A fine balance needs to be found between caring for individuals and caring for the larger community of which they are a part. Much of this comes down to how resources are managed and allocated, so in this guide, I will be talking to you about everything you need to know about Resource Allocation, including specifically for the context of medical school interviews.
Written by Rozh Akram
What is Resource Allocation?
You’ve probably all heard of the fact that in the NHS, we have limited resources and we need to be mindful about how and who we allocate our resources to. The ideology we use to allocate resources is called Utilitarianism.
Utilitarianism
The definition of Utilitarianism is as follows:
Utilitarianism – the doctrine that actions are right if they are useful or for the benefit of a majority.
So in simpler terms, this means the actions we do should provide the greatest good to the greatest number of people.
So in simpler terms, this means the actions we do should provide the greatest good to the greatest number of people. Vaccinations, for example, benefit many at the expense of a few. Fluoridation of drinking water and public health measures such as sanitation can also raise social and political issues.
Resources have to be rationed at 3 different levels:
- Macroscopic: What percentage of the nation’s resources should be spent on healthcare?
- Mesoscopic: How should this healthcare budget be divided up between the different fields? This is overseen by the Clinical Commissioning Groups, advised by NICE.
- Microscopic: Differentiating between patients by individual practitioners- need to use the 4 principles with the greatest focus being on justice, i.e. how to decide that one patient gets treatment over another.
Each of these issues should be made with the principles of Utilitarianism in mind, but this is value laden and so ignores the old and the chronically ill, who may have a lower quality of life.
Peak efficiency of resources may not always fall in line with the four pillars of medical ethics or the NHS’s Core Values, so both principles must work side by side, often leading to compromise. This is where two other theories come into play:
Libertarian Theories
These emphasise individual liberty and are implemented in USA, encouraging a free market in healthcare services, including body tissues, organs and babies.
Egalitarian Theories
To believe in equality of distribution unless an unequal distribution would work to everyone’s benefit. This system tries to create a decent minimum, as in the Oregon Health Plan and the criteria are based on feasibility in cost-benefit analysis of treatments.
Why Is Resource Allocation So Hard For The NHS?
A common reason for this is money. Remember that everything costs about 100x more than what you think it’s going to, and you’re always going to have to balance the good of the many vs. the good of the individual. When it’s down to the major governing bodies that have to allocate resources, they use a very utilitarian view and try to help the most people, even if this sometimes leaves vulnerable people behind.
However, as we’ll see, there are other factors that affect the available resources of the NHS, many of which come down to political or societal reasons.
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Difficulties in Resource Allocation
Resource allocation isn’t easy, especially when budgets are squeezed by governing bodies. As of 2024, the NHS is struggling with several resource challenges that impact patient care and service delivery:
Organ Availability
The shortage of donor organs remains a significant issue. About 7,000 patients are on the waiting list for organ transplants, but only 4,000 transplants are performed each year due to the limited supply of organs. This mismatch leads to long waiting times for those in need.
NHS Staffing
The NHS faces a critical staffing shortage, with over 112,000 vacancies across various roles. This includes approximately 40,000 unfilled nursing positions. These gaps result in increased workloads for existing staff, contributing to stress and burnout, which are major issues within the healthcare system.
General Resource Constraints
Financial and infrastructure challenges further strain the NHS. Hospitals and clinics often operate at full capacity, struggling to keep up with the demands of an aging population. Outdated equipment and limited funding exacerbate these issues, leading to inefficiencies and longer wait times for treatments.
Data gathered from the NHS Digital and The BMJ.
These statistics highlight the ongoing struggle of the NHS to provide timely and effective care amidst significant resource limitations.
Example Medicine Interview Questions - Resource Allocation
So reflecting on what we’ve learnt, it is quite understandable that NHS staff and doctors will have to make really difficult decisions about who to allocate resources to and it’s absolutely crucial everything is done with empathy and understanding of the sensitive nature of each situation.
