James: Hey Everybody, welcome to the Healthcare Scholar. We are an online publication, not a podcast, but today we are going to do a mini-little podcast interviewing two amazingly unique students from different backgrounds. So we have Hannah Ho, from the US, the University of Texas at Austin. And Emily from the UK. They’re both nursing students, and I’ll let them talk a little bit about themselves. Hey, welcome everyone!
James: So let’s hear a little bit about yourselves and your background. We can start with Hannah.
Hannah: Okay! I’m a fourth year nursing student at the University of Texas at Austin. In 2017 I finished a business foundation certificate, and now I’m working on a business in healthcare certificate. I’m really interested in the business of healthcare.
James: Okay, so the business side and also nursing. That’s quite the combo. What about you, Emily?
Emily: Hi, my name’s Emily Beuaie, I’m 23 years old and I’m studying adult nursing at the Sheffield Hallem University in England, which is in the North of England. I’m in my third year, which is the final year for us here in England. Yeah, that’s me really.
James: Cool, so just a brief background there. I also wonder what are the paths you took so far just to get to where you are now. We can flip around, so Emily what about you?
Emily: I didn’t always want to do nursing. In fact, I was quite opposed to nursing originally. Both my parents trained as nurses, so I wanted to do something a bit different. I didn’t want to go around and down the same path. So I went and did an English literature degree first, after I’d finished at school. So undergraduate degrees are usually three years here in England, so I did three years of English literature. Didn’t really enjoy it. Wasn’t really for me, unfortunately. Although I loved reading and loved writing, I didn’t really love the academic side of it so much. About halfway through I gave my parents the fright of their life and told them that I wanted to go do nursing! They were a bit worried that I was going to drop out of my English degree at the time. But no I finished that, I graduated, and I went straight into nursing after that. I graduated in July, and then I went straight into nursing in September of 2016. I did a bit of volunteering before that, to decide if that was actually what I wanted to do, and I realized it was. I wanted to do something more practical, I wanted to work with people, and I just think there are so many different areas you can go into in nursing. It’s a really good career, it’s so varied, so diverse, so I thought I’d have a go at it and here I am. A few years later with no regrets, I’m really enjoying it.
James: Wow, so it’s really just in your blood. You can’t get away.
Emily: No, no I can’t. We have a wide family of nurses, and my partner is a doctor as well.
James: You guys could open a whole practice together!
Emily: We actually could, it’s not a bad idea.
James: Hannah, what about you?
Hannah: So I came here straight out of high school thinking “Well I’m not sure what I want to do, so I’ll try out nursing”. And then I got into the UT program. About two years in, I started to become curious about business, and how in nursing I was just getting exposed to a lot of, you probably hear this a lot too, ‘the system is so messed up’. But then I got the sense that business people were running a lot of the things that go in healthcare, so then I thought “well, if I learn business, then maybe I could get my hands into that” and it didn’t feel like nursing could do that. So now I’m pursuing both!
James: Wow, yeah that hybrid I’m sure will serve you very well. I think that from the healthcare side, anyone who works in it should understand the big picture. That’ll be very unique and beneficial. Emily, the majority of the population that is reading and watching The Healthcare Scholar is from the United States. I’m sure they have a very big question for you, let’s jump straight into it: for you, what are the most noticeable differences in your healthcare system in UK compared to what you’ve heard about in the US.
Emily: The biggest difference I think would be, for me, and a lot of the general public of the UK, not that I want to speak for everybody… but I think generally it’s probably the financial aspects of it. From what I understand, you pay insurance. So you have different insurance companies, and then Obamacare comes into that. I was saying to Hannah earlier, I’m a bit confused on how that works, exactly. But it is very different from how it works in the UK. Because in the UK we have the National Health Service (NHS) which is free at the point of use. Pretty much everything is free. We pay for prescriptions unless you are of low income. If you are unemployed you can get your prescriptions for free. But most of us pay for prescriptions. But actuall when you go for a scan, or when you come into the emergency department, you don’t pay anything. You don’t have any bills coming up after you in the post. It’s just completely free. Although I suppose some people would argue it’s not technically free, because we do pay national insurance tax. If you’re working and earning a certain amount of money, you pay a national insurance tax that goes towards things like the NHS. So it’s not technically free, I suppose, but I suppose it’s still less than you pay in the US. That’s probably the main point of difference that I’ve noticed.
James: Ok, so not even everyone has to pay the national tax if they do not make above a certain income?
Emily: I can’t remember the exact figures or percentages of what your pay or how often. But yeah, I know if you’re unemployed… like for me I have a part time job, but I don’t make that much money compared to people who work full time, so I don’t pay any national insurance at all. So I do get it for free, but my parent and my partner do pay national insurance tax. I think it’s pretty great.
James: That’s really cool! It’s a supportive system. Hannah what do you think about our healthcare system here in the US compared to these regards.
