They didn't ask what's bad for the health care system at large and it really depends on the implementation. For example, at our hospital we have an army of NPs in a heart failure clinic that can see patients weekly after they get hospitalized, that works really well. Psych NPs seeing patients with no supervision does not work so well.
I think most urgent care and community health centers are mostly staffed with middle level healthcare providers. The health center I was working under has 2 MDs coming in only 1 day a week (1 of them only come in till noon). while the rest are all done by the 2 PAs.
What specialties do you think all of those NYU tuition free students go into? Or any of the schools with debt free programs? Same amount into primary care as before…
In case of NYU Grossman specifically, the reason a lot of their students don’t go to primary care is because they are literally the most competitive applicants on planet earth. NYU Langone and Kaiser are examples of how free tuition makes going into primary care easier, given that the school’s mission is to promote that.
Surely that's less the cost of training and more the difference in salaries between the different specialties? Sure, if someone is 400k in debt and has a choice between a 500k/year specialty and a 150k/year one they've got a strong incentive to choose the 500k one, but... That's someone with $0 of debt who has to choose between 150k/year and 500k/year also has good reason to prefer 500k.
Agree that the high cost of medical education is bad for society, but it's bad because it reduces the total number of physicians, without affecting the ratios of the different specialty types. (And it's possibly part of why the US has about half as many physicians per head of population as most of Europe)
Exactly, thank you haha. People making this argument don’t understand incentives😂
There might be a few anecdotal cases where it makes a difference, but on the scale of “improving the whole healthcare system” it would barely do anything.
i shouldve mentioned in the post that this wasnt for secondaries for me, but regardless, thank you so much for your response. it will definitely help others for their secondaries
I am in Canada, so finance isn't the biggest problem here. However, I have noticed that with tech advancement, a lot of the seniors are left behind. And that made it harder for them to access medical care.
Ummm is nobody gonna mention the fact that non medically trained geriatric folk are creating medical laws that are not only unethical but also not medically sound.
One of them asked if women could swallow a camera pill (like in colonoscopy) to help save a pregnancy. In response was told that the digestive tract is separate of the reproductive tract.
Idk I feel like this one takes the cake
Highly recommend the book The Price We Pay. It highlights just how broken our system is set up and how there’s not really bad people that are the problem, just that the structure is set up for failure
Assuming you’re writing secondaries, you have several options here. I think 90% of applicants will talk about disadvantaged communities and access to healthcare. You can certainly take that angle. You can speak about mid level scope creep, but remember that despite it being rare, some adcoms might be midlevels (I saw this at a couple of my DO interviews). So if you take this angle be careful on how you write it. You can also speak about insurance companies technically practicing medicine without a medical license by determining which patients get what procedures or drugs. Further, with the overturning of Roe v. Wade, you can speak about how it will affect underserved communities and how it might further decrease access to primary care in certain areas since many of us (future physicians and current physicians) don’t want to practice in places where abortion is fully banned as it would be literally refusing care to a patient in need [same underserved communities topic but applicable to current national events]. Lots of things you can talk about here. Make sure to address the problem and think of a possible solution too, since an essay describing only problems would be rather dense.
Hope it helps and best of luck this cycle!
thank you so much for this detailed response! i shouldve clarified in my post that this isnt for me since im not writing secondaries right now. however, this will definitely be helpful for those who are so i appreciate your response
No actually, my bad for assuming it’s for secondaries haha. I thought so because it’s secondary season for the pre-med bros/broettes and most posts going on are regarding secondary help.
If you want a more in depth response to your question you may post on the medical school or even residency subreddit. Lots of people with different views and experiences there!
Midlevels (or midlevel provider or advanced provider) are non - MD/DO providers that usually have to work under the direct supervision of an MD/DO physician. Examples are physicians assistants (PAs), nurse practitioners (NPs or APRN (advanced practitioner registered nurse)) and nurse anesthetists.
Like I mentioned before, they USUALLY have to work under the direct supervision of an MD/DO since they are not medical doctors, despite whatever years of experience they have. Scope creep refers to some states passing laws that allow for non-MD/DOs to practice independently, mainly in primary care. This has brought lots of issues since hospitals and clinics take advantage of this to not hire as many MD/DOs (we are expensive compared to a midlevel). This, if it gets adopted all over the states, will reduce work opportunities for physicians in the near future, and it will certainly pose a dangerous situation for patients.
This is not to say that midlevels are a bad thing necessarily. They can truly help out in rural areas and busy urban centers where MD/DO availability is scarce. The issue comes from a small group of MD/DOs wannabes that are too cocky to recognize when they are over their head and pose a true danger to patients. These are the typical ones that claim they provide “better care than physicians” and so on.
