It’s very likely that in the last year, you postponed a medical appointment. It’s also very likely that it had something to do with Covid-19.

Putting off medical checkups is not a new phenomenon, of course, but the scale of deferred care doctors have seen in the last year is unique. The CDC estimates that as many as 41% of adults delayed or avoided medical care because of concerns related to Covid.

The reasons were abundant: fears about visiting health care facilities and bringing home the virus, burnout from too much work, the struggle to balance work and childcare, or the loss of employer-based health insurance. With all of these factors stressing people out, it’s understandable that routine checkups got pushed back. Even some doctors deferred their own self-care.

The result, however, can be bad for your health, as well as your finances. That’s why health care leaders are urging Americans to get back into the habit of regularly seeing their doctors.

Leah Rothman, D.O., is a family physician and the Northern California regional medical director for One Medical, a national advanced primary care provider. From Day One spoke with her about the risks of deferred care and how we can all safely return to making timely visits to our clinicians. Excerpts:

What is deferred care?

Deferred care is a reaction to Covid. We know that a lot of people during sheltering-in-place orders deferred care for things that were active issues, new things that may have popped up, chronic issues, things that they had a diagnosis for–or even things that were preventative. Because the threat of Covid was looming so large, there was so much fear and anxiety and uncertainty as to whether or not the health-care setting was a safe place to interact with.

Is this a phenomenon unique to Covid?

I think Covid has really accentuated the concept of, “I have a health care question. Am I going to be motivated to act on that question by seeking the guidance of a clinician?” In the past, I'd say delaying care was intermittent, but not nearly as large. Deferred care in the past was predominantly influenced by access. So if you had a clinical question but the next available appointment wasn't until a month out, you'd say, “Ah, what's the point? It'll probably be better by then.” So barriers to access in primary care and medicine, I think, was previously the largest influencer of whether or not somebody would engage.

Who has been deferring their health care and why?

I would be hard pressed to come up with a group that hasn't been deferring care. Adolescents defer care because a lot of times adolescents are drawn in when they're required to see a doctor for sports physicals. I've seen young adults defer care because they're working from home and they want to stay safely in their bubble. I've seen parents defer care for those same reasons, with the addition of “How do I manage everything that's going on at home?” I've seen a lot of elders defer care because they feel like they are in the highest-risk group of contracting or having a very negative impact from Covid. I couldn't tell you that there's a single group that's reliably come in during the pandemic and said, “This is great, your waiting rooms are empty, and I'm happy to be here.”

Have physicians, yourself included, deferred care?

Yes. I will say that not sheepishly or apologetically. I think it's really important for us to acknowledge that amid the fears and uncertainty, the health-care team was not outside of that. We too had all of the same information the general public had, and there were big gaps of time where we didn't know what the risk of coming to work was, or what the risks that we ourselves might bring to others.

For my own personal example, I forwent any dental-cleaning appointments in the year of 2020. It was related to that concern or the potential guilt that I would have if I exposed somebody, because here I am interacting with others with Covid testing or treating for Covid.

What are the dangers of deferring even the most routine health-care appointments?

There are a couple of things I think of as the downstream effects. The first one is that the intention of screening is to identify things early, before they get more difficult, before they get messy, before they get too big to recover from. You want to find something early so that you can make changes early and prevent it from being more costly.

The other thing that can happen is just not diagnosing something. So something that may have been found and prevented from becoming a cancer is now a cancer. And just that diagnosis alone, even if it's treatable, is something that really looms large on people's psyche.

What could be the long-term effects of delayed care for communities and populations?

What plays out in the community is highlighted by deferred care for chronic conditions. Let's say an individual has elevated blood pressure and they're seeing that their blood pressure at home is not what their provider told them is the goal, but they're not inclined to go into the health care setting. This becomes a ticking time bomb. Rather than address it early on to bring an uncontrolled blood pressure under control, it might progress to the level of being an acute issue where this person has chest pain and needs ER care.

The message we've been trying to get out throughout Covid is ensuring that people know the safety of the care that they can get in a primary care setting, so they're not postponing their own needs to the point that they have to go to the hospital, which we'd like to decongest so they can care for the most ill. But it’s also so they themselves don't have to go through the very high stakes and real risks.

