher costs) and makes all the doctors miserable because they've been turned into walking targets.
Not saying that that's really the biggest problem in medicine, but it's a respectable and safe answer. Everyone hates malpractice lawyers. Different doctors have different opinions on socialized healthcare, insurance companies, midlevels, Medicare, etc, but I've never met a single one that didn't hate John Edward's.
Obesity was another interesting 'safe' answer. Good suggestion whoever said that.
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Are you implying that emergency room docs should refuse to take care of illegal aliens in critical condition? Or should they ask for a green card/US Passport everyone who doesn't speak English? And if yes, how do you imagine implementing these rules in Miami or Southern California hospitals... 😱
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I don't like this answer because if I am saying this is the biggest problem with healthcare, I might sound like I'm in it for the money. Not that you are saying that, but an interviewer might see it that way.
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You know there are better things to do on SDN than calling me an idiot. Medicare has had substantial cuts, but in recent years, as you say, they have been turned into 1% increases, still less than inflation. And they are definitely low enough that a PCP who only takes Medicare/Medicaid will not make any money (overhead costs will overwhelm any earnings). So I think it is a problem. But the biggest problem is greedy insurance companies and HMOs. Many pay doctors peanuts, charge very high premiums on patients, refuse to pay sick patients when they need it, and lobby politicians for ridiculous things like Hillarycare.
And the fact is, doctors have a very weak lobby. Sure the AMA may be able to scramble in the last minute and convince Congress to stop a scheduled cut, but if the doctors had any solid lobby, then no one would be talking about pay cuts.
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Illegal aliens aren't really filling out the census though are they? Also...a large majority of the uninsured can afford insurance? Tell me where I can look that up...and preferably not at a biased, political think tank's website. I'm not implying anything other than the fact that almost everyone puts the raw number at about 47 million.
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/thread
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Not really, what you're arguing is that the need to exclude every 1/1 million condition with an expensive test for legal reasons is hurting patients financially. It actually helps doctors, because those tests have a pretty good profit margin. Anyway even the most hippieish ADCOM isn't heartless: maybe they want you to want to work for dirt voluntarily for the benifit of the poor but they don't expect you to want to be sued for the benifit of a trail lawyer
Anyway other safe topics:
-The rising rate of obesity was good
-The drug/tobacco epidemic
-The problem of the increase in demand for healthcare rapidly outstripping the supply as baby boomers age and the supply of doctors increases only slightly
-The need for more primary care in this nation (only if you're talking to a primary care doctor, but that's pretty easy to figure out)
Just avoid anything that people could strongly disagree with you on.
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Is there really a tobacco epidemic in this country??? I thought that smoking rates declined significantly over the past few years partially as a result of successful National Anti-Smoking Campaign...plus smoking is now prohibited almost everywhere...even in casinos (although not in all states)...
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Malpractice is far from the major problem.
Malpractice suits make up less than 3% of total health care costs. Also in states that have enacted tort reform (i.e. caps on law suit payouts), health care costs have still risen.
Malpractice suits make up less than 3% of total health care costs. Also in states that have enacted tort reform (i.e. caps on law suit payouts), health care costs have still risen.
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1) refocus on primary care
- why would it matter if the interviewer is a specialist? every specialist i've talked to agrees with this. it's no secret. it's just that after all that schooling many doctors want money, which you get from specializing
2) refocus on preventive medicine
- more screening. catch that breast (#3 cancer casualty rate) and colon (#2 cancer casualty rate) cancer early with breast exams and sigmoid/colonoscopies. you'll help lower health care costs a lot by avoiding the expensive chemo later down the road. you'll also decrease the risk of cancer, the country's #2 cause of death
- more wellness education - stress the importance of nutrition, dieting, exercise, etc. all of these things will lower the risk of heart disease, the country's #1 cause of death. also, smoking cessation is another big thing. lung cancer is the #1 cause of cancer and causes the most cancer-related deaths!
3) obesity - for sure, include this under wellness education
4) more free clinics for the uninsured (free clinics have income guidelines that prevent those $50K+/year income, uninsured ppl from receiving the free care. although I must say, there are families who make that much but have a high number of dependents to support. these families are ineligible for Medicaid and the free clinics. they truly fall in the cracks that not even free clinics can support. 🙁 )
- get those uninsured out of the ER and into free clinics for non-emergency cases, which make up 50% of those going to the ER! the ER is like 10x more expensive than anywhere else. I think one doctor told me that one aspirin is $10.
5) electronic medical records
- will save money and increase efficiency for hospitals, make info more easily accessible between hospitals, etc.
those are the ones that first came to mind.
EDIT: these were all things to lower the cost of health care.