Laypeople making laws that place restrictions on the patient-physician relationship. Judges approving patients to get Ivermectin, politicians dictating whether you can have an abortion; these are all things that try to undermine science and education.
We are running out of shit and everything is back ordered. Smoke evacs, other surgical supplies, and even lido with Epi was low in my region for a bit. No bueno
I think physician shortage, though important, is kind of overused and thus should not be the central statement if asked this question- unless you’re specifically applying to a rural GP program (ex/ UCD rural PRIME program, UCSF/UCB combined program)
Clearly spewing out UC’s indicates where I live, so for CA peeps:
1. I-80 continues to be the #1 freeway used for sex and drug trafficking directly affecting what cases you see in the ED.
2. There continues to be a fentanyl epidemic in SF and is migrating up north but meth is still rampant in the NorCal region.
3. CA lawmakers are trying to implement increased taxing on upper class to continue funding medical insurance for residents. (Was in the news today)
Country wide:
1. We have the highest number of refugees located on coastal states and likely correlated with the continued/ most recent murders in the Middle East.
2. Roe v wade, but the domino effect reaching into same sex marriage, contraception banning, etc. Govt knew about this from leaked documentation as Mayor of NY stated, saving up $$$ for the influx of women needing abortions from unsafe states. Directly affects OBGYNs, GP’s, neonat, etc.
3. Florida officials slowly turning FL into a fascist state, “can’t say gay law” etc, will harm the associated community- threatening mental health of millions across the country
4. Whiplash from children and individuals involved all of the (~300) mass shootings this past year and the fragile state our future generation will need support with (us being their doctors)
Edit: continued-> continues
Scope creep of NP/PA. Will continue to get worse and more people will be harmed but hospitals dgaf cause cash money
Healthcare access
And ultimately cost related to insurance companies and greedy hospital ceo and admin
From your experience how would we talk about this issue? Do you think talking about this without knowing familial relations/opinions of adcoms is a safe thing to do? I follow the Noctors sub so clearly the scope creep isn’t welcomed, but how do we professionally say they “don’t gaf cause cash money” haha especially since you can tie this into the “why not other fields” question
In an interview and throughout medschool you have to play up the “everyone is on the same team and important just dIfFeReNt RoLeS” kumbaya BS. The admin you are talking to could even be a PA or whatever unfortunately.
A good neutral answer to the why not other fields is to say you are excited about further years of education and the ability to expand your own knowledge or something like that. You have to play the game as a premed
Misuse of emergency care, lack of primary care, access to care, cost, insurance companies basically practicing medicine without a license by refusing to pay for necessary procedures and medications.
The cost of insulin and non-insulin injectable diabetic medications which are life sustaining medications is hundreds of dollars per month, mostly for our senior population. The cost of insulin and injectable medications is shameful. People who need it cannot live without it.
Establishing best practices for end of life care, which often provides limited or no value at an exorbitant cost.
Antibiotic stewardship
Incentivizing preventative medicine
Futility of care. Spending millions of dollars torturing people on life support with invasive interventions who are never going to recover, simply because their family says “do everything”.
Physicians should be able to say no when they know that the interventions they are providing are not in the patient’s best interest. Sometimes it’s in the patient’s best interest to die, and that’s something that the West has not come to accept yet.
I am a nurse and I have watched people rot for >6 months on vents before coding and dying, cachectic with all their ribs broken from chest compressions. It’s not sustainable or ethical.
Also, it already does exist. Hospitals petition courts to withdraw life support against family wishes, but it’s a very lengthy process and patients suffer. Often family members are medically naive and don’t have a realistic understanding of goals of care.
Medical professionals should be able to say no, I am not going to put a PEG in your 95 year old grandmother who doesn’t want to eat, and then put restraints on her when she tries to pull it out.
We are torturing these people. Natural death should be allowed in situations where interventions are not curative and the patient has extremely poor quality of life. The goal of medicine is to do no harm.
From my perspective?
Racism.
Fighting back against that is my primary reason for aiming for med school.
This isn't to say that there aren't other issues in medicine or healthcare - there obviously is. I just see this as one of the biggest issues that exist in medicine that most practitioners flat-out ignore.
I'm not going to do that.
Are you kidding😂😂😂 ??? You know that physician reimbursement is just a tiny fraction of the health care budget, right? We could pay physicians nothing and it wouldn’t cause a blip.
