ASPIRING HEALTH PROFESSIONALS’ HEALTHCARE REFORM ORIENTATIONS

Future Health Professionals

Running head: FUTURE HEALTH PROFESSIONALS’ HEALTHCARE REFORM

ORIENTATIONS: A QUALITATIVE CONTEXTUALIZATION

Future Health Professionals’ Healthcare Reform Orientations:

A Qualitative Contextualization

Joel B. Goodin, PhD

Vanessa M. D’Brot

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Submitted to Florida State University Undergraduate Research

Journal

October 31, 2013

Introduction

“Less than a decade away from becoming a doctor, I need to start thinking about my future.

The reform was a change that I had not prepared for.”

~Undergraduate Pre-health Student

One of the most “tangible” ways that Americans show

opposition or support for an idea is through their voting

behavior. For the last 100 years, Republicans and Democrats have

been proposing healthcare reform, but only in 2008 did an actual

legislative push gain substantial traction. The Obama

administration and Congress successfully passed the Patient

Protection and Affordable Care Act (ACA) on March 23, 2010,

despite a divisive vote 219-212 (with 34 Democrats joining the

opposing Republicans), perhaps foreshadowing years of contention,

repeal attempts, and the government shutdown of 2013.

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The United States’ substantial undersupply of physicians and

other healthcare providers (currently approximately 66%), already

grappling with the increased needs of the aging “Baby Boomer”

generation, will only be exacerbated by an approximated 32

million newly-insured citizens resulting from the ACA.1,2 In the

midst of a changing healthcare landscape, the end goal of the

current research is to provide information that can be used to

better understand factors that affect “potential” (future)

healthcare providers so that the areas of need can be

strengthened.

The importance in understanding the factors that drive and

deter future health providers (e.g., physicians) is essential to

ensuring the success of the healthcare system and to maintaining

or improving the quality of care provided to US citizens. The

political emphasis surrounding healthcare is currently elevated,

with the birth pains of the ACA Individual Mandate and the recent

government shutdown, both in October of 2013. The ACA requires

systemic change as the healthcare system makes strides toward

assisting underserved populations. That shift may require

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adjustments to Health Education to guide and support students

toward areas of need within their changing career fields.

Health policy and educational researchers have a unique

opportunity to understand and influence health education during a

time of change and great need. The current study is one of many

studies of future healthcare providers facilitated by Author2 and

his colleagues. Their studies have focused on the development and

implementation of a healthcare reform perceptions instrument3,4

and the identification of determinants of specialty choice such

as self-efficacy and a calling to a career,5 community-based

training,6 political alignment,7 and cultural background.8

In contrast to the studies of medical students, the current

study seeks to understand how undergraduate pre-health students'

perceptions and goal-orientations may have changed as a result of

ACA effects on their future professions. It was hypothesized that

the undergraduate students were comparatively less invested

(time, finances, energy) than the medical students in similar

previous studies.3 Perhaps the ACA has spurred more consideration

among pre-health students with regard to alternative career

options. The current qualitative study is a preliminary analysis

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of undergraduate pre-health students, with the purpose of

providing a valuable analysis of the pre-health students'

cognitions, motivations, and emotions regarding the ACA, as the

foundation for a larger-scale mixed method study.

In the research presented here, the researchers were

interested in understanding how pre-health students’ orientation

to the ACA results in emotions, motivations, and behaviors (i.e.,

Reaction)3,4 toward a health-related career. The researchers were

particularly interested in how each orientation would show

students’ degree (strength of opinion) and direction

(support/opposition) in the operationalization of their views

exhibited by their past and predicted future voting behavior. The

following section includes discussion of relevant theories.

Theoretical Frameworks

The current study was built on Locke’s9 Goal-setting Theory

and Inglehart’s10 Critical Life Event Theory. The pursuit of a

health-related profession is a long-term commitment to a goal

which is often made before a student reaches the undergraduate

level. Based on Author2’s3,4,11 findings, medical students differ

in how they perceive and respond to the ACA. Thus, understanding

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pre-health students' ACA perceptions is an important factor in

predicting and preparing for a changing healthcare system (i.e.,

adequate supply of physicians).

Goal-setting Theory9 describes how goals and motivations are

interconnected. Goals guide and direct human effort and behavior.

