Dean's Blog

It is irrefutable that fresh, wholesome food is necessary for good health. It is similarly undeniable that many people in our country lack the ability to acquire good food. Tragic but true in a land as well to do as the United States. Recently, new information has emerged about this not so new problem, a problem with dramatic health consequences. We all need to pay attention.

The Institute of Medicine (IOM) recently released an important report, “Hunger and Obesity: Understanding a Food Insecurity Paradigm” (IOM article). This extremely comprehensive publication arose from a meeting convened in November, 2010 by the IOM on behalf of the Department of Agriculture’s Food and Nutrition Service.

But let’s start with the taxonomy surrounding the spectrum of “Food Security” (access to nutritional, safe food coupled with the ability to acquire these foods in a socially acceptable way) at one end to “Hunger” (the uncomfortable painful sensation due to lack of food) at the other. Toward the “Hunger” end of the scale is “Food Insecurity”, defined as “limited or uncertain ability to acquire acceptable foods in socially acceptable ways”.

At the very least, this IOM treatise summarizes much of what we already know about the problem. While perhaps intuitively obvious, the data are stark reminders. Before 2008, the prevalence of food insecurity in the U.S. was between 10-12%, highest among Latinos and African Americans. In 2008, this jumped to 15% – the correlation with the beginning of the recession is striking – where it has remained since.  Food insecurity is highest in new immigrants, not surprisingly; imagine the challenge in arriving in a new land and not having enough to eat, perhaps coupled with a dim chance of employment on the horizon. Interestingly, however, food insecurity is not synonymous with poverty; the definition of food insecurity includes challenges in access to and acquisition of healthy foods, regardless of one’s ability to pay.

Let’s go back for a moment to the title of the IOM report – “Hunger and Obesity”.  Hunger AND Obesity? Yes. While the association of food insecurity and obesity in children and adolescents is somewhat variable among published studies, healthy nutrition is obviously based on not just quantity, but quality. So it does appear that obesity is a problem among the food insecure. Of note, among those with food insecurity, the prevalence of lower obesity is observed in the persistently poor who lack both food quantity and quality; food insecurity among those living below the poverty line approaches 40%.

Negative health outcomes arising from food insecurity exist: hypertension and elevated lipid levels are increased, but also diabetes. In those homes with significant food insecurity, the risk of diabetes is twice that of households with no food issues. Additionally, the finding of increased stress and depression among the food insecure is no surprise either.

Having the financial wherewithal is only part of the cause of food insecurity. A big part but, nonetheless, only a part. In fact, it is very possible to be food insecure in the United States where causality is significantly related to access – easy, convenient and safe access to acquire healthy, affordable food. Areas without such access are designated by another new phrase – Food Deserts – defined by the USDA as “low-income census tract[s] where a substantial number or share of residents has low access to a supermarket or large grocery store”.   By the way, much of CMSRU’s own neighborhood in Camden, NJ, has been identified as one of these Food Deserts (see the USDA’s Food Desert Locator here).  And there is one more important variable – “Food Literacy – that is, having enough of an understanding of nutrition and food to select appropriate food items.  In an upcoming blog, I’ll be writing more about food deserts and food literacy.

So perhaps the “formula” is this:

Financial Resources + Food Access + Food Literacy = A nutritional and balanced diet that will support good health.

Shouldn’t this be possible? As health professionals, we have an obligation to our communities to help ensure that the most fundamental needs are met – the needs that will help foster well-being. The health and human consequences of doing less are not acceptable.

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University

Medical schools educate adults. That’s a simple (and obvious) fact, but it has important implications for how we at CMSRU have designed our curriculum.  A great deal has been written about adult learning. Some of the earliest and most influential work on this topic was done by Malcolm Knowles, a late 20^th century American educator, who called the field of adult education andragogy (literally translated from the Greek as “man-leading”— although which we wish he would have called it enilikasagogy, or “adult-leading”).

Adults want to know what they are expected to learn.  Recognizing this, we have designed all our courses and learning experiences by first explicitly developing the goals and objectives that will drive the content, instructional methods and assessments. These will be readily available to all students in advance.