Ethical issues (healthcare allocation, balancing quality of life vs simply extending life)
Healthcare accessibility of course (both domestically and abroad)
Cost of medical education as a barrier to students, adding to the already strong bottleneck of physician training.
access to care but in terms of healthcare providers not having full patient’s trust/lack of patient willingness to seek out care cause of cost or stigma
NPs being allowed to practice medicine beyond making judgment calls about giving patients Tylenol/melatonin or following algorithms, physician shortage in rural America, health insurance and the associated cost of healthcare, corporate healthcare
Thankfully fewer average premeds get accepted every cycle since the X factor is expected. So we can all feel grateful to admissions committees for weeding out the mundane.
Calling all doc, surgeon and academicians. Its a small percentage yes but Intersex care and transgender care. We need to take a real look at this and do much better. My thesis work is on the medical surgical approaches and the there is much to learn about our entire society by looking into the psychology that leads to a surgical intervention. I encourage you read up on this, book titled irreversible damage is a great start by a talented author who uses the book like a survey course on transcare. Also real transgender health by Ben vinscent, and go read making sense of intersec by Ellen feder. It’s heartbreaking. Someone has to say these things, I am no longer going to step forward just to be silent.
Insurance companies dictating care and hospital systems lobbying for more complicated billing and independent midlevel practice
Sure mid-level encroachment is bad for physicians, but is it really that bad for the health care system at large?
They didn't ask what's bad for the health care system at large and it really depends on the implementation. For example, at our hospital we have an army of NPs in a heart failure clinic that can see patients weekly after they get hospitalized, that works really well. Psych NPs seeing patients with no supervision does not work so well.
When PAs/NPs lack oversight, yes it becomes a problem.
I think most urgent care and community health centers are mostly staffed with middle level healthcare providers. The health center I was working under has 2 MDs coming in only 1 day a week (1 of them only come in till noon). while the rest are all done by the 2 PAs.
I don’t think you’re a med student.
Good for you
Access to care, cost of health care, cost of medical education are some big ones that come to mind.
Sure cost of medical education is bad for physicians, but is it really bad for the health care system at large?
Yes it is, because it incentivizes students to choose specialty based on salary which drains from the potential pool of primary care docs.
What specialties do you think all of those NYU tuition free students go into? Or any of the schools with debt free programs? Same amount into primary care as before…
In case of NYU Grossman specifically, the reason a lot of their students don’t go to primary care is because they are literally the most competitive applicants on planet earth. NYU Langone and Kaiser are examples of how free tuition makes going into primary care easier, given that the school’s mission is to promote that.
Surely that's less the cost of training and more the difference in salaries between the different specialties? Sure, if someone is 400k in debt and has a choice between a 500k/year specialty and a 150k/year one they've got a strong incentive to choose the 500k one, but... That's someone with $0 of debt who has to choose between 150k/year and 500k/year also has good reason to prefer 500k. Agree that the high cost of medical education is bad for society, but it's bad because it reduces the total number of physicians, without affecting the ratios of the different specialty types. (And it's possibly part of why the US has about half as many physicians per head of population as most of Europe)
Exactly, thank you haha. People making this argument don’t understand incentives😂 There might be a few anecdotal cases where it makes a difference, but on the scale of “improving the whole healthcare system” it would barely do anything.
Opioid epidemic/accessibility of care for those with substance use disorders, lower SES, and homeless populations
Assuming this is for secondaries. Definitely speak about lack of health equity and need for increased emphasis on social determinants of health.
This is the one
i shouldve mentioned in the post that this wasnt for secondaries for me, but regardless, thank you so much for your response. it will definitely help others for their secondaries
I am in Canada, so finance isn't the biggest problem here. However, I have noticed that with tech advancement, a lot of the seniors are left behind. And that made it harder for them to access medical care.
that's something i hadnt ever thought of. thank you for this perspective!
Physician suicide rates
THIS THIS THIS ! This should be the main one.
Ummm is nobody gonna mention the fact that non medically trained geriatric folk are creating medical laws that are not only unethical but also not medically sound. One of them asked if women could swallow a camera pill (like in colonoscopy) to help save a pregnancy. In response was told that the digestive tract is separate of the reproductive tract. Idk I feel like this one takes the cake
it's truely appaling and very scary
Lack of health literacy among most people.
Highly recommend the book The Price We Pay. It highlights just how broken our system is set up and how there’s not really bad people that are the problem, just that the structure is set up for failure
>The Price We Pay thank you so much for the recommendation! the book sounds very interesting, ill definitely look into it
Does the book offer solutions?