In order to stay on course to goal completion, a person must

overcome obstacles and avoid distractions that may deter them

from their prospective goals.12,13 In the current study, the

effects of ACA implementation on the healthcare system will be

evaluated as a possible “critical event” (deterrent or

attraction) for undergraduate students with health career plans,

such that it may affect their motivation and cause a modification

of goals, as was discussed in previous research by Author2.3,4

Inglehart10 described a critical life event as a positive or

negative event that elicits (a) tension, regardless of the

positive or negative perception of the event;14 (b) appraisal of

the stressor’s relevance and the resources with which to maintain

equilibrium;15 (c) cognitive re-evaluation of goal

attractiveness;16 and (d) stability or decrease of goal

commitment.17 It was unclear to what extent pre-health students

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might experience tension, appraisal, re-evaluation, and goal

commitment changes in light of the ACA.

Research purpose

The purpose of the current research was to examine the ways

in which undergraduate pre-health students’ retrospective and

current accounts of their political and professional motivations

converge to affect their current ACA perceptions. The goal was to

understand the extent to which the ACA was a relevant issue and

students’ responses to said relevance in terms of attention and

evaluation of the law and its possible personal or social

ramifications. Perceived relevance played a large role in

determining an orientation toward the ACA that was associated

with stimulation of information-seeking behavior, a decision of

ACA support or opposition, or stability/modification of goals to

decrease potential risk or discomfort in students’ future

careers. The researchers were particularly interested in

exploring characteristic differences in the individuals that held

similar philosophical and political ACA orientations, their

career goal stability, and variance in their respective cognitive

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appraisals (attention and value) of the ACA and its possible

effects on their personal lives, social environments, and

professional careers.

Methods

In order to explore individuals’ ACA orientations from 2012

to present, the researchers took a cross-sectional, retrospective

approach. In doing so, the researchers chose to survey a variety

of undergraduate students who were in the College of Human

Sciences at a large, southeastern university. In particular, the

researchers inquired about students’ career plans, and their

statements regarding ACA-related variables: attention,

importance, knowledge. Additionally, the researchers studied the

students’ responses regarding the influence of the ACA on their

attention, voting behaviors, and their self-regulatory thoughts

and behaviors of redirection processes (e.g., career goal

modification).

Subjects

Purposive sampling was implemented in order to target

subjects that would be able to provide research-related

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information. In other words, the sampling served the purpose of

gaining information from those who would find the subject of the

study (pre-health ACA orientations) to be most relevant and

would, thus, have the greatest likelihood of having attended to

and evaluated the ACA. Therefore, as part of a larger study of

pre-health students’ goals and beliefs during a time of change in

the healthcare landscape, the researchers were able to obtain

qualitative information in addition to the quantitatively-focused

study through the inclusion of demographics and free response

items. The exploration of retrospective accounts of ACA-related

beliefs and behaviors was used to compliment current beliefs and

behaviors with enhanced clarity and insight.

The researchers collected 44 subjects’ demographics and free

responses to career- and ACA-related prompts. Participants’ ages

ranged between 20 years and 26 years; the mean age was 21.2. Of

the total, 36 of the participants were female (81.8%); eight were

males (18.2%).

Qualitative Responses

As part of the larger, multivariate study of pre-health

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students, the participants completed the entire survey, including

the qualitative questions, in the days directly after the

government shutdown of 2013. It should be emphasized that

contention surrounding the ACA was considered to be one of the

most influential factors leading to the government shutdown. The

primary research question, “What are the most common orientations

of pre-health students toward the ACA?” had the purpose of

gaining an understanding of how students were attending to and

reacting to the ACA with respect to its relevance to their future

professions. It is important to note that the study’s purpose was

not to identify support or opposition to the ACA, but rather to

ask for open-ended responses to glean the important themes from

students’ statements.