Hannah: Ours is pretty confusing, even to Americans. Honestly, it’s called a system, but in the US it’s not actually a system, because we have private insurance companies, private hospitals, we have the VA system, which is most like the UK model where it’s government run and works for people who are government employees. But other than that, it’s a lot of public, non-profit, private, insurance companies, hospitals, individual providers, all negotiating with each other on “ok you’ll pay me this much, but another person will have a different amount they get paid”, and then you have patients that may or may not be on insurance, might have government or private insurance, and everyone pays something different. A lot more complicated.
James: Yeah, definitely I would say so. Coming from the pharmacy side myself, just pharmacy insurance and prescriptions and that whole process, there are so many different parties involved. So healthcare as a whole is crazy.
Hannah: Something that I think is so cool about the UK is that the general practitioners make more than their specialists. So about 60% of UK practitioners are general practitioners, whereas in the US I think about 30% are in general medicine.
James: Wow, I didn’t know that. Emily is that your experience, that general practitioners make more?
Emily: I didn’t know that. I didn’t really have a placement in general practice or in community nursing at all, so that’s news to me as well I suppose.
Hannah: For every patient they take, they get a certain amount of money, it’s called the cap-/???**** model. And then whether these patients come and see you or not, you get paid money. So they’re super incentivized to keep everyone healthy, and here are your flut shots, and all the preventative tests you need, and let’s not do anything extra.
James: In the US we’re also playing with the CAPTIN!?!?@?!@ model, things like ACOs, accountable care organizations, but it’s definitely not everywhere. Emily, Hannah is making you look bad, she knows stuff about the UK that you don’t!
Emily: I should’ve more research. I feel bad because I don’t know quite as much about the American system. I did try, I have tried over the years to actually try and understand it but it’s just so different from the UK. It’s hard to grasp when you’ve not grown up in that system.
James: Absolutely. Or even if you have grown up in the system it’s pretty difficult. So just based on a little bit of talk earlier, there’s something, an interesting point that was brought up: Emily, can you tell us a little bit about the waiting list in the UK?
Emily: Waiting list, yeah. I think most of us in the UK have been on a waiting list at some point. I’m assuming you mean waiting list for surgeries or appointments.
Emily: They can be very long, from personal experience. I’ve waited a few months sometimes for a scan or an outpatient appointment in a certain area. They are quite long, really. I suppose it’s for non-urgent procedures, presumably. If you’re critically ill, you will get seen and you will get treated. But yeah, they are long, they are long and quite frustrating actually.
James: Okay, so it’s kind of a triage of whoever really needs service right away is going to receive it first.
Emily: Yes, they do have certain targets to meet in certain areas. Things like oncology areas. Don’t quote me on this, but some areas I think you have to have an appointment within two weeks of seeing your doctor. They do have some limits and targets to meet.
James: That makes sense, because oncology you know, you can have a much worse symptoms or likelihood of mortality if you wait just two weeks.
James: Ok, that’s very interesting. Since our publication is all about collaboration and professionalism, Hannah, how do you feel about the state of interprofessional collaboration here in the US? In terms of what they teach you in school and also what seems to be going on in actual clinical settings.
Hannah: I think UT may or may not be unique in this, but right now I’m in an interprofessional collaborative practicum class, where they bring together social work, nursing, medical students, and pharmacy students, to learn how to work with each other. What we do, what each role does. I think it’s only in its second or third year, so in that sense, interprofessional education seems kind of new. But I heard from staff at the hospital, because I work as a nursing assistant at the hospital, that students coming out of that program, they see the difference. So that’s a good sign. For example, some of our instructors that are older, they said “we wish we had your education, because we weren’t taught to work with each other and, as physicians, we are pressured to know all the answers, but apparently medical students aren’t being taught that these days, which is great”.
James: Yeah, that’s sort of the power of collaboration. Everyone is an expert of their own area. I guess we’re seeing a trend towards moving away from the physician-centric model and to a group-practice model. But it sounds like we’re not quite there yet, from what you’ve experienced. Emily, what about you? How does it feel in the UK for how much different professions work together in terms of who’s leading care and then also how well there is communication?
Emily: In practice, from what I’ve seen on my placements, I think the professions I see do work really well together and do communicate together. There is much less of a top-down model, a lot less doctor-centric, I suppose. A lot less of “all the doctors are God, he must be right” which is the way it used to be. Back in the day, when my parents trained, there was a huge hierarchy, and student nurses were right at the bottom. Doctors were ‘the Gods’. Now it’s a lot less like that, I think. There are a lot more health professions now, there are physios, occupational therapists, and social workers, and there are volunteers as well. I think it’s really great that we have all these professions now. In our course, a bit like Hannah I suppose, we have an interprofessional education module at university. I don’t know if that’s just at Sheffield or if they do it elsewhere. But every year of our course, we come together with the other healthcare students at university. So the physios, OT, social workers, paramedics, and we all get together and maybe do a project or some group work. And then we write an assignment on interprofessional collaboration, what we’ve seen in practice. And I think that’s really good, it’s really interesting to see other students. But we don’t, one thing that is missing, is contact with the medical students. Where I am at university in Sheffield-Hallem, there are no medical students at this university, that’s at the other university in the city, the University of Sheffield. So we really only have two days over all three years where we meet them. One in first year, where we do basic life support with them at a session, and then this year we have ‘smart day’, which is about a bit more advanced life support skills. So it seems strange to me because nurses and doctors come into contact so much in practice, so I think that’s something that could be improved perhaps in the UK. But overall, it’s moving towards a more interprofessional approach. I understand with the new nursing courses rolling out, more nursing students will be in lectures with other healthcare students.