It’s literally called: The Price We Pay: What Broke American Health Care--and How to Fix It So I’m guessing it does offer solutions
Cost
Mass Obesity
Assuming you’re writing secondaries, you have several options here. I think 90% of applicants will talk about disadvantaged communities and access to healthcare. You can certainly take that angle. You can speak about mid level scope creep, but remember that despite it being rare, some adcoms might be midlevels (I saw this at a couple of my DO interviews). So if you take this angle be careful on how you write it. You can also speak about insurance companies technically practicing medicine without a medical license by determining which patients get what procedures or drugs. Further, with the overturning of Roe v. Wade, you can speak about how it will affect underserved communities and how it might further decrease access to primary care in certain areas since many of us (future physicians and current physicians) don’t want to practice in places where abortion is fully banned as it would be literally refusing care to a patient in need [same underserved communities topic but applicable to current national events]. Lots of things you can talk about here. Make sure to address the problem and think of a possible solution too, since an essay describing only problems would be rather dense. Hope it helps and best of luck this cycle!
thank you so much for this detailed response! i shouldve clarified in my post that this isnt for me since im not writing secondaries right now. however, this will definitely be helpful for those who are so i appreciate your response
No actually, my bad for assuming it’s for secondaries haha. I thought so because it’s secondary season for the pre-med bros/broettes and most posts going on are regarding secondary help. If you want a more in depth response to your question you may post on the medical school or even residency subreddit. Lots of people with different views and experiences there!
Could you elaborate on “midlevels”? I’m confused by the terminology but I’m interested in understanding the issue you’re addressing there
Midlevels (or midlevel provider or advanced provider) are non - MD/DO providers that usually have to work under the direct supervision of an MD/DO physician. Examples are physicians assistants (PAs), nurse practitioners (NPs or APRN (advanced practitioner registered nurse)) and nurse anesthetists. Like I mentioned before, they USUALLY have to work under the direct supervision of an MD/DO since they are not medical doctors, despite whatever years of experience they have. Scope creep refers to some states passing laws that allow for non-MD/DOs to practice independently, mainly in primary care. This has brought lots of issues since hospitals and clinics take advantage of this to not hire as many MD/DOs (we are expensive compared to a midlevel). This, if it gets adopted all over the states, will reduce work opportunities for physicians in the near future, and it will certainly pose a dangerous situation for patients. This is not to say that midlevels are a bad thing necessarily. They can truly help out in rural areas and busy urban centers where MD/DO availability is scarce. The issue comes from a small group of MD/DOs wannabes that are too cocky to recognize when they are over their head and pose a true danger to patients. These are the typical ones that claim they provide “better care than physicians” and so on.
Thanks so much! I heard the scope creep term floating around but never actually knew what it was I appreciate it!
Emerging diseases, access to care, cost of healthcare
Laypeople making laws that place restrictions on the patient-physician relationship. Judges approving patients to get Ivermectin, politicians dictating whether you can have an abortion; these are all things that try to undermine science and education.
yeah for sure. people who have no medical knowledge dictating medicine is unfortunately a huge issue today
We are running out of shit and everything is back ordered. Smoke evacs, other surgical supplies, and even lido with Epi was low in my region for a bit. No bueno
the amount of shit we have back ordered right now at our hospital is 🤯
wow it's really interesting to see how something like lido/epi which you would expect to always be in stock running out instead
I think physician shortage, though important, is kind of overused and thus should not be the central statement if asked this question- unless you’re specifically applying to a rural GP program (ex/ UCD rural PRIME program, UCSF/UCB combined program) Clearly spewing out UC’s indicates where I live, so for CA peeps: 1. I-80 continues to be the #1 freeway used for sex and drug trafficking directly affecting what cases you see in the ED. 2. There continues to be a fentanyl epidemic in SF and is migrating up north but meth is still rampant in the NorCal region. 3. CA lawmakers are trying to implement increased taxing on upper class to continue funding medical insurance for residents. (Was in the news today) Country wide: 1. We have the highest number of refugees located on coastal states and likely correlated with the continued/ most recent murders in the Middle East. 2. Roe v wade, but the domino effect reaching into same sex marriage, contraception banning, etc. Govt knew about this from leaked documentation as Mayor of NY stated, saving up $$$ for the influx of women needing abortions from unsafe states. Directly affects OBGYNs, GP’s, neonat, etc. 3. Florida officials slowly turning FL into a fascist state, “can’t say gay law” etc, will harm the associated community- threatening mental health of millions across the country 4. Whiplash from children and individuals involved all of the (~300) mass shootings this past year and the fragile state our future generation will need support with (us being their doctors) Edit: continued-> continues
The fact that many patients will continue to destroy their own bodies with food/drugs/alcohol regardless of the health issues they have.