What’s the first appointment someone should schedule if they’ve been deferring care for the last year?

There's no wrong visit. Even if you haven't been seen in a year, even if you think your health is optimal, there is a visit for you, and that is an annual wellness exam. It's a great way to just get a tune-up on knowledge and screening and then set you up for success for another year.

An annual wellness exam is intended to allow a conversation between the clinician and the individual to take stock of their current lifestyle and habits that will inform their health today and in the future. What are the screening tests that you are eligible for? What are the vaccines that you might be due for? What are the over-the-counter medications you're taking? And is it safe with the frequency with which you're using them?

The other thing that we've seen a lot of is deferred care around mental health, whether it was your concerns around Covid itself, the isolation that you may have felt and depression from a grief response–if you lost a loved one, a neighbor, a family member–or just the anxiety of saying, “Oh my gosh, I've lost any sense of organization to my time, I work at home, I live at home, I do child care at home, I'm a home teacher. I didn't sign up for any of this.” Pretty overwhelming.

Primary care is a great place to go when you need to take stock of how those thoughts and emotions or feelings are influencing your health or influencing your relationships and maybe even your productivity or your sleep. The beauty of primary care is that there's always something to come in for. And it's always the right place for any clinical question. If you've thought, “I'm going to Google this,” then the primary care provider is the right place to go with that question.

To what extent can virtual-care visits take the place of in-office visits?

I am delighted to say almost seamlessly for a large number of conditions. It’s about having a dialogue and the clinician asking probing questions around it and then coming up with what the plan is. In a number of instances, the exam is not the highest-value item for that discussion. So for people who aren't able to come into the office, remote visits with One Medical are a really wonderful way to stay connected. Rather than be uncertain about which one to book, I welcome everybody to book for a remote visit and know that I as a clinician will guide you if an office visit is truly warranted.

When is it safe for someone to resume their in-office health-care visits?

Today! It has been safe for a very long time to come into a doctor's office. I know each office comes up with its own tools to de-risk the office. There is not a time where I could tell you that a health-care setting is a zero-risk experience, but all of the tools that we use significantly lower the risk. Offices are a very safe place to come, not only because of the tools that we have in place, but the knowledge that we have gained over a year’s worth of information about Covid.

How will your relationship with patients and your relationship with your profession change post-Covid?

While empathy, relationship building, and interest have always been important, the opportunity for us to invite the questions and really bring our own humility into the room as clinicians and say, “Yep, that happened to me too.”

What else do you want people to know about resuming regular health checks?

I really want to encourage people to know that our offices should always be a place where there's no judgment. We can offer validation and humility as clinicians that we ourselves have had the same struggles, that we are not above them. We can use that as a bonding moment to say, “Yep, we've been there.” The important thing is not to have a lot of self-judgment around it, but rather know that we can partner together to build a plan to get back to what your idea of optimal health is.

I really want to encourage people to return to that clinical consultation, knowing that you have a champion who's looking out for your health. There really isn't any substitute for the primary care clinician who knows your health and who can make an informed recommendation. They know what's in the background and not just what's on the surface. Having a person in your corner, having a conductor of the orchestra, a coach in the room, is a great way to know that you're making really informed decisions that are based on the best evidence we have today.

Editor's note: From Day One thanks our partner who sponsored this story, One Medical.

Emily McCrary-Ruiz-Esparza is a writer, editor, and content strategist based in Richmond, Va.