Adults also like to know why they need to learn something. They want to be able to see the applicability of their knowledge. This led us to allow much of the curriculum’s content to emerge through robust exploration of realistic patient cases, rather than just through subject-driven lectures.  (Indeed, only six hours per week are allotted to formal lectures in our curriculum.)  Through case-based learning, students can a) see the immediate relevance of the presented material to the practice of medicine and b) determine what additional information they need to obtain to “solve” the case.  It is exactly this   motivation to “find out more” that drives much of the life-long learning that characterizes the best physicians.

Adults bring a wealth of life experience to the learning environment, and we are recruiting a charter class that is characterized by great diversity of cultural, social, economic and educational backgrounds. Adults learn best in a classroom atmosphere that is informal and friendly, where a sense of mutual respect exists between the teacher and the student, and which provides opportunities for them to share their unique understanding of the material with other learners.  We expect our students to learn a great deal from one another.  To take maximum advantage of this learning opportunity, we have allocated 25% of the week’s schedule to small groups (Active Learning Groups) of eight students each.  Each group has two faculty facilitators who serve as guides to the students as they explore the material.  In their role as a “guide on the side,” facilitators recognize that all the participants contribute to the group’s understanding of material.

Finally, adult learners have a concept of themselves as self-directed rather than dependent learners, and their motivation to learn is internal rather than imposed from outside (e.g., teachers, parents).  Recognizing this, we have allocated 25% of the week’s schedule to self-directed learning (SDL).  Students may use this time to explore topics in greater depth or to learn new material, working alone or in groups of their choosing.  Crucial to the success of such self-regulated learning is reflection.  Students will share their thoughts about their SDL experiences: what they learned; why they learned it; whether they thought the experience was fruitful, and why (or why not); and what the next steps might be.  This sort of “metacognition” (knowledge of our own cognitive processes) enhances learning and creates a firm foundation for successful life-long learning.

By building our curriculum on the tenets of adult learning theory, we have created the blueprint for an enjoyable, productive and cooperative learning environment that will lay the groundwork for success as a physician in the 21^st century.

Cindi Hasit, PhD
Assistant Dean for Faculty & Student Assessment & Development
Cooper Medical School of Rowan University

Lawrence S. Weisberg, MD
Assistant Dean for Curriculum – Phase I
Cooper Medical School of Rowan University

In our ongoing series of guest bloggers, Dr. Harry Mazurek, Associate Dean for Research for CMSRU discusses the challenge of developing our research mission – and the guiding principles behind that process.

As a new medical school, one of the challenges faced by CMSRU is deciding the direction of our research endeavors.  It is “research endeavors” rather than just “research” because there are two equally important and vital components.  The first component is scientific inquiry and the ability to push the frontiers of science.  Exciting and often idealistic, it is what draws people to science, as ultimately the goal is benefit to humanity.  Much less appreciated is the second component, the infrastructure needed to do support research – the people, the space, the regulatory issues, and ultimately, the money.

Using a nautical analogy, before eager sailors shove off in search of adventure, it is imperative that their course be feasible given the size and capabilities of the ship, the capacity of stores on board, the prevailing and predicted weather, and how crowded the waters are.  Similarly, CMSRU has much to consider before embarking on our research “adventure.”  To this end, a broad based committee is developing a research strategic plan that we hope to complete this spring.  With representation from our basic science and clinical faculty, engineering, life sciences faculty from Rowan University, faculty from the Coriell Institute and the University of the Sciences in Philadelphia – both with which CMSRU has an academic affiliation, and  computational and integrative biology faculty from our neighbor in Camden, Rutgers University, we have developed our research mission:

The research program at CMSRU is committed to a collaborative approach to conducting the highest quality research and advancement of knowledge in order to provide our students with opportunities to develop critical thinking skills and empower CMSRU to make discoveries in the art and science of medicine and healthcare delivery aimed at improving the health of our community.

