Louisville Medicine Volume 63, Issue 5 | Page 36

SPEAK YOUR MIND If you would like to respond to an article in this issue, please submit an article or letter to the editor. Contributions may be sent to [email protected] or may be submitted online at www.glms.org. The GLMS Editorial Board reserves the right to choose what will be published. Please note that the views expressed in Doctors’ Lounge or any other article in this publication are not those of the Greater Louisville Medical Society or Louisville Medicine. ALWAYS AN AFTERTHOUGHT Mary G. Barry, MD Louisville Medicine Editor [email protected] N ever a priority: that’s the way US female veterans feel about the care they’ve received from the VA. Currently, women account for a bit more than 15 percent of active duty personnel, and about 30 percent of post-9/11 veterans, the highest percentage of women ever to need care from the VA. Fifty-seven percent of female veterans have a diagnosis qualifying them for disability in the VA system, compared to 46 percent of male veterans, according to a VA report from Feb 2014. In 2008, recognizing that women would need all kinds of services, the VA began an investment of $1.3 billion to improve women’s health care. Yet today, one-fourth of VA hospitals have no designated gynecologist, and about 15 percent of primary care outreach clinics have no doctors or nurses who specialize in the care of women. According to 2014 VA records, nearly two-thirds of female veterans have a VA-qualifying disability based on injury or illness of the musculoskeletal system; over one-third have substance abuse or mental disability. However Dr. Patricia Hayes, then the VA’s chief consultant on women’s health affairs, said that the VA typically covers all gender-specific health care for women, with the exception of IVF and abortion. The VA’s stated goal is to have a GYN-trained doctor or PA or Advanced Practice Nurse in every one of those outreach clinics. Women who must drive miles and miles to get OB care or GYN care are supposed to be reimbursed by the VA for travel costs. This is a particularly sore point on the female veterans’ message boards. They must navigate the federal paperwork over 34 LOUISVILLE MEDICINE and over and over for basic health needs, and afterwards are still refused payment because of delays in processing the paperwork, delays that they could not control or even know about. If they deliver a baby emergently instead of in the planned “window” of labor and delivery by due date, they may not be reimbursed at all because of the change of date – counter to the official policy, but subject, as always, to the people on-site processing the request. They have to fight a bureaucratic battle for their primary, everyday health needs, which male veterans do not. Wait times for women, because of the lack of providers, are longer even than for men. A woman with several disabilities who needs multiple clinic appointments might well despair. Women of child-bearing age – the great majority of post-9/11 veterans – are also far more likely to be given medications dangerous for those who might turn up pregnant. Nearly half of them had been in the VA’s internal study, as compared to one in six women with outside providers. Half is a very, very bad number, considering that from a young age doctors are drilled to consider the effects of all medicines on pregnant women. Assuring that older female veterans get mammograms has been an area of focused effort for the VA, but because so many are done outside the system, getting the results back to women has been slow and frustrating, with nearly double the wait for women who anxiously seek their results. But the biggest problem facing the modern military and our veteran care networks is that of suicide. Suicide rates among those actively serving are viciously high since 9/11, compared to those who fought in previous wars. Tragically, the rates rise even more for veterans. Typically, data on women (always the afterthought) did not come to light until t