Measuring What's Really Happening in the Workplace in 2024

In today’s increasingly digital and often remote working environment, software can help organizations get a better handle on how their teams are tackling challenges and discover ways to fill in the gaps. The highest performing teams are 2.6 times more likely to be investing in performance management software, according to Lattice’s State of People Strategy Report. But of those not using such software, 27% are unsure of how to begin and 22% are even concerned about the cultural implications of doing so.But what does an average day of digital work look like? Does worker behavior vary during a typical workweek–or throughout the year? Workforce analytics company ActivTrak drew on three years of data, from more than 135,000 employees across 1,000 companies to provide an examination of workplace behaviors in its annual State of the Workplace Report.Among the findings: workdays are shorter and productivity remains steady. But at the same time, disengagement is growing, which may lead to problems of underutilization but also presents opportunities to make better use of untapped workforce capacity.In a From Day One webinar webinar, leaders from ActivTrak spoke about their critical findings related to productivity, burnout, technology, and AI usage trends. They discussed industry-specific best practices and benchmarks so you can take action and boost productivity across your organization.The State of the Workplace The goal of the report was “to reveal the current state of work and how organizations can better anticipate and plan for the future,” said Sarah Altemus, manager at ActivTrak’s Productivity Lab. “Notably, we found that workdays are shorter and productivity remains steady. Burnout is in decline, which should boost positive engagement and utilization. However, we did see that disengagement is growing, possibly due to previously burned-out employees who are increasingly checking out,” said Altemus.The study, which covered 2021 through 2023, found that employees were about eight minutes per day more productive in the first half of 2023 vs. the second half. This means that if an organization with 1,000 employees was able to maintain those earlier productivity levels throughout the whole year, it would gain an additional workload capacity of 18 full-time employees, worth approximately $1.1 million, assuming each employee has a $60,000 salary.Employees are also finishing their tasks in less time. The workday got a full 15% shorter from Q1 2021 to Q4 2023, dropping from nine hours and 52 minutes to nine hours and five minutes. Time spent on collaborative activities such as chat and messaging increased slightly. Meanwhile, total digital activity, productive time, and focus time stayed consistent.Sarah Altemus, ActivTrak’s Productivity Lab Manager, led the webinar (company photo)Efficiency, measured in productive time in relation to total time, remained steady. This, Altemus says, is a good thing. “We were creeping into almost 10 hours of ‘on’ connected time a day in 2021. I think a lot of that was really performative productivity, people wanting to be constantly online. And so it's encouraging to see that shift to a more sustainable period of time.”How can employers make the most of this trend? The ActivTrak Productivity Lab suggests utilizing workplace analytics software to boost performance management, enhance employee productivity, and maximize workforce investments. Leaders should continuously analyze current and long-term data to pinpoint gaps and obstacles, and identify employees who may benefit from additional training.A disengaged employee is defined as one who spends greater than 75% of their year in an underutilized state. Distressingly, they found that 20% of employees were disengaged due to underutilization, up 67% since 2021. Meanwhile, 7% of employees risked burnout due to overutilization. 4% of employees in 2023 worked on weekends, down one percentage point from 2022. Often, a small, overworked group of employees is taking on too much.Megan Moller, productivity enthusiast at ActivTrak, says multi-tasking and context-switching is often the culprit. “That can be exhausting,” Moller said. “And so when you are doing that every single day for a period of time, you can get burned out.” Leaders need to assess and track employee utilization to help right the balance.If you don’t find the right balance, the results can be costly. 27% of employees risk attrition due to burnout or disengagement. Employees who are burned out are more likely to leave. And ActivTrak calculated that for an organization with 1,000 employees, a workload imbalance that leads to attrition equals a potential loss of 70 employees, valued at $2.1 million, based on 20% annual voluntary turnover and replacement costs equal to half of a $60,000 annual salary.To combat this, Altemus suggests gathering context through team meetings and one-on-one discussions to identify issues and offer targeted support to employees who are overburdened or underutilized. And leaders should encourage employee development by demonstrating how their daily work contributes to the organizations’ broader strategic goals.AI AdoptionArtificial intelligence is being adopted in the workplace – and fast. 22% of employees used AI tools in 2023, an increase of 50% from Q1 to Q4. While AI usage increased, however, ActivTrak found there was no apparent impact on productivity when comparing employees who used AI tools to those who did not. So that freed up time was not necessarily put to good use.Factors such as industry, company size, and workplace environment influenced AI tool adoption, but generally about one in 10 employees used AI tools. Remote workers were 5% more likely to use AI. 115 unique tools were used, with the free-to-use ChatGPT being the most popular.While the true role of AI in the workplace is not necessarily crystal clear, it’s obvious that AI is not going away. Altemus suggests striking a balance: train employees on effective AI use without solely relying on it. Promote a culture of experimentation and learning by encouraging employees to try new approaches and share what they learn. Offer guidance to ensure AI usage aligns with your organizational goals, and always be mindful of protecting sensitive or proprietary information.A Productive FutureIn terms of productivity, Altemus advises transferring best practices from earlier months to boost output and yield significant gains in the latter half of the year, when productivity tends to decline. To combat burnout and disengagement among employees feeling an unbalance in workload, try redirecting resources to support targeted training and growth opportunities. And with AI use on the rise, there is a need for clearly defined policies around appropriate use to maximize the benefits.Leaders can better understand the current state of their specific workforce using analytics tools, and add context with employee sentiment data gained through pulse surveys. They should always communicate their findings and take action when it’s relevant.Editor's note: From Day One thanks our partner, ActivTrak, for sponsoring this webinar. Katie Chambers is a freelance writer and award-winning communications executive with a lifelong commitment to supporting artists and advocating for inclusion. Her work has been seen in HuffPost and several printed essay collections, among others, and she has appeared on Cheddar News, iWomanTV, and CBS New York.