James: Oh wow!
Emily: So it won’t just be one week where you spend time with them, you’ll have actually more lectures together with them. So I’m intrigued to see how that works, to get some feedback on that.
James: Yeah, I’ve never even thought about classes here in the US where different professions would share the same class together. I think that’s basically unheard of.
Emily: Yeah, it’s quite revolutionary.
James: Yeah, you guys seem to be ahead of us in that sense. That really brings a lot of new ideas to the table. We have time for two more questions. Emily, this is interesting because we had another nurse write an article for us on the topic of gender disparities in nursing in the US. In general, in the US, men tend to be paid a little more than women, which is often not fair. At the same time, nursing is unique because it’s almost 90% women in this field, compared to men. At least here in the US. I have no idea about the UK, what are your thoughts on gender disparities in the UK for nursing?
Emily: I don’t know what the exact figures are, but it’s predominantly female. I think in my group there’s maybe one guy. It’s mostly female still. In terms of pay, or wages, I think male and female nurses are paid the same, because it’s a public sector job, so the pay is set out by the government. Everyone is paid the same. So I guess it’s fairly equal, fairly fair. I did read that article actually, from the male student talking about a patient not wanting him to care for her because he was a male student. I’ve heard that actually before from other male students on placements. Feeling anxious about that, about looking after female patients, and you know, will they feel comfortable with me looking after them. It’s something that you don’t think about necessarily, as a female nursing student. It’s not something I really think about, because it’s a more typically female dominated profession. But no I really hope that more men will apply, because I think men have many wonderful things to offer nursing as well as women. My dad is a nurse, he does a wonderful job! I wonder what Hannah thinks of that.
Hannah: Well, in my experience, on the floor at least, I heard that male nurses are really popular, because you do a lot of heavy lifting in nursing. If you’re smaller, or can’t lift something super heavy, you want someone stronger than you to help you out. If you’re a male nurse around who looks strong, everybody on the floor is going to call you.
Emily: That’s very true, my experience as well.
James: That’s a good, unique insight.
Hannah: In my class of about 60-something nursing students, we have four male students, and everyone knows their names.
James: Very interesting, so men are like celebrities in nursing, since there are so few of them.
Hannah: I also brought that up because the article talks about how it’s not always like that.
James: Final question, one thing that’s interesting here at least in the areas that I’ve practiced, is that there are a lot of homeless or underserved patients that come in without insurance or without a place to stay or without any funding. How is that taken care of in your health system, Emily?
Emily: If you’re homeless, you are treated the same as everybody else, I suppose. You receive the same free healthcare as everybody else. There’s no real difference there. In terms of social services, outside of the hospital, I’m not really sure what they’re like. I know that there are funding cuts in the UK, a lot of resources and staff in areas have been taken away, in certain social sect.s. So I’m not sure what services are available for people who are homeless, but I know that in hospital and in terms of what they pay, well they won’t be paying anything. That’s the short answer.
James: What about, you said people have to pay for their own prescriptions. When it comes to long term management, what do they do?
Emily: If you’re on long term prescriptions, I believe you can get discounts. If you are unemployed or if you are homeless, you would get them for free I imagine. You do have to fill in a lot of paperwork for that though, so that could be a barrier there. Also if you don’t have a permanent address, that could be quite difficult.
James: Hannah, what are your experiences in this regard?
Hannah: Well, for the homeless population in Austin, they don’t get healthcare until they have a life-threatening illness or if you’re a danger to yourself or if you’re drunk or high or if you’re having a heart attack. The emergency rooms are required, by law, to at least stabilize patients that come into the ER. So that’s how they usually get healthcare, and then maybe social work can discharge them to the mental hospital or back to the bridge where they came from. It’s pretty sad. For underserved patients, people with pre-existing chronic conditions that don’t have insurance, or people under the poverty line, hopefully most of them are on Medicare or Medicaid. If not, that’s tough luck.
James: On that dreary note, Hannah and Emily, I want to thank you guys very much for joining us today. It’s been very informative, a lot of unique insights into healthcare systems and also nursing in general. So thank you very much for joining us!
Hannah: Thank you.
Emily: Thank you for inviting me.
James: Alright, I’ll let you go, and hopefully a few years down the road we can bring you back on for a follow up interview!
Emily: Definitely, I’d be up for that.
Hannah: That sounds fun.
James: Alright, bye guys!