First, given a list of the most common health-oriented

professions, students were asked to indicate their most likely

career choice. They were then asked to respond to the question,

“How has the Health Care Reform affected your current career

plans?” Participants then indicated the political party with

which they usually align, the candidate they voted for in 2012,

the amount of attention they have paid to the ACA, their current

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level of comfort with the ACA, the extent to which the ACA played

a role in their voting choice in the 2012 Presidential Election,

and the extent to which they believed the ACA would influence

their vote in the 2016 Presidential Election. Finally, with

regard to their vote in 2012 and their predicted vote in 2016,

each participant was asked to respond to the prompt, “Please

explain in 1-2 sentences how the Health Care Reform affected

[will affect] your voting choice.”

Analysis and Results

The demographic data and qualitative statements and answers

were separated from the quantitative data for analysis. Based on

the process described by Strauss and Corbin,18 a grounded theory

approach was used to analyze the data. The first step in the

analysis was “open-coding,” a process that included the

construction of descriptive words or phrases that captured the

meaning of responses. Each code was then grouped into “parent”

(higher-order) categories. Categories, or themes, emerged during

the coding process, such that with each additional participant’s

statements, the researchers were able to reach theoretical

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saturation, wherein new ideas or content no longer surfaced.18

Rather, themes and phrases began to be repeated.

The major themes that emerged from participants’ interviews

were ACA-related (1) orientations (e.g., ambivalent), (2) degree

of importance (3) degree of knowledge, and (4) career goal

modification. The following sections describe examples of

students’ “orientations,” the emergent categories derived from

their responses, and a comparison across the groups with regard

to each higher order grouping in order to provide a more thorough

understanding of the ACA’s role in the pre-health student’s

cognitions and motivations.

ACA Orientations. Based on the qualitative data collected

via survey, 44 participants’ statements regarding ACA degree of

interest (i.e., how much), direction (i.e., for, against, or

undecided) produced 6 themes or viewpoint categories based on

consistent emphases found in the open coding described above. The

names ascribed to the 6 viewpoints, or “orientations,” are “ACA

Supporters (Support),” “ACA Opposition (Oppose),” “Alternate

Reformers (Alternate),” “Attentive Undecided (Attentive),”

“Relaxed Undecided (Relaxed),” and “Uninvested / Disinterested

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(Uninvested).” The flowchart model in Figure 119 illustrates the

categorization process based on ACA support/opposition, promotion

of an alternative healthcare reform, and evidence of attention

and investment in the ACA.

Each group title was based on the degree and direction of

ACA support that were consistently common among the same

individuals. The most apparent and predictable groups were the

“Support” group, which was firmly supportive of the ACA, and the

“Oppose” group, which was firmly opposed to the ACA. However, a

third group, “Alternate,” opposed the ACA, but consistently

promoted the need for a “replacement,” or alternative, healthcare

reform in the United States healthcare system. Among those who

were undecided, there was the “Attentive” group, which did not

take a stance for or against the reform, but reported the

importance of watching and learning as the ACA is implemented.

Most in the Attentive group proposed to “wait and see” until it

was time to vote (i.e., 2016; approximately 3 years later) or

until they would begin a health profession (1-5 years later).

The “Relaxed” group showed no evidence of investment or

attention to the ACA, despite indications that the ACA was at

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least mildly important. In contrast to the Attentive group, The

Relaxed students lacked the motivation to pay attention to the

ACA and continue to evaluate it.

The “Uninvested” group showed complete disregard for the

subject and unwillingness to engage in the topic. Even when

probed a second time on the subject for an opinion, these

students gave repetitive answers that were almost defensive of

their indifference.

Findings

Descriptive analyses and coding of the remainder of the

qualitative data were analyzed for meaningful patterns that could

provide more depth of understanding of each of the six groupings.

Demographics provided important context to the statements of the

students and has implications for future research.

Demographics. The demographics of each ACA Orientation are

described in Table 1. The seven Support students had the highest

mean age of all six groups (M = 22.2). They were primarily

female and were predominantly Caucasian. The nine Oppose students

averaged 21.4 years of age with three females and three ethnic

groups represented. The Oppose group was balanced with four 14


juniors and five seniors. The eight Alternate students average

21.3 years of age and had the highest proportion of males (60%).

Alternate students were solely of Caucasian descent and primarily

Exercise Science majors in their junior year. The 14 Attentive

students had an average age of 20.3 with only one male and

thirteen females. Attentive students were the most diverse,

specifically including the highest proportion of Hispanics (36%).