- why would it matter if the interviewer is a specialist? every specialist i've talked to agrees with this. it's no secret. it's just that after all that schooling many doctors want money, which you get from specializing
2) refocus on preventive medicine
- more screening. catch that breast (#3 cancer casualty rate) and colon (#2 cancer casualty rate) cancer early with breast exams and sigmoid/colonoscopies. you'll help lower health care costs a lot by avoiding the expensive chemo later down the road. you'll also decrease the risk of cancer, the country's #2 cause of death
- more wellness education - stress the importance of nutrition, dieting, exercise, etc. all of these things will lower the risk of heart disease, the country's #1 cause of death. also, smoking cessation is another big thing. lung cancer is the #1 cause of cancer and causes the most cancer-related deaths!
3) obesity - for sure, include this under wellness education
4) more free clinics for the uninsured (free clinics have income guidelines that prevent those $50K+/year income, uninsured ppl from receiving the free care. although I must say, there are families who make that much but have a high number of dependents to support. these families are ineligible for Medicaid and the free clinics. they truly fall in the cracks that not even free clinics can support. 🙁 )
- get those uninsured out of the ER and into free clinics for non-emergency cases, which make up 50% of those going to the ER! the ER is like 10x more expensive than anywhere else. I think one doctor told me that one aspirin is $10.
5) electronic medical records
- will save money and increase efficiency for hospitals, make info more easily accessible between hospitals, etc.
those are the ones that first came to mind.
EDIT: these were all things to lower the cost of health care.
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I don't think you're getting the concept of defensive medicine. It's not cost of the lawsuits themselves, it's the cost of doing thousands of useless tests and procedures because failing to do a single one opens you up to litigation. It's the cost of letting every homeless man who says "I got chest pain" take up a bed in the ER until he is sufficiently fed and rested for his maybe- heart attack to stop because your legal department says not let even the most obvious liar out of the hospital if they might be having a heart attack. It's the cost of the billions that we pour into pointless end of life care because doctors have no option to say "no, your mother is 95 and dying and that's not going to help" without exposing themselves to litigation. The cost of the lawsuits that make it past all that caution is secondary.
That being said, yeah, malpractice is still probably not the biggest problem in medicine, but I maintain that it's the best answer. The goal here, as I see it, is to pick an issue where the interviewer passionately agrees with you, since that gets you remembered as an intelligent human being. Obesity is a safe pick but it might put them to sleep. Socialized medicine will get a passionate response but there's a 50% chance your interview will passionately call you an idiot. So I recommend malpractice. One man's opinion.
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My answer to this question is paper charts (i.e. lack of EMR). Keeping patients' health information in huge, overflowing bulky charts *by provider* is insanely sloppy and inefficient... not to mention irresponsible, and even dangerous. When the patient moves, that information certainly doesn't move with the patient. When the patient gets a new doctor in a different state, s/he has to remember his/her own meds, record of immunizations, whatever. The new doc & the old doc COULD communicate, but typically do not. And typically the patient doesn't have easy access to his/her own info, either. So the typical scenario is that s/he starts all over with a brand new doc.
And this is the reason why America has such a shoddy record on immunizations compared to other industrialized nations. The record keeping is so spotty. This doesn't just affect discrete issues like immunizations etc. It also has a huge impact on care for patients with comorbid conditions (which is like, practically everyone). For example, the patient with chronic ailments like diabetes & depression ON TOP OF something else like coronary artery disease probably has multiple doctors... yet unless these docs are all part of an integrated system like Kaiser Permanente, more likely, they have nothing to do with each other and have no idea what other care the patient is receiving from the others, short of what the patient can remember himself/herself and think to regurgitate at appropriate times. This is not only dreadfully inefficient, it's downright irresponsible & dangerous. A functional EMR would go a long way towards improving these care-linkage deficiencies.
The other huge component an EMR would help is quality control/process improvement. Improvement isn't possible without analysis through studies such as a medical chart review. And ongoing medical chart reviews aren't likely devoid consistent, easily accessible data. I've done paper chart reviews myself and process is so tedious, the data is so inconsistent, it's almost impossible to get anywhere. With the adoption of an EMR, doing studies would be much quicker, not to mention more accurate. The ability to do regular, consistent studies is a fundamental pre-requisite to improving quality of care. Data should be stored consistently, and it should be stored by patient, following the patient around, rather than in bits & pieces by physician on bulky paper charts.
I work in a hospital with an EMR right now and cannot imagine working in one with paper charts... my whole work day would just be filled with so much extra work. The other great thing about the EMR we have is that staff DO use it to communicate to each other. Getting universal adoption of EMR is something that CAN be done in the near future which will dramatically improve the quality of care. So in contrast to the many other healthcare problems out there today (47 million uninsured, etc.), here's a HUGE problem that does have a pretty clear cut solution.