Since this is such a pressing issue in the field of medicine, there’s a chance you may be asked about it in your interview. Here are some potential questions you could be asked:
1️⃣ What do you understand about the limited resources at the NHS right now?
2️⃣ Why do you think we have finite resources at the NHS? Why do you think we have such issues from the first place? What would be some solutions?
3️⃣ If you had 40 million pounds, how would you go about investing in primary care and why?
4️⃣ You have one genetically compatible liver and three patients, an unemployed former alcoholic mother of 3 children, a lawyer with an overly active immune system, and a 17 year old who suffers from non-alcoholic fatty liver disease . Who will you give the kidney to and why?
That last one is particularly interesting and could be asked at either a Panel interview or MMI. Not only does this test your understanding of resource allocation but also requires you to consider medical ethics, so let’s take a look at one and consider how we would answer it:
Medical Ethics Scenario - Resource Allocation
An ideal answer to this question could contain the following:
- Weighing up the reasons for each patients.
- Implementing the four pillars of medical ethics.
- Explaining the idea that alcoholism is self-inflicted but as a health care professional and a doctor we shouldn’t be judging our patients.
- Mention of age and Quality of Adjusted Life Years (A quality-adjusted life year (QALY) is a unit of measurement that combines a person's length of life with their health-related quality of life (HRQOL) to assess the overall health of a person.
- Acknowledging the fact that doctors will have an impartial role for this and would not make making a decision like this on their own.
- Strong communication and empathy displayed, as well as an overall answer as to who would get the liver.
Here’s how I would consider answering the question:
This is a challenging scenario that requires careful consideration of the ethical principles involved. As a healthcare professional, I would need to balance the four pillars of medical ethics when making this decision
In this case, all patients are seeking the liver transplant, so autonomy might not significantly tip the scale toward any one individual.
Beneficence and Non-Maleficence require us to act in the best interest of the patients and to do no harm. The unemployed mother of three might have previously struggled with alcoholism, which could be viewed as self-inflicted harm. However, as healthcare providers, we must avoid judgment and focus on her current health status and her role as a caregiver to her children.
The lawyer’s overly active immune system might complicate the success of the transplant, increasing the risk of rejection and harm. The 17-year-old, despite being young, has a severe liver disease through no fault of their own, and their young age suggests a potentially high benefit from the transplant with fewer complications.
Justics requires us to consider the fair distribution of healthcare resources. We can consider the concept of Quality-Adjusted Life Years (QALY), which is important here.
The 17-year-old potentially has the most life years ahead, with a high potential for a better quality of life post-transplant. The mother, while older, has dependents who rely on her, which adds a societal value to her survival. The lawyer, although facing a challenging immune condition, could still contribute significantly to society if the transplant is successful.
In reality, this decision would not be made by one doctor alone. A multidisciplinary team would evaluate the medical, ethical, and social factors in each case. The team would likely include ethicists, social workers, and medical specialists to ensure a fair and balanced decision is made.
However, using my understanding of the situation, I might lean toward prioritising the 17-year-old due to their potential for long-term survival and high QALY, which aligns with the principles of beneficence and justice. However, the mother’s role as a caregiver could also heavily influence the decision, depending on the support available to her children if she were not to survive.
In this scenario, it’s essential to communicate compassionately with all parties involved, ensuring that each patient and their family understands the reasoning behind the decision. The decision-making process must be transparent and grounded in ethical principles, aiming to achieve the best possible outcome for all involved.
Never fall into the trap of saying that somebody deserves treatment more than anybody else (the elderly, the obese, smokers) but say that certain factors such as age or lifestyle choices can cause certain groups of people to go overlooked or, perhaps, be overrepresented at the expense of the care of others.
That’s all you’ll need to know about Resource Allocation for now. While all doctors will need to make these decisions on a day-to-day basis, it’s very rare for an individual to make a singular decision that will have a significant impact on many different lives.
If you’d like to see more examples of potential interview questions, we’ve got 240 available right here. Plus, we have a bank of ethical principles and topics that will help you prepare for anything your interviewer might bring up.
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