Ultimately, we hope to achieve our research vision:

To be a high caliber, nationally recognized, scientific program committed to the translation of discovery and innovation directly benefiting patients and the public at large.

During the next several months, the committee will be determine research priorities based upon realistic, consensual and measureable goals and arrive at objectives and action plans needed to meet these goals.

It is imperative that CMSRU be deliberate before embarking on research given “the prevailing and predicted weather and how crowded the waters are.”  While the very recently signed spending bill has NIH funding increasing  1% from last year, it is significantly below the inflation rate.  Thus, it would be foolhardy for CMSRU researchers to compete for a shrinking pool of federal support in the same research areas as those from very large, well-established research-based  centers.

Ultimately, research is a business.  And just as industry has used the competitive strategy model developed by Harvard professor Michael Porter, similarly, our research strategic planning process will help us find niches where we can effectively compete for research funds.  One such area stems from our efforts to address the healthcare challenges facing the residents of Camden – research in the science of healthcare delivery.  Another, research in medical education, takes advantage of the fact that we are a new medical school using a very innovative curriculum and approach to educating our medical students, very different from that offered in long established schools.

The CMSRU research strategic plan, once complete and implemented, will afford our students many opportunities to participate in meaningful and innovative research projects whose outcomes will translate into benefits for our patients and the public at large.

Harry Mazurek, Ph.D.
Associate Dean for Research
Cooper Medical School of Rowan University

Over the holidays, one of the cable stations showed a marathon of Dr. Kildare movies and, as a fan of old movies and of Dr. Kildare, I watched a fair number.  I hope that some readers will remember Dr. Kildare.  No, not the 1960’s TV series with Richard Chamberlain as the young Dr. James Kildare, but the 1940’s series of nine movies with the late Lew Ayres in the lead role. Now for a little background.

The fictional Kildare was an intern receiving his post-graduate education at Blair General Hospital, under the mentorship of the irascible and cranky-yet-underneath-there-beats-a-heart-of-gold Dr. Leonard Gillespie, played by the wonderful actor Lionel Barrymore. The wheelchair-bound Gillespie is the master clinician, an incredibly astute diagnostician, and educator. In “Dr. Kildare Goes Home,” Kildare has just finished his internship and, as was commonly the practice 70 years ago, prepared to enter clinical practice. Gillespie offers young Kildare a position as his partner – a fabulous offer indeed.  Yet Kildare chooses to go home to Parkersville to help his overworked and incredibly stressed out physician father. The young doctor conceives the idea of he and two of his internship colleagues opening a practice there –  a clinic that provides health care services to the community,  funded by a 10 cent per week contribution by all local residents. Under this plan, everyone will have access to care that is funded by the community, regardless of the individual’s ability to pay. Is this beginning to sound familiar?

Now recall that Medicaid funding of health care for those unable to pay was still some 25 years away when this movie was made.  Based on historic inflation rates, 10 cents in 1940 is worth $15.66 per week in 2011, or a little over $800 per year.

The citizens of Parkersville are skeptical of this unheard of concept and are quite resistant to converting to such a system. This also sounds somewhat familiar, right? Well, as luck would have it, the newly trained Kildare becomes concerned that  George Winslow, a community leader and major opponent of the proposal, is ill and offers to “run some tests.” The skeptical Winslow adamantly resists but the clever new physician obtains a blood sample (by somewhat less than ethical means) and learns that Winslow has a elevated white blood cell count suspicious of an infection.

Somehow, Kildare is able to diagnose pneumococcal meningitis (I admit I am mystified how he did this based on an almost total lack of signs and symptoms of the disease, but I digress). Kildare successfully treats the community icon. Winslow recovers and convinces the city to support Kildare’s health care delivery plan. For now at least, the city of Parkersville is happy and healthy!

Like all of the Dr. Kildare movies, there are lessons to be learned and “Dr. Kildare Goes Home” is no exception. Many of Kildare’s ideas about public financing of health care have come true. Yet, resistance to new ideas about access to care and the funding thereof remain ever present.