What a Five-Generation Workforce Means for You: The Myths and Realities

Nick, a senior manager in a global tech company based in Seattle, has worked with people of many different ages, both older and younger than him. His experience is increasingly typical in a workforce that spans five generations, a growing diversity of experience that provides the benefit of workers sharing wisdom across the ages, but also gives rise to problems like ageism–the bias against others based merely on their calendar age. Nick recently learned that one of his direct reports is notably older than Nick assumed. “At that moment, I realized that I had been thinking of him as less serious and more in need of guidance. I knew I had to examine my prejudices about age.”This is the first time in history that such a rich mixture of people from their teens to their 80s are at work. But the implications for business are still being sorted out. In 2020, a Deloitte white paper reported that 70% of executives surveyed believed a multigenerational workforce was important for their organizations, but only 10% felt ready to lead one and understood how it might affect operations.The widespread assumption has been that the generations are distinct enough in their affinities that they should be treated differently. In the Deloitte survey, more than half the respondents said they consider differences between the generations in designing operations and benefits But are these differences more perceived than real? Deloitte’s report cites the new concept of a “perennial” employee, or someone who transcends generational stereotypes.As the Deloitte survey explains: “Why is generation becoming less relevant as a way to understand the workforce? The starting point is that careers have become more dynamic and complex, loosening the historic correlation between age and career progression. Rapid technological and organizational change means that workers must now reinvent themselves multiple times throughout their working lives; at the same time, the broader business culture has shifted to make it acceptable, sometimes even desirable, to promote younger individuals into leadership positions. The upshot is that 65-year-old interns can today be found working side by side with 25-year-old managers, calling into question the assumption that age is a reasonable proxy for understanding people’s workplace challenges and needs.”A 2012 analysis of more than 20 studies supports this view, finding few generational differences in work-related variables like attitudes towards work or technology. Where they do exist, the differences can likely be attributed to variables other than age, like education level.Yet ageism persists. In this story, the first in a three-part series, we'll be looking at how employers can confront this challenge by adopting more age-inclusive practices. There’s good reason to do so, since lack of trust between generations can create unnecessary competition and resentment, to the detriment of working relationships. One experiment found that negative beliefs about older people and how they adapt to new technology led to poorer training of those people. Another survey found that hiring managers view younger workers as having more relevant education and experience and being a better cultural fit with organizations. On the other side is a view that goes as far back as Socrates: young people are flighty, have a poor work ethic, or require constant praise from above. Stephane P. Francioli, Ph.D., a postdoctoral researcher at the Wharton School of Management, has made a study of “youngism” and found that when asked about age-related abuse or discrimination, younger workers report higher rates than bias related to sexual orientation, race, religion, or gender, he says. Could this be because they see the workplace as wholly unfair? No, he says. If that were true, younger workers would also complain about issues of racism, sexism, or anti-LGBTQIA+ actions at higher levels than other age groups. They don’t. Heather Tinsley-Fix is a Senior Advisor at AARP where she helps employers support a multigenerational workforce (company photo)Pigeon-holing different groups can impair how teams work together, says Heather Tinsley-Fix, a senior advisor at AARP, whether it’s saying that older people are not flexible with new tech or younger people have no loyalty. “If someone was young and not tech savvy, they wouldn’t mention it, but if they are older, it gets attributed to age,” she said. “It's often just a knee-jerk reaction.”Abuse and discrimination can take many forms. Younger workers may be asked to run personal errands outside of their job description, or handle on-call hours at night because they don’t have children to take care of. They may be denied flexible work arrangements that parents of