Breaking Down PA School Interview Questions IV

Q: What do you feel is one of the biggest issues currently facing our health care system?

What are they looking for?

  • Understanding of what is happening in our health care system.  This shows the panel that you are interested in medicine and what is going on in the field you want to enter (in a lay persons answer: you know what’s up)
  • Perhaps you have a member ship to AAPA and read PA professional or JAAPA, mentioning these or others  as your source of information demonstrates a few things: dedication to the profession, extra effort to obtain information, self motivated behavior

What to avoid

  • This is tricky here, because you need to mention what is happening in health care without associating your personal opinion to the matter which can be difficult (to some degree you have to give an opinion because they are asking you what you think–just be careful!)

What to say

  • There are so many issues facing health care right now, below are a list of issues I feel are at the forefront of medicine and affecting providers:
    • Opiate abuse and dependence, both prescription and street heroin use
      • I would say 2/3 patients I admit or see have a prescription for a narcotic pain medication.  It’s a very intense issue in our country and is complex and multi-factorial.
        •  Patients who are given prescriptions after surgery and continue to have pain therefore continue to have a prescription for pain medication.
        • Lack of conservative measures or patients failing conservative measures such as physical therapy, weight loss.  I see a lot of patients on narcotic pain medication for arthritis, much of which joint destruction is caused by obesity (not ALL of the time but pressure on joints can really destroy them)
        • Pressure for patient satisfaction.  Docs, PA’s and NPs are being scored and reimbursed based on how patients feel they are treated.  As part of that crisis I don’t doubt that some providers view part of that satisfaction as controlling patients pain control.  I’m not stating all providers do this by any means, but I know I can say I saw it on rotations and I have treated patients in the hospital who have not seen their provider in 6 months and they continue to provide scripts for family members to pick up for them (by the way this is not ok and I’m fairly certain is some type of violation of a DEA license because patients need to be seen at regular intervals for a continued narcotic script to be valid)
        • Street use I hope is an obvious one that I’m not going to breakdown here
        • Serious implications for health, especially with heroin use–infections, overdose, etc.
    • Shortage of providers/Rural Medicine/Access to treatment
      • This issue is real.  As a traveling PA I can tell you that both of my assignments now will be in areas that desperately need providers.  
      • This is also a great way to talk about how PA’s help bridge the gap (Mind the GAP!— London anyone?) 
    • Cost of health care
      • This issue is also all too real.  Listen I pay 193$ a month and I’m a completely health individual.  I barely use my health care.  That is just the BEGINNING of this issue.  High monthly payments, high deductibles (my deductible is $2,700 and just for some perspective my financial advisor thought this plan was best for me), cost of medications, lab work, imaging.  I could go on.
      • IMO patients not being able to afford their medications creates a number of issues. 
        • First, they can’t get basic control of their chronic medical problems–say diabetes
        • Second, if patients can’t control their basic medical problems they end up with complications in the hospital and then they can’t afford their hospitalizations.  This is a problem not only on a personal level for the patient but also health care at large–driving up costs like crazy. 
        • The bottom line is that patients are more concerned with paying for healthcare than their own wellness which is is just bad all around
    • The specialization of medicine
      • We have become a society that continually self-refers to specialists.  Ankle pain? See ortho.  Diabetes? See endo. Both on an inpatient and outpatient basis–heres the issue:
        • PCP’s have less time with patients and more issues to cover–which creates more referrals and also patients to self refer because they can’t get appointments (which goes back to both cost and access)
        • Less continuity of care.  As best as we try for communication between offices it doesn’t always happen the best. 
        • Devaluing general medicine
          • Ok, this is my bias–but I believe that a medical home is really important.  Having a provider that knows you well and a “first line of defense” when you have a problem.  We are driving providers away from family practice and internal medicine for many reasons (less pay being one of them) and it seems to create the persona that this is not important and it is! 
          • Despite my bias/opinions make sure that if you discuss this you do so in a positive light.  Again, reinforcing the importance of family medicine and giving as many people as possible access to quality care.

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