The day after I watched this movie, I came upon a piece from “The Atlantic” entitled “The Year in Preview: The Top 10 Politics Stories to Watch in 2012” (read it here). Included on the list is health care reform, specifically The Affordable Care Act, and the upcoming court challenges to the legality of the nearly two-year old Act. While 28 states to date have filed challenges, the Supreme Court will hear the challenge from Florida to the law, which specifically argues that the requirement for individuals to buy health insurance is unconstitutional.  With arguments scheduled to be heard in March, and a decision anticipated in June, there will be ample time for the Court’s decision to impact the Presidential campaign – and the ultimate election outcome – in a big way.

While the new and unique 1940 ideas of Dr. Kildare about insurance and funding were ahead of their time, the Parkersville-like controversy remains.

Buckle up – the year ahead should be very interesting!!

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University

It’s the time of year when “lists” begin to appear in the media documenting the “Top Stories of the Year”.  In looking at a few sites over the last several days, it is not surprising that the lists are very similar: the earthquake in Japan, the Arab Spring, Osama Bin Laden’s death, Libya, Occupy Wall Street, Gabrielle Giffords’ shooting, the death of Steve Jobs, etc., etc.  I think it is fair to say that all of us were touched by these stories in some way, as well as by the other events that warranted designation among the “elite” group.

While the “CMSRU Top Stories of 2011” weren’t of the same magnitude, we nonetheless had some pretty wonderful accomplishments during the past 12 months, many of which are detailed in the Dean’s Blog and elsewhere on our website.

As we plan for 2012, it is a little daunting to think about how quickly this year has passed. It was December 10^th, 2010 (it seems like yesterday!) that we sent our 2,000+ page database to the Liaison Committee on Medical Education for Preliminary Accreditation! After taking a few days off for the holidays, our team began the New Year energized about preparing over next 20 months for the arrival of the charter class.

The activities undertaken and completed since last January are too numerous to recount here and this is not the time or place to do so. Suffice it to say, I am extraordinarily proud of all that we have accomplished – we are on time and on target for August 13, 2012, the first day of Orientation for the Class of 2016!

Our trajectory is true and we are exceeding all of our important milestones – but we are really just beginning to build a medical school that all of southern New Jersey can be proud of – a school that will graduate the kind of physician that every one of us would want to care for our families. To help us develop the resources needed to do this, we have just launched our initial philanthropic initiative at CMSRU, the “2012 Legacy Society”.   This program was developed especially for those who believe, as we do, in this rare opportunity to help change the way in which physicians are educated – to help train those doctors who are distinctly recognized as CMSRU graduates.  For those who are able to support the school at levels of $1000 and above, you will become members of the CMSRU 2012 Legacy Society.  To learn more about the 2012 Legacy Society, go to http://www.rowan.edu/coopermed/giving/.

So as we turn the page on 2011, we at CMSRU owe a debt of thanks to so many who have supported and assisted us – this “list” is also too long to include here. We would not be here without you.

Finally, the CMSRU team offers our very best wishes to you and yours for the holidays and for a rewarding and healthy 2012.  To those of you who have tracked our progress and who have followed us on Facebook, Twitter and this website, I promise you that the year ahead will be even more exciting than 2011 as we bring CMSRU to life and as we begin to educate the next generation of physicians.

Stay with us!!

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University

While biomedical research has led to great strides in medicine over the past 75 years, it has often been accompanied by egregious harm perpetrated on human subjects in the name of medical science.   Physician scientists, often reflecting cultural norms of the time, sacrificed patients in the pursuit of medical advancement, assuming that the ends justified the means.  All too frequently, it was only after intervention by outsiders that the practices used in these trials were brought to light, and we were forced to take a hard look at the human toll and ethical ramifications of this research.

Only after abhorrent practices were “discovered” post hoc (using ever-evolving ethical norms) did we apply regulatory constraints to prevent future insults to trial participants.  Nazi experimentation on concentration camp prisoners came to light at the Nuremberg war crimes trials and resulted in the Declaration of Helsinki in 1964.  From that document was formulated a set of ethical principles for medical research involving human subjects, and the concept of informed consent was established.