young children are given because a manager doesn’t think young, childless employees will work as hard at home without supervision, says Francioli.The problems that affect younger workers are often not addressed because they are not recognized legally, at least at the federal level. In the U.S., the Age Discrimination in Employment Act covers age discrimination in workers over 40, but can disregard other workers. Employers need to be careful not to encourage and reemphasize generational differences by organizing training according to age groups, like courses on how to manage millennials, helping older workers navigate technology, or how your Gen Z staff is different. “There is no scientific basis for any of this, it creates an us vs. them atmosphere, and encourages an in-group/out-group mentality,” Francioli said.One other consideration is how people can project age-related perceptions onto others. An older worker, for example, may believe coworkers think he is slow to adapt to new work methodologies, when they may not feel that way at all. In fact, one study found that what people believed about other generations was usually positive. The outlier was what people thought of younger generations, though young people believed others’ perceptions of them were far more negative than the reality.While putting stereotypes aside, there are still some age-related realities that employers should take into account. For example, companies can consider ergonomic factors when it comes to older workers, as well as developing support programs for staff members going through menopause. But assuming attitudinal characteristics of specific age groups and training workers based on those assumptions is often counterproductive.At the same time, the world is changing fast, so generations are experiencing factors like media and economic conditions in different ways, which shouldn’t be overlooked, says Corey Seemiller, Ph.D., a professor at Ohio’s Wright State University, and author of several books about Gen Z. Understanding those differences can be key to engaging with team members and the future success of your organization. She points to Gen Z, the social media generation, and their comfort with video as a form of communication. “Do you offer the opportunity for them to provide a video resume? Not all of them will, but some might prefer it,” she said.Many in Gen Z are uninterested in public accolades for their work; some actively dislike it, Seemiller says. Similarly, those from Gen X, often called the Latch-Key Generation, experienced a lot of freedom during their childhood and are often averse to micromanagement.Knowing what might discourage different generations and meeting them where they are doesn’t make you ageist. But if, for example, you note that older people who worked in an analog culture for most of their careers are having trouble adapting to a new tech platform and subsequently require special training for all people over 50, Seemiller says, that is when it becomes discriminatory. The best way to support the different needs of employees is to talk to them and treat them as individuals, advises Seemiller. Employers should find out what they want, what they need, and where there is room for improvement. Regular surveys are a good way to do this. All of this can be highly nuanced, but for employers, it will be worth the effort. We are experiencing a great age shift in the workforce. The UN estimates more than a third of the population will be over 65 by 2050. In the U.S., one-fifth of the population will be over 65 by 2030. Better health, and better healthcare, as well as economic circumstances, have led to people working longer. At the same time, the birth rate is declining.Is your organization prepared for fewer younger workers and more older workers? How can you create a culture where ageism and prejudice against anyone, young or old, doesn’t gain a foothold? How can you harness the power of a multigenerational workforce? In part two of this series, we’ll provide actionable ideas and examples of programs that have helped other organizations successfully navigate changing demographics.Editor’s note: From Day One thanks our partner, AARP, for sponsoring this story, the first in a series on how employers can foster age inclusion in the workplace. Interested in assessing how you are doing with age inclusion–and learning more? Try AARP’s new tool, Age Inclusion 101. Just send an email to employerpledge@aarp.org, with the subject line betatest.Lisa Jaffe is a freelance writer who lives in Seattle with her son and a very needy rescue dog named Ellie Bee. She enjoys reading, long walks on the beach, and trying to get better at ceramics.

Deferred Health Care: Why Americans Are Due for a Checkup

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