Attentive students were predominantly Exercise Science majors and

were somewhat balanced by their representation of juniors and

seniors, while including the only sophomore in the sample. The

four Relaxed students gave no age data and all were female

seniors, representing three different ethnicities. Finally, both

Uninvested students were 21-year-old females in the Exercise

Science major. Overall, the average age of the sample was 21.2

years. Males represented only 18% (N = 8).

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Figure 1. Author2’s Model of Pre-health Student ACA Orientations19

Note: Group names were modified for clarity in the current study.

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Qualitative Findings. The six groups of ACA orientations

varied in terms of career commitment and ACA importance,

attention, and knowledge. The next section explores how the

groups varied.

Basic Political Information. The different ACA orientation groups

varied in their basic political information which included their

levels of ACA attention and comfort as seen in Table 2. With

regard to Political Party, the sample was somewhat evenly split

with regard to party affiliations (i.e., Democrats, 36.4%;

Republicans, 38.6%; Libertarians, 13.6%). However, as expected,

the Support group was primarily aligned with the Democratic Party

and the Oppose and Alternate groups were primarily aligned with

the Republican Party. It seemed noteworthy, however, that one

Support student was Libertarian. This “cross-party” behavior is

in accordance with the findings of Author2, Levey, and Author17

in their study of the influence of the ACA on voting behavior.

With regard to the Undecided orientation groups, the

Attentive group was balanced in its political alignments, while

the Relaxed and Uninvested groups were less conservatively

aligned (e.g., Democratic alignment). The Attentive group was the

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only group to represent all political parties, perhaps

emphasizing the hesitance, concern, and continued evaluation

shared across political parties.

Retrospective accounts of voting choices in the 2012

Presidential Election were mostly consistent with current party

alignment. As will be discussed in the following section,

however, it was clear from student accounts that attention to the

ACA was much lower in 2012 than at present. Nonetheless, Support

students supported Obama, while the entirety of the Oppose group

supported Romney. The Alternate group split its votes between

Obama, Romney, and Johnson. Alternate student responses indicated

that the Romney campaign (i.e., Paul Ryan) did not

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succeed in proposing an acceptable alternative to the ACA. Their

responses indicated that their future voting would be for the

candidate that proposed a viable alternative to the ACA.

Alternate students’ statements included words such as "hoping"

and "curious," and one Alternate student stated, “I will vote for

the party that proposes a better solution for our healthcare

problems.” The Attentive, Relaxed, and Uninvested students voted

along party lines for the most part, though two non-Democrats

voted for Obama and a single non-Republican voted for Romney.

Student responses regarding their attention to the ACA were

categorized as “high” (high attention) and “low” (low attention)

based on evidence found in their statements. An example of high

attention was when an Alternate student stated, “I am curious to

see what the opponents choose to bring to the table and will

decide who has the better plan to fix our now broken health care

system." Conversely, an example of low attention was when an

Uninvested student stated, "I do not know enough about the reform

to let it [a]ffect my decisions."

With regard to ACA Attention, just over half (57%) of

Support students were attentive to the reform, while the Oppose

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students were the most attentive of any group (78% attentive).

Alternate students were similarly high in their attention to the

ACA (75%). The undecided groups showed lower attention with the

Attentive group (43%) ironically trailing the Relaxed group

(50%). Though the Relaxed group reported slightly greater

attention, their level of overall investment in the ACA (i.e.,

importance and influence) was much higher in their reports.

As with attention to the ACA, students’ responses regarding

their comfort with the reform were categorized as high (high

comfort) and low (low comfort) based on evidence found in their

statements. An example of high comfort was when a Support student

stated, “The [ACA will] be beneficial since [i]t would allow more

people to see a dietician.” An example of low comfort was when an

Oppose student stated, "The reform was a change that I had not

prepared for or am comfortable with [sic]."

ACA comfort was highest for the least decisive groups

(Relaxed and Uninvested) whose members all claimed high comfort

with the ACA. The Support group (71%) was somewhat comfortable

with the ACA as was the Attentive group (64%). Both the Oppose

and Alternate groups were predominantly uncomfortable with the

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ACA. The influence that the ACA’s relevance had on ACA comfort

and support was reinforced by students’ heightened emotional

responses such as “hoping . . . a better, more affordable and

realistic option involving less government, more private

initiative will evolve.”