In 1972, the decades-long Tuskegee syphilis experiment came to the attention of the US public.  Poor, rural African-American men who erroneously believed they were receiving treatment for “bad blood” were, in fact, having the progression of untreated syphilis observed and reported by US government investigators.  In part due to public outcry, the Belmont Report was issued in 1979, establishing the Office of Human Research Protection.

Henrietta Lacks, an African-American woman who died of cervical cancer in 1951, became the unwitting source of a cell line used by researchers in academia, industry, and NIH for over 25 years.  Her story – and the story of how her cells came to be used without her or her family’s knowledge or consent – is told in The Immortal Life of Henrietta Lacks, authored by Rebecca Skloot.  CMSRU hopes to host Ms. Skloot in the fall of 2012 to discuss the racial, economic, and education issues that allowed this happen.  It is an important story that we hope will prevent future transgressions.

In our efforts to address and study the healthcare challenges facing the residents of Camden, we envision CMSRU becoming a research leader in the science of healthcare delivery.  It will be imperative that the research be “Community Engaged Research” – inviting active community participation in study design, recruitment of subjects, conduct, and sharing of data.

We must always remember that while “Camden is our classroom; Camden is our home,” Camden is not our laboratory.

Harry Mazurek, Ph.D.
Associate Dean for Research
Cooper Medical School of Rowan University

On Wednesday, CMSRU was very proud to receive an SNJ Business People Impact Award for our contribution to economic growth in southern New Jersey. At this very early stage of our development, we truly appreciate this recognition – even before our Medical Education Building is completed and before our charter class begins their education next August.

But there is more to come for CMSRU and for Camden and the region. Medical schools have been demonstrated to be big economic engines. Given the challenges the country is facing, we are very pleased as a new and growing school to be able to play a part in reversing the current economic situation.

In 2009, the Association of American Medical Colleges (AAMC) published data gathered by Tripp Umbach that measured the impact of AAMC member schools and teaching hospitals. In 2008, the total was more than $512 billion and more than 3.3 million full time jobs. Surprising to me at least is that this number of jobs equates directly or indirectly to one in every 43 wage-earning positions!

So how do these numbers add up? In addition to employment opportunities, medical schools and teaching hospitals and their staffs spend money on goods and services; spending by medical students and patients and their families also contribute significantly. As the AAMC points out, these are “direct” expenditures – these dollars “re-enter” the economy through re-spending by those who received the funds initially thereby generating a “multiplier” effect. Tripp Umbach data indicate that in 2008 this multiplier was 2.3, generating an even greater return!

For CMSRU, one of the ways in which this community benefit is now being realized is through the construction of our $139 million, 200,000 sq. ft. Medical Education Building. We’re very proud that this magnificent structure is being built primarily by New Jersey-based companies at a time when the construction industry is struggling. The purchase of the bricks and mortar, plumbing, lighting and the too numerous to count building components from local companies is having a positive impact as well.

We are delighted that local residents are being put to work; we track the number of workers on site and where they are from. The “metric” of hours worked by city of Camden and Camden County residents is above benchmark – and we hope it becomes the new standard against which other projects are measured. As the number of workers grows to up to 350, we believe this will increase even further.

But beyond the construction of this building, we anticipate many economy-boosting effects from CMSRU, such as the over 100 employees located in this building plus the 400 students  who will eventually  study, live and spend in the city and region.

In a recent blog, I wrote about the social missions of medical schools and the metrics associated with these missions.  Part of that social mission includes supporting our community – not just supporting physical health, but economic health as well.  We hope the next economic “annual physical” demonstrates that the patient is on the mend and well on the way to robust health!

