Editor’s Note: Below is the third of three posts on providing care to members of the military, veterans, and their families. Read additional perspectives on this issue. Be sure to also read the commentaries by Gleeson and Hemmer and by Lee et al, which are online now.
By: Kristin Berg, MD, Gail Gunter-Hunt, MSW, LCSW, and Molly Carnes, MD, MS
The influx of veterans from the wars in Iraq and Afghanistan is one of several contemporary challenges facing the U.S. health care system. Efforts by the First Lady and the Joining Forces Initiative have drawn the attention of the public and the medical community to our veterans’ health care needs. The recent “wait list” dilemma has cast unfavorable light on systemic flaws in the ability of the Veterans Health Administration (VA) to respond to this growing demand. Although clinic appointment wait times may be no worse or even better than outside the VA, we have a special obligation to provide timely quality care to those who put themselves in harm’s way in the service of our nation, as Gleeson and Hemmer and Lee et al argue in their recent Academic Medicine commentaries.
In addition to the overall increase in the numbers of veterans, the demographic is also changing. The proportion of women veterans is projected to reach approximately 18% of the total veteran population by 2040, from less than 10% in 2010 (1). Women veterans have sex/gender specific health care needs. There are routine issues faced by all women: family planning, cervical cancer screenings and prevention, breast health, osteoporosis, and hormone replacement options to name a few. There are also military-specific issues: military sexual trauma affects nearly one in every four women who serve in the military (2), and returning women veterans face specific reintegration challenges, such as limited social support, homelessness, mental illness including PTSD, and different physical health problems than men (3).
The VA is taking a systems approach in tackling the challenges of providing care to women veterans. All VA medical centers must have a full-time women veterans program manager and designated women’s health providers. Performance measures include adherence with cervical and breast cancer screening guidelines. The VA provides a maternity care benefit as well as 7 days of infant care postpartum (3). Last year, the VA contracted with a company to make lower extremity prostheses that included a foot shaped to wear a moderately high heel for women veterans with lower extremity amputations so that they could dress in accordance with female gender norms. Women’s health provider mini-residency programs began in 2008 and have since trained nearly two thousand health care providers on women’s health care issues, procedural techniques, and screening guidelines. Teleconferencing and educational meetings are routinely available on specific women’s health topics. The VA trains more physician leaders in women’s health than any other organization: since 1996, they have run 8 fellowship programs around the country. In 2012, these fellowships expanded beyond physician trainees to include non-physician fellows in women’s health, and a coordinating hub site was funded to foster cross-site collaboration.
We as health care providers have a duty to understand the issues facing the new generation of veterans. This includes providing high-quality, gender-sensitive care to the growing population of women veterans. This charge falls upon both VA and non-VA providers. Gleeson and Sanders reference that 80% of the nation’s medical schools are affiliated with a VA, which ensures that providers and trainees at those institutions have access to women veterans educational activities and the opportunity to care for women veterans through collaborative agreements. Providers also can encourage their veteran patients to participate in outreach events sponsored by the VA, even if that patient isn’t registered within the VA health care system. For additional information, including information about health care services at the VA, providers and patients can reference the U.S. Department of Veterans Affairs website.
While this challenge of caring for the increasing and changing Veteran population is daunting, VA and non-VA providers are rising to meet the challenge. And perhaps there is truth to the saying “there’s no such thing as bad publicity,” as long as the outcome helps us take care of the Veterans and service members who keep our country safe.
Dr. Berg is an advanced fellow in women’s health, William S. Middleton Memorial Veterans Hospital; clinical instructor, Department of Medicine, University of Wisconsin-Madison; and MS candidate, Department of Population Health Sciences, University of Wisconsin-Madison.
Ms. Gunter-Hunt is the women veterans program manager at the William S. Middleton Memorial Veterans Hospital. She provides oversight and leadership for the Women Veterans Health Program and coordinates high-quality interdisciplinary health care services for women within the medical center and across organizational elements at the VA network level.
Dr. Carnes is director, Center for Women’s Health Research, and professor, Departments of Medicine, Psychiatry, and Industrial & Systems Engineering at the University of Wisconsin-Madison. She directs the Women Veterans Health Program at the William S. Middleton Memorial Veterans Hospital Geriatric Research Education and Clinical Center.
- National Center for Veterans Analysis and Statistics. Quick Facts: Veteran Population Projections. http://www.va.gov/vetdata/docs/QuickFacts/Population_quickfacts.pdf. Accessed 07/03/2014.
- U.S. Department of Veterans Affairs. Mental Health: Military Sexual Trauma Fact Sheet. http://www.mentalhealth.va.gov/docs/MST_FaceSheet_April2014.pdf. Accessed 07/03/2014.
- Gunter-Hunt G, Feldman J, Gendron J, Bonney A, Unger J. Outreach to Women Veterans of Iraq and Afghanistan: A VA and National Guard Collaboration. Federal Practitioner. 2013; 30: 25-31.