UCSF Students Pack Classroom to Learn About Health Care Reform

Second-year medical student Jeff Doyon had a hunch that his health care reform elective might get some interest from fellow classmates, but he didn’t anticipate a line stretching out the door on its first day.

A year after the passage of the federal Patient Protection and Affordable Care Act, students at UCSF are showing up in large numbers to learn about the landmark legislation two years before they were scheduled to learn about it. Signed into law by President Barack Obama on March 23, 2010, the act reforms certain aspects of the private health insurance industry and public health insurance programs, including increasing insurance coverage of pre-existing conditions, expanding access to insurance to more than 30 million Americans and mandating an increase in total national medical expenditure.

“Reform is on everyone’s mind here,” Doyon said. “We are just starting our medical training and want to know how it’s going to affect our approach to providing care.”

More than 80 students attended the standing-room-only lecture led by Laura Schmidt, PhD, MSW, MPH, who kicked off the course on Sept. 21 with an overview of U.S. health care and past reform efforts.

“I was excited to see so many interested students,” Schmidt said. “I think they thirst for an understanding of where doctors fit into the vast maze we call our health care system and are deeply motivated by concerns about health equity and the fairness of a system that leaves so many uninsured. It speaks volumes to the kind of curious and engaged people UCSF attracts.”

The UCSF School of Medicine ranks among the top four medical schools in the nation, based on a 2011 survey conducted by U.S. News & World Report. Drawing many of the nation’s top pre-medical students, the school encourages them to not only excel at medicine, but to become health leaders by developing courses for peers across the health care professions. The students in attendance during this elective represented the schools of medicine, nursing and pharmacy and Doyon expressed hope that they could learn from each other as they asked questions about how the law would affect their respective fields.

Doyon’s elective, called “Affordable Care Act and the Future of Healthcare Reform,” approaches the legislation from the perspective of various stakeholders, including patients, nurses, small businesses, and both public and private insurance companies. It will also feature a lecture dedicated solely to California — nearly half of Californians are on government-sponsored health insurance, so the law will affect millions of people in that program alone.

“Given all the changes in our health care system, I think it's important to stay up to date on what policies will affect my career,” said Ruben Lachica, a second-year medical student and executive director of Mabuhay Health Center, a free Filipino clinic in San Francisco. “I think it’s especially important for me to be informed on this issue for the advocacy work I want to get into.”

Average attendance for student-coordinated electives ranges from a dozen to more than 100, according to David Rachleff, curriculum coordinator for the UCSF School of Medicine. The student-created classes, he said, are meant to provide first- and second-year students with opportunities for active and collaborative learning.

“By encouraging students to coordinate the electives across different subject areas, it gives them a professional and personal stake in learning,” Rachleff said. Although many medical schools offer similar opportunities, Rachleff said the UCSF faculty is especially eager to help students lead by setting up effective and unique introductory courses ranging from homeless health care to surgical techniques.

Doyon organized the elective after hearing Molly Cooke, MD, FACP, director of the Haile T. Debas Academy of Medical Educators, give a lecture that challenged medical professionals to better understand how health care costs are affecting patient’s decisions about when and where to seek treatment. Doyon decided then that he and his classmates should learn about health care reform issues earlier in their educational careers. Cooke serves as the faculty mentor for the elective.

“Typically, we hold policy education until the third year when medical students have more practical experience in a clinical setting,” Cooke said. “But it’s great that so many students are seeking out this type of knowledge, and doing so on their own terms.”

Health Care Reform Elective Lecture Schedule

1.   Overview of health care reform: history and current context; current state of health care in the US. (Laura Schmidt, UCSF, Sept. 21)

2.   An overview of the Patient Proection and Affordable Care Act (PPACA): The basics and timeline. (Molly Cooke, UCSF, Oct. 5)

3.   Effect of PPACA on businesses and private insurance programs; health insurance exchanges, high risk pools (William Kramer, PBGH, Oct. 12)

4.   The individual mandate and constitutional issues; the legislative process of the PPACA; politics of health care reform - stakeholders (Catherine Dodd, SFDPH, Oct. 16)

5.   PPACA: its current implementation in California and the effect on California  (Andrew Bindman, UCSF, Oct. 26)

6.  Health care reform and cost (Steve Schroeder, UCSF, Nov. 2)

7.   Demands on the health care professions, what types of services will be in demand and how will compensation be affected? (Janet Coffman, UCSF, Nov. 9)

8.   Improving quality: comparative effectiveness, pilot programs, etc. (Adams Dudley, UCSF, Nov. 16)

9.   Effect of PPACA on public programs (Medicaid expansion, CHIP, Medicare donut hole, Medicare Advantage) (Mark Smith, CHCF, Nov. 30)

10. The future: Is the PPACA just a starting point?  How do we move beyond this law to improve care and coverage?  Can this happen politically? (Hal Luft, PAMFRI/UCSF, Dec. 7)

Photo by Susan Merrell