Voting Behavior. As illustrated in Tables 3 and 4, the voting

behaviors and motivations between the ACA orientations varied

between groups and across time with respect to their

retrospective accounts of the 2012 Presidential Election and

their plans for the 2016 Presidential Election. Students’

responses regarding the influence of the ACA on their past and

predicted voting choices were, once again, categorized as high

(high influence) and low (low influence) based on evidence found

in their statements. An example of high influence was when an

Oppose student stated, “[The ACA] is why I didn’t vote for

Obama.” An example of low influence was when an Attentive student

stated, "It did not affect my voting."

An increase in the importance (see influence and importance)

of the reform from 2012 to 2016 was a common theme among all

groups except for the Relaxed and Uninvested. For example, one

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Attentive student had a significant shift in Influence from 2012

to 2016, as is represented in the statements, "I was unaware to

the details of the Health Care Reform. I wished to be more

educated in it." (low influence in 2012) and "[S]ince it will

affect me greatly I wish to

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26


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be more aware of what I'm voting for." (high influence in 2016).

It is important to note that the increase in influence seemed to

be motivated by goal-orientation and its perceived relevance.

Attentive and Uninvested students who did not perceive the

ACA as more important in the 2016 election made abrupt statements

of disregard such as "I don't know yet." Every other group placed

more importance on the reform in 2016, as indicated by statements

such as, "Now that it is in effect, I know more about it.

Depending what happens from now till [sic] the election [in] 2016

[it] will affect my voting choice."

Varying degrees of knowledge about the ACA were apparent

through students’ responses regarding the reform and were

categorized as presence of knowledge (high knowledge) and absence

of knowledge (low knowledge) based on evidence (or lack thereof)

found in their statements. An example of low knowledge was when

an Attentive student stated, “I was unaware of the details of the

Healthcare Reform.” Knowledge about the reform was balanced

within the Attentive group, which was consistent with their

undecided stance on the reform. Attentive student statements

often included non-committal phrases such as "I will have to wait

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and see." It is important to note the relationship between

knowledge and ACA indecision within the groups.

ACA Motivations. Students’ responses regarding their ACA-

related voting motivations were categorized as social (e.g.,

universal good), personal (e.g., individual relevance),

politically-oriented (e.g., for the good of a political party),

and goal-oriented (e.g., for the good of my future career). An

example of a social motivation was "I believe everyone deserves

health care." An example of a personal motivation was “My family

has been negatively affected by it already especially my

grandparents. I will not . . . vote for it.” “Americans should

[not] be so reliant on the government and its subsidies for care

and help” was considered evidence of a politically-oriented

voting motivation. An example of a goal-oriented motivation was

“Less than a decade away from becoming a doctor, I need to start

thinking about my future. The reform was a change that I had not

prepared for.”

From 2012 to 2016, all three decided groups displayed strong

political motivation toward the ACA, especially among the Support

students. Support students were slightly more socially motivated

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than the Oppose and Alternate groups, both of whom were much more

motivated by a political orientation. Attentive students showed

high social, personal, and political motivations, while only five

students in Support, Oppose, and Attentive noted a goal-oriented

motivation, evidencing a connection between their ACA orientation

and their career. One particularly interesting quote from a

forward-thinking Oppose student evidenced a professional

motivation, saying “This will be a major part of my voting

because it will directly affect my profession.” Such forward

thought will be expounded upon in the Discussion.

Professional Behavior. Students’ professional behaviors were

discussed in terms of reactions to the reform. Reaction as

described by Author23, 4 was discussed in terms of commitment to

career choice and ACA-related modification of career goals. The

descriptive statistics regarding professional behaviors are

presented in Table 5.

Based on Author2’s4,20 Model of Activating Uncertainty (See

Figure 2), students’ responses to the effect the ACA has on

career plans were categorized by the stability/modification of

their goals in reaction to the ACA. Author2 hypothesized that

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individuals would be differentially “activated” by varying levels

of uncertainty, such that when an individual meets a subjective

“limit” of discomfort with the uncertainty in their life

situation, they take action (e.g., changing goals) to remediate

uncertainty and the related discomfort. The categories of

stability specified for the current study were “more-likely to

enter a health-related field,” “more likely to become a health

provider,” “less-likely to enter a health-related field,” “less-

likely to become a health provider,” or “no change in goals.”

