One of the recurring topics at the annual meeting of the American Society of Clinical Oncology held a couple of weeks ago here in Chicago was the aging of the population. The number of Americans 65 and older will double over the next 15 years. By then, the incidence of cancer is expected to have jumped 67 percent from what it was in 2010. Do we understand these patients — and more importantly, do we understand that patients who may be the same age chronologically are not necessarily the same physically, emotionally or in any other respect? A treatment regimen that’s appropriate for one 75-year-old may not be appropriate for another 75-year-old.

The aging population is an enormous challenge for everyone in health care. Will we have enough physicians and nurses with at least some training in geriatrics? And beyond patient care, do we understand enough about the younger generations taking over for today’s clinical and C-suite veterans as baby boomers retire at an ever-faster pace?

Generational issues play into several of the articles in this issue of H&HN. The cover story considers what hospitals should be looking for when hiring a new CEO given the dramatic transformation now underway in health care. Are the traditional health care management skills still a priority or are certain personality and attitudinal traits even more important?

In The Interview on Page 28, Linda MacCracken describes the generational differences among physicians. What are younger doctors’ expectations for work and for their personal lives, and how must hospital leaders adjust to accommodate them?

Random Musings

'The talk' takes root in Wisconsin

A movement is “quietly spreading across the Midwest” in which conversations about end-of-life care between physicians and patients are becoming the norm rather than the exception, wrote Sarah Kliff in on May 28. The movement began in La Crosse, Wis., in the mid-1980s as a grassroots effort by doctors. Patients were understandably confused and somewhat alarmed when their doctors brought the issue up at first but, over time, the conversations have become a routine part of patient-doctor talks. By 2008, 90 percent of La Crosse residents had an advance planning document in their records. Most surprisingly, Kliff writes, “people who die in La Crosse spend approximately 32 percent less than the average Medicare patient in their last six months of life, the Dartmouth Atlas of Health Care shows.”

Trying to make sense of drug costs

In May, Richard Harris began an article for NPR with this: “American medicine is heading into new terrain, a place where a year’s supply of drugs can come with a price tag that exceeds what an average family earns.” Harris focuses on the soaring costs of multiple sclerosis drugs, which now average $60,000 a year, compared with $8,000 to $11,000 a year in the 1990s, according to a study from Oregon State University and the Oregon Health & Science University. Every time a new drug came onto the market, the price of all drugs jumped, too, noted Daniel Hartung, a pharmacist and OSU associate professor who helped lead the study. “Despite more choices, prices just continue to rise, contrary to what you think would happen,” he told Harris.