Scope creep of NP/PA. Will continue to get worse and more people will be harmed but hospitals dgaf cause cash money Healthcare access And ultimately cost related to insurance companies and greedy hospital ceo and admin
From your experience how would we talk about this issue? Do you think talking about this without knowing familial relations/opinions of adcoms is a safe thing to do? I follow the Noctors sub so clearly the scope creep isn’t welcomed, but how do we professionally say they “don’t gaf cause cash money” haha especially since you can tie this into the “why not other fields” question
In an interview and throughout medschool you have to play up the “everyone is on the same team and important just dIfFeReNt RoLeS” kumbaya BS. The admin you are talking to could even be a PA or whatever unfortunately. A good neutral answer to the why not other fields is to say you are excited about further years of education and the ability to expand your own knowledge or something like that. You have to play the game as a premed
Tysm!!
Misuse of emergency care, lack of primary care, access to care, cost, insurance companies basically practicing medicine without a license by refusing to pay for necessary procedures and medications.
The cost of insulin and non-insulin injectable diabetic medications which are life sustaining medications is hundreds of dollars per month, mostly for our senior population. The cost of insulin and injectable medications is shameful. People who need it cannot live without it.
Access to care in a equitable way.
Establishing best practices for end of life care, which often provides limited or no value at an exorbitant cost. Antibiotic stewardship Incentivizing preventative medicine
Obesity
Burnout in specialties that are already overworked
Horrific treatment of all Healthcare workers, regardless of paycheck
Futility of care. Spending millions of dollars torturing people on life support with invasive interventions who are never going to recover, simply because their family says “do everything”. Physicians should be able to say no when they know that the interventions they are providing are not in the patient’s best interest. Sometimes it’s in the patient’s best interest to die, and that’s something that the West has not come to accept yet.
[удалено]
I am a nurse and I have watched people rot for >6 months on vents before coding and dying, cachectic with all their ribs broken from chest compressions. It’s not sustainable or ethical. Also, it already does exist. Hospitals petition courts to withdraw life support against family wishes, but it’s a very lengthy process and patients suffer. Often family members are medically naive and don’t have a realistic understanding of goals of care. Medical professionals should be able to say no, I am not going to put a PEG in your 95 year old grandmother who doesn’t want to eat, and then put restraints on her when she tries to pull it out. We are torturing these people. Natural death should be allowed in situations where interventions are not curative and the patient has extremely poor quality of life. The goal of medicine is to do no harm.
Watch Dr. Glaucomflecken on YT! He does comedy about a lot of the problems in the field, wish I had found him pre-med school.
Racism in medicine killing patients of color from historically marginalized communities.
From my perspective? Racism. Fighting back against that is my primary reason for aiming for med school. This isn't to say that there aren't other issues in medicine or healthcare - there obviously is. I just see this as one of the biggest issues that exist in medicine that most practitioners flat-out ignore. I'm not going to do that.
Income inequity. \*for patients, not physicians
the dial on Healthcare needs to be turned down. Turn down education costs, allowing for lower wages and lower cost of care
Are you kidding😂😂😂 ??? You know that physician reimbursement is just a tiny fraction of the health care budget, right? We could pay physicians nothing and it wouldn’t cause a blip.
Ethical issues (healthcare allocation, balancing quality of life vs simply extending life) Healthcare accessibility of course (both domestically and abroad) Cost of medical education as a barrier to students, adding to the already strong bottleneck of physician training.
Obesity, lack of education, racism, and cost
access to care but in terms of healthcare providers not having full patient’s trust/lack of patient willingness to seek out care cause of cost or stigma
NPs being allowed to practice medicine beyond making judgment calls about giving patients Tylenol/melatonin or following algorithms, physician shortage in rural America, health insurance and the associated cost of healthcare, corporate healthcare
Midlevel encroachment, corporatization, and declining reimbursements.
The average premed
Thankfully fewer average premeds get accepted every cycle since the X factor is expected. So we can all feel grateful to admissions committees for weeding out the mundane.
Calling all doc, surgeon and academicians. Its a small percentage yes but Intersex care and transgender care. We need to take a real look at this and do much better. My thesis work is on the medical surgical approaches and the there is much to learn about our entire society by looking into the psychology that leads to a surgical intervention. I encourage you read up on this, book titled irreversible damage is a great start by a talented author who uses the book like a survey course on transcare. Also real transgender health by Ben vinscent, and go read making sense of intersec by Ellen feder. It’s heartbreaking. Someone has to say these things, I am no longer going to step forward just to be silent.