Study: Pharmacy and medical students have similar attitudes toward underserved

A recent study found slight differences in the way medical students and pharmacy students view the medically underserved. While views of medical students fluctuated more during their schooling, the medical students left with slightly more favorable attitudes toward the underserved than those held by departing pharmacy students.

The study, “A Longitudinal Comparison of Pharmacy and Medical Students’ Attitudes Toward the Medically Underserved,” was written by Sonia Crandall, PhD, MS; Stephen Davis, MA; Amy Broeseker, PharmD, PhD; and Carol Hildebrandt, BA.

The survey was given to the first-year classes at the schools of pharmacy and medicine at two Southern universities, Crandall said. Data were then compared to assess changes in students’ attitudes over time. The surveys were again completed each year of the curriculum. Scores were converted to a scale of zero to 100 and then standardized, Crandall said.

“There is some theoretical evidence that attitudes may predict behavior; thus some providers may be less inclined to provide services, especially if there is no reimbursement that can be recovered,” Crandall said. “Attitudes and behaviors are probably related to a belief about whether healthcare in America is a right versus a privilege. Not all providers may believe that healthcare is a right.”

Pharmacy students’ attitude scores toward the underserved were more stable over time, while medical students’ attitudes dipped over the period of testing, according to the study. Pharmacy students scored a 45.2 at the beginning of their first year, 48.3 in the second year, and 45.7 in the fourth year. Medical students scored a 55.5 in their first year, 52.4 in the second year, and 46.4 in their fourth year.

Crandall suggested several explanations for the results.

First, she said, pharmacy students had most of their patient contact in their fourth year. Consequently, they didn’t see as many underserved patients. “Entering pharmacy students were more favorable concerning the provision of expensive procedures regardless of an individual’s ability to pay,” the survey’s authors wrote. “However, both pharmacy students’ and medical students’ scores in this factor decreased as they progressed in their respective professional programs and as they learned more about the complexities of healthcare economics.”

Crandall also said that many uninsured or underserved patients are cared for by providers at academic health centers, so the medical students are expected to have had more experience with the population.

“Educators must consider how service-learning experiences within the formal curricula can promote ‘responsible professionalism and personal sacrifice’ fundamental to the practice of medicine,” the investigators said. “Academic health centers, although economically stressed, have a social contract to train competent professionals, improve healthcare access and quality, and grow their research enterprises prudently,” they continued.

The researchers hope educators at medical and pharmacy schools will address the findings. “Nurturing a commitment to service as part of medical professionalism is essential if we hope to address the health of those who have been marginalized in our healthcare system,” they wrote. “Educators must enhance and support inter-professional role modeling, longitudinal curricula, and experiential practice sites in order to fulfill this social contact.”

According to Crandall, if educators don’t do their part to correct the declining view, there could be negative consequences. “Most severe, I think, are the negative biases and stereotyping that can occur,” she said. “Many clinicians may be unaware that quite a few underserved patients are working but not insured, or are underinsured. Many patients are willing to pay cash for services. Assumptions about individuals who are underserved, indigent, uninsured may be totally incorrect.”