Author24 noted the importance of modification in either direction

(more or less likely) to be evidence of reaction to the event,

emphasizing the positive valence of reaction (e.g., excitement)

in addition to the negative (e.g., anger).

Similarly to the ACA influence categorizations, students’

responses regarding their commitment to their most-likely career

were categorized as high (high commitment) and low (low

commitment) based on evidence found in their statements. An

example of high commitment was when a student stated, “In 2016 I

will be starting my career as a pharmacist . . .” An example of

low commitment was when a student stated, “I will be a practicing

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health care professional in 2016, so my view may change after

being directly affected by the reform at that period of time.”

Although, this student stated that they will be a practicing

healthcare professional, his statement was coded as “low

commitment,” due to the uncertainty displayed in his ACA opinions

and the possibility of direct results on the healthcare

professions by "the effects of the reform [in 2016]."

Career goal commitment was more high than low across groups,

especially for the Undecided. Support students were the most

aligned with preventative health career goals, while Oppose and

Alternate students varied somewhat evenly between career goals.

The Attentive students were predominantly invested in traditional

medicine career goals. Most Attentive students evidenced a desire

to manage ACA uncertainty in a logical manner, by watching the

implementation unfold and reserving judgment.

Although more supportive of the ACA than any other group,

Support students were one of the most diverse groups in their

reactions (i.e., career adjustments) to the ACA, second only to

the Oppose group. Support students reported increased likelihood

that they would enter health-

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Figure 2. Author2 Model of Activating Uncertainty20

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related fields and professions, though one reported a decreased

likelihood that she would become a health provider.

Students’ ACA Orientations seemed to play a large role in

their political and professional behaviors. The high levels of

attention and importance among the Support, Oppose, Alternate,

and Attentive groups seemed to invigorate heightened emotions,

voting responses, and goal modifications that fit uniquely and

differentially with each group’s philosophies and

personal/professional goals.

Discussion

The primary research question and purpose were to identify

the most common orientations of pre-health students toward the

ACA to better understand its relevance and influence in their

lives. The data illustrated that, for undergraduate pre-health

students, the ACA has different roles and influence with regard

to the students voting behavior, career commitments, and career

goal modifications based on six ACA orientations.

The three decided orientations and the Attentive orientation

all reported that the ACA was an important factor in their

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current and future-oriented thoughts. Their responses

demonstrated differences that can be explained to some extent by

the aforementioned Author2’s4, 20 Model of Activating Uncertainty,

wherein individuals differentially react or remain passive to

uncertainty in their lives. Author2, Levey, and Author1’s7 study

asserted that ACA uncertainty, operationalized as voting choice,

was activated primarily in those with conservative political

alignments. Their findings showed that, while liberally-minded

individuals also felt uncertainty about the ACA, they were more

tolerant of that uncertainty, such that they did not modify their

goals. However, in the current study using a sample of

undergraduate, pre-health students, there seems to be

modification of goals for both opponents, supporters, and those

who are attentive, but undecided regarding the reform. Those who

supported the reform often reported a firmer commitment to

health-related career goals, while those opposed to the reform

often showed decreased commitment to health-related career goals.

Perhaps Husman and Shell’s21 Future Time Perspective (FTP)

Theory provides additional understanding to the findings. FTP

Theory suggests that individuals vary in the extent to which they

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consider future goals in present-oriented decisions and

behaviors. This concept, called “connectedness,” was evidenced by

statements that indicated that the future (e.g., 3 years ahead)

was relevant. Connectedness was common among Support, Oppose,

Alternate, and Attentive students, who also consistently

indicated more knowledge about the ACA, as opposed to the lacking

evidence of connectedness or ACA knowledge among Relaxed and

Uninvested students.

