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Discussing Obamacare in Your Med School Interviews

Created December 1, 2014 by Nathan Moore, MD
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Medical school and residency interviews are nerve-wracking enough without putting politics in the mix as well; unfortunately with all of the news coverage and debate surrounding the Affordable Care Act AKA “Obamacare”, many interviewees are finding themselves faced with questions about health policy and politics. These questions can be a minefield of potential admissions-killing errors, so here’s a quick guide to how to handle them.

Be Careful
The Affordable Care Act is a highly emotionally-charged subject for many Americans, and physicians are no different. It will have a wide ranging impact on all aspects of the health care system, including physicians, teaching hospitals and medical schools, and–not surprisingly–the range of opinions among physicians varies widely as well. Some physicians think the ACA is the greatest thing since sliced bread, while others see it as the first step to European-style socialized health care. These strong (and not necessarily fact-based) opinions make answering questions on the subject treacherous because you don’t want to disagree with your interviewer’s personal opinion: even if they are incorrect, your interview is probably not the best time to educate them. I recommend that you keep your answers fact-based and neutral. Just about every health policy question can be answered intelligently and thoroughly without indicating a strong political preference. One easy way to do this is to include both pros and cons in your answer. For example, answering a question about Medicaid expansion could include the benefits, like expanding health insurance to previously uninsured citizens while the federal government picks up most of the tab, and drawbacks, including the costs of coverage and recent studies showing limited health benefits to those who get Medicaid. This kind of answer will demonstrate knowledge and critical thinking skills.

Know What You’re Talking About
Contrary to popular belief, the easiest way to screw up an ACA related question is not to disagree with the interviewer – it’s showing the interviewer that you don’t know the facts about the ACA in the first place. The ACA was the most significant overhaul of the US health care system in 60 years and every medical professional should know how it will affect health care providers and patients – especially those who are just starting their careers. You don’t need to become a health policy expert, but you should definitely know the basics of US health policy, including the Affordable Care Act. There are plenty of free websites available, including the Kaiser Family Foundation, the Department of Health & Human Services and of course Wikipedia. Good books include my book, The Health Care Handbook, Health Care Reform by Jon Gruber, The Medical School Interview by Samir Desai, and Understanding Health Policy by Bodenheimer and Grumbach. In addition, do some quick reading about current hot topics that are likely to come up, including Medicaid expansion, the hospital readmissions penalty, the physician open payments act and DSH cuts.

Turn It Around
Doctors love to hear themselves talk. I recommend ending all of your answers by asking your interviewer’s opinions as well. It can be quite illuminating and can lead to more engaging discussions that may be memorable for the interviewer. When the interviewer finally says “Well, that’s all I’ve got – what questions do you have”, you should have at least 3 prepared questions on health systems topics that you can draw on. Even better, ask specific questions about the institution you’re interviewing at after doing some background research; for example, on that institution’s readmissions penalty and quality measures. Doing that will demonstrate both knowledge and initiative.

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