Medical Students Favor Affordable Care Act

Laurie Barclay, MD

March 20, 2015

Most medical students approve of the Affordable Care Act (ACA), according to findings of a cross-sectional email survey published online March 10 in the Journal of General Internal Medicine. However, there was variation by intended specialty and political views.

Among 2761 medical students enrolled at eight geographically diverse US medical schools, 75.3% of the students said they understood the ACA, 62.8% said they supported it, and 56.1% said they felt a professional obligation to assist with implementing it

"While physicians' and physician organizations' views regarding health care reform are well documented, little attention has been paid to the views of medical students," write Tyler N. A. Winkelman, MD, from the University of Minnesota Medical School in Minneapolis, and colleagues. "These future physicians will begin medical practice after implementation of the [ACA's] key provisions has begun, and will spend their careers working in health systems shaped by the legislation. Therefore, the goals of health care reform are more likely to be realized if current medical students are prepared and willing to engage with implementation efforts, and to advocate for necessary refinements to the current legislation."

To determine the level of support, Dr Winkelman and colleagues sent an email survey to 5340 medical students, asking four questions regarding views of the ACA and nine knowledge-based questions about the ACA.

Overall response rate to the survey was 52%, and the mean knowledge score from nine knowledge-based questions was 6.9 ± 1.3. However, more than half of students were confused regarding two key ACA provisions: Medicaid expansion and health insurance exchanges.

Compared with students anticipating a medical specialty, those anticipating a surgical or procedural specialty were less likely to support the ACA (odds ratio [OR], 0.6 [95% confidence interval (CI), 0.4 - 0.7] and 0.4 [95% CI, 0.3 - 0.6], respectively) and more likely to have negative expectations (OR, 1.9 [95% CI, 1.5 - 2.6] and 2.3 [95% CI, 1.6 - 3.5], respectively). They were also less likely to report a professional obligation to implement the ACA (OR, 0.7 for both).

Support for the ACA was highest among students identifying themselves as political moderates (OR, 5.7; 95% CI, 4.1 - 7.9) or liberals (OR, 35.1; 95% CI, 25.4 - 48.5) compared with conservatives. In addition, students who identified themselves as liberals were more likely to report understanding the law than were self-identified conservative students (OR, 2.2; 95 % CI, 1.7 - 2.9).

In addition, students who had an above-average ACA knowledge score were more likely to support the act (OR, 1.7; 95% CI, 1.4 - 2.1) and more likely to report a professional obligation to implement it (OR, 1.2 [95% CI, 1.02 - 1.5]).

"In this national study of medical students' views and knowledge of the ACA, the majority of students (63 %) indicated support for the ACA, with higher levels of support among students anticipating a medical residency and self-reported moderates and liberals," the study authors write. "A majority (56%) also endorsed a duty to assist with ACA implementation as part of their professional obligations."

Limitations of this study include cross-sectional design precluding determination of causality, nonrandom sample with limited generalizability to the overall medical student population, and underrepresentation of states that have chosen not to expand Medicaid.

"Our respondents' views of the ACA indicate that future physicians are willing to support and engage with health reform legislation that expands coverage and support previous statements that physicians are likely to be an integral part of efforts to redesign the health care system," the study authors conclude.

The authors have disclosed no relevant financial relationships.

J Gen Intern Med. Published online March 10, 2015. Abstract


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