The connectedness of an individual seems to provide some

explanation for the aforementioned variations in perceived

relevance of the ACA. The Relaxed and Uninvested groups did not

mention the future. It would thus make logical sense that Relaxed

and Uninvested students’ lack of perceived relevance, explained

by limited FTP Connectedness, would result in lower perceived

importance, attention, knowledge, and goal modification. In fact,

Relaxed and Uninvested individuals showed the most consistent

evidence of absolute commitment to their career goals. Though FTP

could not be presumed to explain the full extent of students’

orientations toward the ACA, it makes theoretical sense that

connectedness does play some noteworthy role. Thus, future

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research may benefit from targeted measurement of FTP variables

such as connectedness to better explain why an individual may

exhibit a specific orientation and the political and social

behaviors that they display among and across different

orientations.

With specific regard to the elevated, unyielding career goal

commitments of the two “Uninvested, Disinterested” students, FTP

connectedness could help explain what the research observed as

indifference that approached a hostile defensiveness. One might

wonder how someone so invested in a career goal could be so

indifferent to what many of their peers consider to be a

significant, relevant issue. Based on Tubbs13 views of goal

commitment maintenance, Author24,20 postulated that those who felt

that the ACA was a threatening or uncomfortable issue might not

always react. Rather, he suggested that due to the high degree of

investment, some students would avoid a realistic evaluation of

the ACA in order to protect their goal from a possible

encumbrance. Thus, Uninvested students may be avoiding cognitions

about the ACA in order to maintain their commitment in light of

their investment. Students who vary in their perceived degree of

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investment may report disparate levels of comfort with the ACA as

(a) legislation, and (b) change in their career path. Perhaps,

some students with high FTP experience the connectedness to the

future as a sort of “cognitive investment” that increases the

need to modify goals, or avoid the subject altogether.

Conclusion

Future health providers at the undergraduate level, perhaps

due to a lower degree of investment in their careers, seem to

have consider more options than those in graduate medical

training. The ACA presents change and possibility for this

specific sample of the Health Sciences students by emphasizing

preventative health public awareness and career opportunities, a

principal thrust of the reform movement. Understanding the

orientations, perceptions, and reactions of the future

preventative health workforce will be of great importance to the

successful integration of the old and new healthcare system.

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pdf.

2Association of American Medical Colleges (2012a). MSAR: Getting started, medical school

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21Husman, J. & Shell, D.F. (2008). Beliefs and Perceptions about the Future: A Measurement ofFuture Time Perspective. Learning and Individual Differences, 18(2), pp 166-175.

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Key Terms

Future Health Professionals: Also known as pre-health students. Refers to students that are preparing for one of a wide scope of medical and health careers that serve to increase or maintain a person's health. Future Health Professionals can include healthcare providers, nutrition and health maintenance, physical therapists, exercise prescription specialists, and others.

ACA: Patient Protection and Affordable Care Act, also referred toas the PPACA, the healthcare reform, the reform, the healthcare reform law, and "ObamaCare." The legislation initiated the current healthcare reform in the United States.

Preventative health: A field of health providers that focuses on disease prevention and health maintenance to improve overall long-term health status.

Calling: The presence of a feeling that an individual is called to serve in a specific career or career field

Community-based training: Also referred to as ambulatory style medicine. Abbreviated as "CBT," this type of training is emergingin medical schools in order to promote community health practice by connecting future providers to communities by serving in a variety of locations.

Traditional training- A highly structured training environment that has been the prevalent training environment for medical doctors. Medical schools often have a local "training hospital" wherein their students do clerkship experiences, wherein they apprentice under a practicing medical doctor.

Self-efficacy: Refers to an individual's confidence in his/her specific, future tasks.

Reaction: Modification of career goals in response to perceived blockage of goals stemming from a critical life event (e.g., a football player breaks his leg). This theoretical construct was coined by Author2 in 2013.

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Grounded Theory: A methodology wherein theory is developed by analysis of the data as a process of the analysis. Theoretical tenets emerge as qualitative data is analyzed for consistent themes.

Open Coding: As part of a Grounded Theory approach, qualitative data (i.e., statements and responses) are analyzed for key words and phrases that are repeated by multiple participants.

Parent Categories: Open Coding provides the building blocks of Parent categories, such that words like "energized," "excited," "ready," "prepared," or "focused," might compose a parent category of "active engagement." Parent categories are used to describe overarching themes.

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Documents

ASPIRING HEALTH PROFESSIONALS’ HEALTHCARE REFORM ORIENTATIONS