WSJ – Americans Cut Back on Visits to Doctor

July 29, 2010

Americans Cut Back on Visits to Doctor

NOW THAT I AM ALMOST 64

Now that I am almost 64, who will meet my needs when I am 84?

BLOGGER: DEBBIE HEISER

AUTHORS:

Deborah Heiser, Judith L. Howe, Robert Maiden, Beverly Horowitz, Pat Brownell

When you think of growing older, what comes to mind?  Fun, family, golf, workforce issues…?  Workforce issues?  Yes, workforce issues.  Believe it or not, we need to pay very close attention to them.  Each day 8,000 baby boomers turn 60.   In 2011, 78 million baby boomers will begin to turn 65. The Bureau of Labor Statistics (2005) estimates the demand for employment in aging will increase 26% over the next few years – particularly in health related jobs.  All the while, those 85 years and older are the fastest growing segment in the U.S. population.  This age group is expected to double in 2030 to 9.6 million and to double again by 2050.

Unfortunately, there is a down side to all of this longevity.  There is a HUGE need for a trained workforce to serve the aging.  According to Boxer and Collins (20007), 8 out of 10 older adults have at least one chronic illness and, of those, about 2/3 have multiple chronic conditions that require complex treatment and coordinated care.  Maiden, Chireac, and Maiden (2002) found that 50% of people requiring in-home care are 85 but older-family members find it difficult to secure, manage, maintain, and pay for adequate in-home assistance.  To met the demand, we need 36,000 certified geriatricians; we only have 7,128 in the U.S.  Despite the demand, and the increase in demand, the supply of in-home workers remains very low and is expected to remain low.  Even those who are available receive very little training and are then asked to perform functions they are not adequately trained for (Maiden & Maiden, 2004). Only 5% of social workers are trained in aging issues and only 3% of advance practice nurses specialize in aging.  “Besides being inadequately prepared in geriatrics, the current workforce is not large enough to meet older patents’ needs. and the scarcity of workers specializing in the care of older adults is even more pronounced” (Institute of Medicine, 2007, p. 5).

To determine what was going on in education, Dr. John Krout, a professor in New York State and a Past President of the State Society on Aging of New York, recommended taking a look at the New York State Institutions of Higher Learning.  Based on this recommendation, an inventory of all schools within the state was conducted.  The findings were astonishing!

Of 242 schools in higher learning:

Note  ***Only one school, now defunct, offered a PhD.

The State Society on Aging of New York (SSA) and The State Office on Aging of New York (NYSOFA) teamed up in 2007to create the Workforce Project charged with understanding training needs in the State of New York. The SSA and NYSOFA conducted a series of 8 Listening Sessions across the State.  The notes taken during each of the Listening Sessions were compiled and a content analysis was conducted to systematically identify key words and phrases used at each Session to determine important structures and themes.  The results are based on ratings provided by three independent coders who identified and tallied themes discussed at each of the Listening Sessions.

A total frequency and percent of discussion associated with each key topic was determined for each of the seven major discussion questions that framed the Listening Sessions.

The 7 Questions asked at each of the 8 Listening Sessions were:

Question 1:
Do you see a need for more education about aging staff in your organization?

Question 2:
On what topic would you like to see more education?

Question 3:
How should training / educational opportunities be presented?

Question 4:
What credentialing and certification should be considered?

Question 5:
Should gerontology be infused into college curricula?  Across disciplines?

Question 6:
What is the ability of organizations to support education/training for employees

Question 7:
Other comments

The Top 10 Key Findings were:

žThe findings from the Listening Sessions, as described in the Content Analysis show that a variety of issues were brought up.  Some were brought up only once, and some several times.

The organizations collaborated again at the SSA’s Annual Conference in 2008 to discuss the findings and “next steps” with 120 conference participants.  The participants completed questionnaires.  Notes were taken and were reviewed for key themes with regard to the four workforce training and education questions posed to the group. The results are broken down by question:

Question 1:
What do you think are good next steps we can take?

The overarching theme for this question was education. Forty seven percent (47%) of the responses and notes highlighted the need for education from k-12 and.  Additionally, they recommended educating college students earlier in their undergraduate education, and employing online education.  Other responses with suggested sensitivity training for gay/lesbian issues in training aides, elder abuse training, expanding nursing programs, fully funding GECs, emphasizing Geriatrics as a career, exposing teachers to SSA and Teach for America, and grassroots efforts.

Question 2:
Of the top 10 key issues identified, what do you see as the most important to focus on?

There were three distinct themes for this question.  Thirty nine percent (39%) of the responses advocated education, 39% training, and 22% financial aide and incentives.  With regard to education, the responses were: education for k-12 and all curriculum, college students receiving education earlier in their undergrad education, and online education.  Training responses were: aide training, caregiver training, and work-site training and mentoring.   Financial aide and incentives were not broken down further.

Question 3:
How can we – area agencies, academics, practitioners, and government – work together to move workforce education and training issues forward?

There were two distinct themes for this question with 42% of the responses advocating financial solutions (financial aide and incentives, support the Boxer Bill, and fully fund GECs) and 31% supporting increased education (education – k-12 and all curriculum, online education, and pilot curriculum programs for secondary education

Question 4:
Can you think of any other incentives for promoting education and training in aging?

Nearly 67% responded that there was a need for community service for high school students; approximately 33% responded that there is a need for increased payments and reimbursement for medical and social services.

Recommendations coming out of the Next Steps, SSA conference, mirrored the listening sessions.  They focused on education (k-12 in particular, and online training).  Responses for education were addressed in questions 1-3, and for two of the three questions, was a top response.

NowWhat?

