Impact of the Affordable Care Act on the Cooper Women’s Care Center

Background: The Affordable Care Act (ACA) increased access to women’s health care by expanding Medicaid eligibility and requiring that insurance plans cover many gynecologic preventive services at no cost to patients. Before implementation of the ACA, pregnant women with low incomes qualified for Medicaid but childless adults of the same income did not, and though prenatal obstetrical visits were covered by plans at no or low cost to patients, most gynecologic services required out of pocket payments. Objective: This study aimed to identify changes in the types of visits (gynecologic or obstetric) and patient demographics (including age, race, and insurance type) at the Cooper Women’s Care Clinic (WCC) as markers of the impact of the ACA. Methods: This is a cross-sectional study that utilized billing data from the Cooper WCC to understand the changes in visit type and demographics (age, race, and insurance type) over two pre-selected time periods, pre-ACA (2005-2009) and post-ACA (2011-2015). Our primary outcome was the proportion of total visits for each time period that were gynecologic vs. obstetrical. Our secondary outcomes were patient demographics, including age, race, and insurance type. Results: The proportion of gynecology visits in the post-ACA time period increased (71.4%) compared to the pre-ACA time period (62.7%), a statistically significant change (p\u3c0.0001) Conclusions: Our study demonstrates measurable changes that occurred in an urban Ob/Gyn practice as a result of the implementation of the ACA. Using gynecology visit volume as a marker of expanded access to Medicaid and free preventive services, it is clear that the ACA is changing the type of care provided by ob/gyns

How often do medical students change career preferences over the course of medical school?

Abstract Introduction During the preclinical years, students typically do not have extensive exposure to clinical medicine. When they begin their clinical rotations, usually in the third year, the majority of the time is spent on core rotations with limited experience in other fields of medicine. Students then must decide on their careers early in their fourth year. We aimed to analyze how often medical students change their career preferences between the end of their second and their fourth year. Methods We conducted a retrospective, cohort study using the American Association of Medical Colleges Year 2 Questionnaire (Y2Q) and Graduating Questionnaire (GQ) from 2016 to 2020. Results 20,408 students answered both surveys, but 2,165 had missing values on the career choice question and were excluded. Of the remaining students, 10,233 (56%) changed their career choice between the Y2 and GQ surveys. Fields into which students preferentially switched by the GQ survey included anesthesia, dermatology, ENT, family medicine, OB/GYN, pathology, PM&R, psychiatry, radiology, urology, and vascular surgery. Many characteristics, including future salary, the competitiveness of the field, and the importance of work-life balance, were significantly associated with a higher likelihood of changing career choices. On the other hand, having a mentor and the specialty content were associated with a lower likelihood of change. Conclusion A majority of students switched their career preferences from the Y2Q to the GQ. Additional research should be focused on curricular design that optimizes student satisfaction with career decisions. This may include early integration of a variety of specialties