High level health

But the constant stress that accompanies their fast-paced lives puts senior executives at increased risk for cardiovascular disease, musculoskeletal disorders and psychological distress. And people at the top—who tend to have a relatively high threshold for stress—generally won’t stop for a little self-care. But without it, the stakes are high—a company’s survival can hinge on the health of its senior team. Enter executive health programs that offer thorough evaluation and efficiency, and even save lives.

“You don’t always think about your health as the number one issue, even though you probably should,” says Lynton Wilson, chairman of CAE Inc. and chancellor of McMaster University. While at the helm of BCE Inc. in the 1990s, Wilson didn’t even have a family doctor.

That’s not unusual. An estimated 4.1 million Canadians don’t have a family doctor. Even with one, it can take days or weeks to get an appointment—six months or more for an annual physical exam. All-too-brief visits with the doctor and long waits for specialist referrals add up to one reality: a regular health exam is an untenable prospect for busy executives.

Bridging the gap
Executive health programs have cropped up across Canada to bridge the gap between executive needs and an overburdened healthcare system. In 2002, 42% of CEOs and 37% of senior executives took advantage of privately funded annual medical exams. By 2008, these figures jumped to 91% of CEOs and 83% of executives.

Many of the programs focus on early detection and prevention. Montreal-based Medisys Health Group has six executive health clinics across Canada. In 2008, the company served 16,000 executives, doubling its growth over five years. “Executives have very specific concerns, needs and stresses in their lives that are not met by our current healthcare system,” says CEO Dr. Sheldon Elman. “We have responded by providing one-stop shopping.”

Medcan Health Management is also seeing more executives. In 2008, the company grew on two fronts: the client service area now occupies over 20,000 square feet and its staff numbers over 200, including a team of 40 physicians. Chairman and CEO Shaun Francis says his Toronto-based company’s services “are completely beyond the bounds of what our healthcare system can support, and far beyond what a family doctor has the time to provide.”

At Foothills Health Consultants in Calgary, a dramatic ongoing expansion will help the company meet the demand for these programs in Alberta. Business development director Kelly Blackshaw says, “We’ve designed programs that identify health risks earlier and provide tools for our clients to manage or eliminate those risks.”

In Ontario’s Muskoka cottage country, another facility, Greenestone, opened its doors in June 2008. It provides executive health and wellness retreats that not only educate executives about health risks, but also emphasize lifestyle and life balance. Their goal? “To produce a healthier, happier, more productive workforce,” says Greenestone General Manager, Kim Leslie-De La Cruz.

One-stop shopping
For busy executives, the efficiency of executive health programs is a big draw. Health assessments are typically scheduled over a three-to-four-hour block in one day. They usually include a risk review, exhaustive physical exam, lengthy doctor-patient consultation, exercise and nutrition assessment, psychological evaluation, and a detailed follow-up report—all handled by a multidisciplinary team that includes physicians, nurses, exercise physiologists, nutritionists, physiotherapists, optometrists and life coaches. It’s a lot, but “the assessment is timely and does not require six different appointments over the course of several months. This is very attractive to our clients,” says Sanjay Shah, president of ExecHealth, an Ottawa-based health management company.

Donna Clark, national manager of payroll and benefits at Gowlings, one of Canada’s largest national law firms, agrees. “Lawyers are busy people. A comprehensive assessment organized in one visit is very appealing.”

While tailored to time-pressed executives, a health assessment builds in significant face-to-face time between client and physician—at least one hour—that both clients and doctors welcome. “When we bring in new physicians who have been in regular practice, universally they come to me and say, ‘This is the way I’ve always envisioned delivering quality care,'” says Dr. Elman.

A better bottom line
Better health can mean a better bottom line. “Healthy people are more productive and are away less often,” says Blackshaw. A 2002 study of 1,773 executives found that those who participated in regular executive health assessments lost 45% fewer workdays to illness. For Wilson, a long-time Medisys client, the investment in executive health programs is well worth it. “Anything that can help prevent executive disability is a great thing.”

Improved productivity is another plus. “Encouraging partners to be proactive about their health is a benefit not only to them but to the firm,” points out Clark. “For Gowlings, having healthy partners contributes to the firm being healthy and providing service at the highest level.” Leslie-De La Cruz believes that a healthy executive can improve overall workplace wellness. “If you commit to making small changes yourself ” you will influence those around and below you.”

Executive health programs also give HR executives another edge. “More and more HR departments are telling us that these programs are crucial for recruiting and retaining top executives,” says Shah. “Not having a program can be a real deal-breaker.”

Too much care?
But executive health programs aren’t universally popular. A recent editorial in the New England Journal of Medicine slammed them as “bad medicine.” One reason: an overly inclusive physical exam. Dr. Trevor Theman, registrar of the College of Physicians & Surgeons of Alberta, agrees with that assessment. “While some screening manoeuvres, like mammographies for age-appropriate women, are beneficial for the general population, screening a healthy person with a whole raft of tests doesn’t make sense,” he says. Take a CT scan of the heart. Leading experts assert that the potential harms of routine screening in low-risk adults—mainly exposure to excess radiation—exceed the potential benefits.

Program providers in Canada address this concern by basing the selection and frequency of screening tests on a client’s risk factors and evidence-based recommendations. This means, for instance, that a CT scan of the heart would be reserved for clients at a higher risk for coronary heart disease, and a CT scan of the colon—called virtual colonoscopy—would be done no more than every five years. Dr. Elman says, “There is a risk/benefit calculation in everything we do.” Francis adds, “We only do tests where the clinical evidence shows there is a net benefit. We do a base level of tests for all clients and then tailor testing to gender, age, family history and symptoms.”

For Dr. Theman, the most problematic issue is preferred access. “The idea that you get preferred access if you can pay is, in my view, antithetical to the whole idea of equity. Patients should get access based on their need, not on their ability to pay,” he says.

Not surprisingly, executive health providers have a different perspective. “It doesn’t fit with our philosophy to say that every single person should have the exact same level of healthcare,” notes Francis. “Medcan is charging for a service that the government has decided it won’t pay for and, frankly, due to economic constraints, never will.”

Saving lives
Despite the critics, the potential to save lives offers compelling support for executive health assessments. While no published studies have examined the association between executive health programs and mortality rates, the data on detection of previously undiagnosed disease is persuasive. In 2007, Medcan diagnosed cancer in 39 clients, cardiovascular disease in 1,313 clients and diabetes in 319 clients. Overall, previously undetected disease was detected in 20% of clients, a third of which may have been life-threatening if untreated. ExecHealth and Foothills Health Consultants quote similar figures of 30 to 35%.

“We are looking for a needle in the haystack, a strategy that is not supported by a mass population health approach,” says Francis. “But if you’re one of those 39 people with cancer, chances are you would want to know about it. We’re helping to manage health on an individual basis and the numbers don’t lie.”

A Gowlings partner, diagnosed four years ago with a potentially life-threatening illness, is living proof. What’s more, Clark says, “He is our greatest advocate for convincing partners to pay closer attention to their health.”

Lynda Cranston is a freelance writer in Toronto.

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© Copyright 2009 Rogers Publishing Ltd. This article first appeared in the January/Feburary 2009 edition of WORKING WELL magazine.