And this is the reason why America has such a shoddy record on immunizations compared to other industrialized nations. The record keeping is so spotty. This doesn't just affect discrete issues like immunizations etc. It also has a huge impact on care for patients with comorbid conditions (which is like, practically everyone). For example, the patient with chronic ailments like diabetes & depression ON TOP OF something else like coronary artery disease probably has multiple doctors... yet unless these docs are all part of an integrated system like Kaiser Permanente, more likely, they have nothing to do with each other and have no idea what other care the patient is receiving from the others, short of what the patient can remember himself/herself and think to regurgitate at appropriate times. This is not only dreadfully inefficient, it's downright irresponsible & dangerous. A functional EMR would go a long way towards improving these care-linkage deficiencies.
The other huge component an EMR would help is quality control/process improvement. Improvement isn't possible without analysis through studies such as a medical chart review. And ongoing medical chart reviews aren't likely devoid consistent, easily accessible data. I've done paper chart reviews myself and process is so tedious, the data is so inconsistent, it's almost impossible to get anywhere. With the adoption of an EMR, doing studies would be much quicker, not to mention more accurate. The ability to do regular, consistent studies is a fundamental pre-requisite to improving quality of care. Data should be stored consistently, and it should be stored by patient, following the patient around, rather than in bits & pieces by physician on bulky paper charts.
I work in a hospital with an EMR right now and cannot imagine working in one with paper charts... my whole work day would just be filled with so much extra work. The other great thing about the EMR we have is that staff DO use it to communicate to each other. Getting universal adoption of EMR is something that CAN be done in the near future which will dramatically improve the quality of care. So in contrast to the many other healthcare problems out there today (47 million uninsured, etc.), here's a HUGE problem that does have a pretty clear cut solution.
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Rip into insurance companies and how the fact that they are run for profit is completely contradictory to their initial use *to help pool against risk in the community* talk about how insurance companies take 30% of the healthcare dollar and use it for services that are not helping patients *because of denying claims, filing, staffing, etc.* Then bring up that it is causing physicians to have to see a larger number of patients, how that lowers quality because they spend less time with their patients and then bring up how this leads to physicians treating symptoms and not causes of disease. This lowers short term costs, but increases long term costs exponentially. For example treating an obese person w/ diabetes by giving them insulin and diet pills w/o changing their diet and having them exercise will not prevent things like heart attacks, high cholesterol, etc.
Everyone hates insurance companies and everyone in medicine understands that they are taking a lot of money out of the system while providing little benefit.
Everyone hates insurance companies and everyone in medicine understands that they are taking a lot of money out of the system while providing little benefit.
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Also, with insurance people tend to see physicians more often than they need to because to them the costs are cheap but the costs to the community is larger. For example: if a doctor's office visit costs 100 dollars you'll go say 5 times a year. However if you have insurance and the copay is only 20 dollars you'll see a doctors office 15 times a year.
While it only costs you 300 dollars, it is costing the community 1500 dollars. Thus tripling the overall price of medicine.
This help explains cost and quality....at least i think so.
While it only costs you 300 dollars, it is costing the community 1500 dollars. Thus tripling the overall price of medicine.
This help explains cost and quality....at least i think so.
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Just look 'em in the eye and state, firmly and clearly, that the biggest problem in American health care is all the freeloaders who will pay two hundred dollars a month for cigarettes but consider having to pay a thin dime for their medical care as an affront to their dignity. That, or some variation of it, is the biggest problem.
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Rather than making a lame attempt at discarding the information because it's funded by those crazy right-wingers, you should address the information. The 47 million people is a significant mischaracterization of reality.
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Not true. Preventative medicine costs more, because you find more, treat more, and occasionally work up more stuff that wasn't wrong in the first place. I'm not arguing against screening for cancer, but we should do it to save lives, not save money.
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1) the 8-10 million "non-American citizens" does not mean only illegal immigrants. that claim states that international students, people here on visas and greencards, etc. have no right to health care. many of those "non-Americans" on greencards are the doctors who are running our VAs. might want to think about that. although since the VA ones are doctors, I'm pretty sure they have health insurance.
for the international students issue, I stand by my point. the student him/herself may get coverage through their university but their families who come here with them do not. they need coverage and the international student who is the father/mother does not have the funds to cover the entire family. they are only students, after all.2) many families who make $50k/year still cannot afford health insurance. if it is a household made of up 1 person, then that's different. if it is a household of 5, certainly not. the Federal Poverty Guide Lines cut off a household of 8 at $35/year. that is simply ridiculous. good thing there are free clinics out there who will raise that number to $65k/year. it's places like that who take care of the ppl who fall in the cracks.
3) you can play devil's advocate all you want by reducing 47 million uninsured to 20-25 million. the reality is that's still 20-25 million who do not have health insurance. the reality is that number increases each year. uninsured will go straight to the ERs, health care costs will increase, and so on. it is definitely a big problem. it is a huge factor of many that make up the biggest problem in health care: cost.
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oh, i see, but doesn't avoiding the chemo later for the lump you could have found 20 years earlier save money? I guess one screening is much less than chemo, but, say, increasing the screening rate 100x would add up to more than avoiding the 1 chemo? is that what you're saying?
also, go respond to my response to your earlier post. thanks!