We must now move toward addressing the issues brought up by New Yorkers as key workforce issues.

Let us know what you think!  Leave a comment below!

To read the full report published in 2008 by NYSOFA, please go to the State Office of Aging of New York Website: http://www.aging.ny.gov/ReportsAndData/WorkforceEducation/Introduction.cfm

To read this article on the SSA website, please go to: www.ssany.org

To become a member of the State Society on Aging of New York, please go to: www.ssany.org

To find out more about Dr. Heiser, click the photo below:

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Mammogram Morning

Mammogram Morning

BLOGGER:  ARIN GOLDMAN

Though October may be the official breast cancer awareness month, January is the month I have my annual mammogram.  As the daughter of a breast cancer survivor I am always nervous before my “mammo” but I have managed to control my apprehension level by following an annual routine.  On mammo morning I go for a run, shower,  resist the urge to put on deodorant, get to the radiologist’s office early and, once told  that my scans are clean, breathe a huge sigh of relief, schedule next year’s appointment and go out for something chocolate.  I had no reason to believe that last year’s routine would be any different but it was:  I flunked.

After taking the normal set of pictures, the technician came back to take another one of my left breast.  Since it is not that unusual to need a do-over or two, I was not  initially alarmed but that changed when she kept coming back for still more shots.  On the fourth take I started to hyperventilate and called for the as yet unseen radiologist who appeared to calmly explain  (just to be clear – she was calm, I was not) that the scans had located a cluster of micro-calcifications within my left breast, something that wasn’t there last year.  She explained that a micro-calcification cluster could be an early stage of breast cancer.  While she reassured me it was likely to be nothing, she said that it was important for me to have a biopsy and offered up an appointment for a stereotactic needle biopsy. Though I had little idea what that was I took the next available appointment for the following Friday, thankful that she did not think it was an emergency, but still very spooked.  When nothing else showed up on my accompanying sonogram,  I left the office clutching a piece of paper with the instructions for how to prepare for day of the biopsy, thoroughly confused by what a cluster of calcifications was and what I really should do next.

Ten years ago when my mother had needed a breast biopsy it was performed by a surgeon.   Was a radiologist the right specialist for this procedure?  I thought that I was medically savvy, but I had no idea what a stereotactic biopsy was, nor what it entailed.  I always scheduled my mammogram to take place mid-week because early on I had decided that if a problem was ever detected I would want to use one of my life lines and “call an expert” right away without any weekend interruption.  I was relieved that this year was no different and immediately called a high school friend,  a surgeon who headed up the breast cancer unit of a major medical center.   She confirmed  that times had changed with the less invasive stereotactic needle biopsy procedure replacing the scalpel for evaluation of calcifications like mine.  She also verified that this was a procedure best performed by a skilled radiologist.  Familiar with my radiologist and comfortable with her capabilities, she recommended that I go ahead with the procedure making sure to copy her on the results in case further action was required. 

Having contacted the expert, my next step was a Google search.  The ability to research medical conditions firsthand is a bit of a mixed blessing, there is a great deal of information available on the Internet but  alot of it is alarming.  Still  despite my jitters I needed to know more so I started surfing.  It did not take long to locate the information I was seeking. Individual calcifications generally do not raise much concern and frequently are just monitored closely.   However, micro-calcification clusters could be nothing at all or a stage zero or stage one form of breast cancer called ductal carcinoma in situ (DCIS).   While the term stage zero might sound pretty innocent, treatment involves both a lumpectomy and a program of radiation, not the news I wanted to hear but what I needed to know.  In terms of percentages, what the doctors had described as a highly unlikely chance of cancer was referred to on the web as a 15 to 20% probability. Thought not as much of a slamdunk as I hoped for, the odds were in my favor  that  this would  turn out to be nothing and if it was cancer my mammogram would have served its purpose by catching it at a very early, treatable stage.

On the day of the biopsy I arrived at the radiologist’s office still unsure of all the procedure entailed but anxious to get it over with.   First I was asked to lie down on a table with my breast positioned over a large hole.  A position as awkward as it sounds. A number of scans were taken to insure that I was positioned so that the targeted calcifications were accessible to the doctor. Given the location of my cluster and the modest size of my breast I had to be pan-caked into the table before the desired view was achieved and then, with the help of a few clips, I had to remain still for the next 45 minutes or so while the biopsy was completed.  The doctor had explained that this was the hardest part of the biopsy.  Awkwardly clamped to the table I found myself hoping that she had been telling the truth.  Fortunately it turned out that she was right, although very uncomfortable, there was nothing painful about the procedure itself.  After injecting my breast with a local anesthetic, a shot less painful than one at the dentist’s office, the radiologist employed a mechanically guided needle to individually remove each of the calcifications.  Once removed, a tiny tag was inserted into my breast to assist in the identification of the site in case any additional procedures were necessary.  No stitches were required; the radiologist merely covered the needle hole with a water proof bandage and  made me promise to wear a jog bra at all times for a few days for compression, to restrict my activities and to keep the wound site dry through the weekend so that there would be no bleeding or scar.  I went home, took it easy overnight, and then spent the weekend walking my dog with one arm,  replacing my usual run with time on the elliptical machine and trying hard to banish any alarming thoughts from my overactive brain.

On Monday, earlier than expected while I was in the shower examining the tiny red scar on my left breast, the doctor called with the best of all results. Everything was fine, my cluster was benign; no additional actions were required.  After the call, I dried off and got dressed, made an appointment for next year’s mammogram and went out for that much deserved chocolate anything.  One year later I am happy to report that this year’s mammogram morning went off with out a hitch.

To find out about Arin, click here to read her bio.

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