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University

Last year at this time, I wrote a blog in which I listed some of what we at CMSRU were thankful:

• • Strong institutions in Rowan University and Cooper Health System with social missions committed to the region
• • A great history of education at both institutions
• • Active participation by broad constituencies in the creation of our school
• • Impressive bipartisan support at the state level
• • A state-of-the-art Medical Education Building now under construction
• • A planned curriculum aimed at preparing our graduates to practice in the changing health care landscape

The past year has gone quickly by and we are again appreciative of these things – but this year we are grateful for so much more:

• The admission of the Charter Class. It’s hard to put into words how exciting this is for all of us! Exciting not merely because we get to interview bright and committed young men and women who are interested in careers in medicine, but exciting because we are identifying future students who are energized about the chance to live our mission. The remarkable commitment to serving those most in need of care, their desire to venture as “pioneers and partners” with us to shape the future of medical education and care, their willingness to explore new ways of thinking and learning – these attributes will ensure our success. Our city and region will reap the benefits of the skills, competence, and enthusiasm that these new CMSRU physicians, the Class of 2016, will bring to the community.

• A growing faculty of true believers. Starting a new medical school and moving the medical education compass is not for everyone. CMSRU could easily retreat into becoming a “me too” medical school – but that’s not what we are about. Our 400-plus faculty members are leading the efforts to do something different, to do something special. This is reflected in our admissions process, curriculum and service experiences. Our faculty doesn’t want a medical school that is a mirror image of other medical schools – they want to be leaders, not followers.

• A clear vision for the future. The process of accreditation and the execution of the plans for the arrival of the Charter Class in August have given us time to refine, polish and put a finer point on where we see CMSRU going as an institution. Our community partners and organizations are helping us implement the vision for the school and we are starting to see glimmers of the impact we will have. This is a critical time for us to ensure that we are headed in the right direction. We’re getting there!

• The support of our families and each other. Make no mistake – starting a medical school is heavy lifting.  There are an enormous number of moving parts and, as incredibly rewarding as creating CMSRU is, the hours are long. I know the sacrifices that are being made and the incredible support we get from our loved ones makes a huge difference – they are as much a part of this journey as anyone. We also have the great support from and camaraderie of each other on our great team. For this, I am especially grateful.

The list of things for which we are thankful continues to grow, and we reflect during this holiday of thanksgiving on how lucky we all are to be part of such an exciting and rewarding venture.  We wish the best to our friends, families, colleagues, and future students, and hope all of our readers have a holiday to remember!

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University

While my “real job” as Associate Dean for Program and Business development at CMSRU includes a myriad of planning and organizing projects that support the long term goals and objectives of the institution, I also teach and take one or two yoga classes every week.  I find that the time I devote to my yoga practice really supports the rest of my life, including my family, my friends, my career and my physical and mental well-being.

Recently, I attended the first annual Yoga Alliance Leadership Conference for registered yoga teachers.  It was an opportunity for people like me (well, sort of like me – most participants teach yoga full-time)  to learn about the various ways that yoga, mindfulness and overall healthy living can benefit one’s life and the lives of those they teach.

While I expected the majority of the conference to provide insights on how I could make my classes and my own practice more inspiring or beneficial, my greatest insight was that much of what yoga offers could provide a great deal of benefit to medical students and their educators, as well to their future patients.  I recall a few recent articles I’ve reviewed which cited studies surrounding the level of stress, anxiety and depression among the medical profession and, in particular, medical students.  A recent NY Times article stated that ‘Students enter medical school with mental health profiles similar to those of their peers but end up experiencing depression, burnout and other mental illnesses at higher rates’.

Another article in Academic Psychiatry in 2008 stated that physician impairment is detrimental to the field of medicine, since these physicians are more likely to lose their licenses and careers, and to patients, since impaired physicians deliver suboptimal care.  In the past 20 years, attention has been given to helping the impaired physician, but less attention has been paid to preventing impairment and increasing the overall well-being of physicians. One aspect of this is the promotion of positive self-care which should begin early in medical training.

Based on the above, CMSRU is considering taking proactive steps to provide new medical students with tools to take care of themselves.  Taking time to breathe, to clear one’s mind and to focus on their own well-being can only serve to nurture our students’ physical and emotional health during their rigorous medical education.  Yoga is a terrific place to start as the benefits reach beyond the physical and have the potential to enhance their future careers and patient care.  Some of the potential benefits of yoga include stress reduction, increased fitness, management of chronic health conditions and weight loss.

I also learned at my  yoga teacher training ‘vacation’ that there are many people out there already using the tools yoga provides to help  a broad array of people in need.  Take Molly Lannon Kenny, for example;  she was once a speech pathologist who turned her passion for yoga into a career in which she uses integrated movement therapy to help all kinds of patients, from those with autism spectrum disorders to PTSD.   She also started the Samarya Center, a non-profit organization dedicated to bringing the healing benefits of yoga to underserved populations.  Another teacher I met spent most of her days teaching seniors, the disabled and stressed out business people how to do ‘chair yoga’ for 15 minutes a day.

Finally, last week at the Association of American Medical Colleges, I was pleased to see an offering of yoga for attendees of the meeting; the sessions were so popular that they added an additional class. Clearly, physicians are seeing the benefits of yoga for themselves.

In short, yoga is growing by leaps and bounds across the country and there are numerous ways that it can benefit the CMSRU community.  From our students to our staff and faculty to the residents of Camden, the possibilities are endless!

Namaste

Patti Vanston
Associate Dean for Program & Business Development
Cooper Medical School of Rowan University

November 11, 2011 (11/11/11) is noteworthy for much more than the interesting numerology of the date. Like many “holidays”, Veterans Day is a time when we should all spend a few minutes thinking about the true reason for the day – giving thanks to those who have served and sacrificed for our country.

But, as is the case with most holidays, there is a tendency to quickly move on to the personal world we face.  With regard to our veterans, this transition back to our own immediate world may not permit us to reflect upon the ongoing needs and challenges that our service men and women must deal with once they leave the military.

The Department of Veterans Affairs (DVA) has appropriately taken a true leadership role in responding to these needs. The difficult economic times exacerbate many of the travails our veterans must confront as they return to civilian life. Despite the efforts of the DVA, many veterans have fallen through the cracks. Lack of work, homelessness, drug addiction, mental illness and service-related conditions and disabilities plague many of those who have served. Additionally, a growing pool of women veterans has required the DVA to expand its services to address gender-related issues.

Homelessness has become increasingly prevalent among veterans. Estimates range up to 200,000 for the number of veterans who have been homeless within the last year. In the state of New Jersey, that number may be as high as 8,000. Our U.S. senators Lautenberg and Menendez announced in July that two sites in New Jersey had been awarded nearly $2 million to help address this problem; Catholic Charities, Diocese of Camden was one of the recipients to help meet the needs in southern New Jersey. A positive step in the right direction.

For many veterans, medical problems are prevalent, including drug and alcohol dependence, suicide, post-traumatic stress disorder (PTSD) and brain injuries. Following hearings last summer that focused on long wait times for mental health services for veterans, Senator Patty Murray (D-WA), chair of the Veterans Affairs Committee, called on the VA to survey their behavioral health providers to determine the extent of the problems. The September report of this survey, “A Query of VA Mental Health Providers”, indicated that there is a considerable need to improve timely access to care, in part due to an inadequate number of providers and limited space for care delivery.

The increasing number of women, who now account for about 8% of all veterans, has also required additional services. The Women Veterans Health Strategic Health Care Group was created in 1988 to help meet these needs. Women veterans are considerably younger than their male counterparts: 48 versus 63 years, respectively. Of note, the three leading diagnoses for women accessing VA health services are PTSD, depression and hypertension. Roughly one in five women veterans seen at DVA facilities reports that they have experienced military sexual trauma (MST) defined as “experiences of sexual assault or repeated, threatening acts of sexual harassment”.  Significant problems, indeed.

All health care providers, regardless of whether or not we practice within VA health care facilities, need to be cognizant of these challenges. It is incumbent upon us to ask our veterans seeking care about these issues. While these medical and behavioral health problems are not unique to our veterans, we must pay special attention to this at-risk group.

Not only on this Veterans Day, let us be continually mindful of the ongoing needs of those who have served us.

Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University