The SIMS Foundation

Introduction

The SIMS Foundation has been in existence since May of 1996. The SIMS Foundation is a 'grassroots' non-profit organization whose purpose is to direct musicians toward professional counseling help. The Foundation provides referral services for counseling and therapy at a very low cost through a network of licensed professionals who offer substantially mitigated fees. The Foundation is also committed to educating the community at large about the effects of mental illness, alcohol and substance abuse. Through the work of the Foundation, it became apparent that many musicians in Austin lacked access to appropriate health care and discussions began regarding the need for medical services for the Austin music community.

In August of 1999 the Foundation began an assessment to determine the health needs of musicians in the Austin area. A one page survey was developed and distributed to musicians in the area through several local clubs, booking agents, the University of Texas School of Music, email lists of Austin musicians and various other organizations which serve musicians in Austin. 246 musicians responded to the survey. 101 surveys were received through email.

Demographics and Health Insurance

As indicated in the SIMS Health Survey Results, the majority of respondents are age 25-40 and single. The majority of respondents do not have children. 47% of the respondents have private health insurance and 44% did not have health insurance. These findings are comparable to results from The University of North Texas, College of Music Musician’s Health Survey (Attachment 4) which indicated that 45% of Classical Musicians and 54% of Non-Classical Musicians had health insurance. Age seemed to have little effect on musician’s health insurance status as the following table indicates:

Marital status appears to have more influence on health insurance status, with married respondents being more likely to have insurance that single respondents as indicated below:

The majority of spouses and children of respondents have private health insurance.

Many respondents sent comments, several of which are included in this summary. Some respondents indicate their primary reason for working is health insurance coverage and concerns that they would lose that coverage if they were to become full time musicians:

"Many musicians I know (myself included) work low-wage "day jobs" simply to get a level of health insurance ------- which is way below the quality we all experienced only a decade ago. Those who don’t work the extra job for insurance go without---------and pray, pray, pray they won’t get hurt."

"One of the main reasons I have a half-time job at UT that is unrelated to music is for the benefits, especially health insurance....…"

Where and How Often Respondents Seek Medical Care

The results of the survey indicate the majority of respondents seek care in physicians’ offices. The option with the next highest results was "often don’t seek care," a sentiment also expressed by respondents in their comments:

"When we are totally broke, we have to go to the emergency room...acquire more bills, or don’t seek help at all."

"Many of the musicians-especially in the Austin area do not make enough money to pay rent let alone make a visit to an emergency room or doctor’s office."

The results indicate that 34% of respondents who don’t have insurance often don’t seek medical care, compared to 15% of the respondents with health insurance.

The survey results also indicate 38% of respondents and their families have sought medical care "more than twice" in the past year. The responses for sought care "none", "once" and "twice" were comparable in numbers. 59% of respondents would have sought care more often if it was available and, predictably, 73% of these respondents did not have health insurance. Surprisingly, 41% of respondents with health insurance also would have sought care more often if it were available. It was indicated, through respondent’s comments, that even those musicians with health insurance often encounter physicians who do not understand their needs.

"I am a professional double bass player, knowing not only rock, but jazz and classical as well. Most medical doctors that I have gone to, are not really in tune (if I can say) with what ailments affect musicians."

Illnesses among the Respondents

Graph 1 summarizes the illnesses that affected the musicians and their families the most in the past year. The survey asked questions about illnesses the family has experienced instead of the illnesses of specific family members so the results refer to the entire family system. The respondents and their families were most affected by cold/flu, allergies, infections and general injuries that are common in the general population. The respondents also indicated they suffer from ailments common to the musician population.

• Muscular Skeletal problems affected 23% of the respondents. "The signs and symptoms encountered in neuromuscular and musculoskeletal ailments of musicians are similar to those of the athlete, or indeed to those of any physically active individual," (Daum, 1998). Daum also sites two surveys of musicians which both indicate approximately half of the respondents experienced musculoskeletal symptoms.

• Respiratory problems affected 22% of the respondents.

• Repetitive Use Injuries affected 15% of respondents. "Instrumental musicians are a special risk group for repetitive motion injuries.....Instrumental injuries often include the same conditions experienced from computer overuse: Carpal Tunnel Syndrome, Tendentious, Bursitis, Tenosynovitis, DeQuervain’s Syndrome, Thoracic Outlet Syndrome, Myofascial Pain Syndrome, and Trigger Finger/Thumb are particularly common among keyboardists, fretboardists, flute and string players. But the particular demands of different instruments produce other problems as well, including hearing loss or TemporoMandibular Joint Disorder (TMJ)," (Marxhuasen).

• Hearing problems affected 12% of the respondents. "During the last several years, both musicians and hearing specialists are becoming increasingly aware that both rock and classical music have the potential to produce noise-induced hearing loss. A 1981 study at Sweden’s Concert Hall and Lyric Theatre in Gothenberg revealed that 59 out of 139 orchestra musicians (42%) had hearing losses greater than that expected for their ages," (Daum, 1998). The University of North Texas Musician’s Health Survey indicated that 24% of classical and 37% of non-classical musicians had experienced hearing loss.

• Eye problems affected 11% of the respondents. "Researchers at Northwestern University have found that the intraocular pressures (IOPs) of brass and woodwind instrumentalists, particularly trumpeters and French Horn players, rise significantly while they are blowing their horns......A blockage of these outflow channels causes a rise in eye pressure, which could initiate or result in further damage to the optic nerve," (Glaucoma Research Foundation, 1996).

The age of the respondent does seem to effect the prevalence of Muscular Skeletal and hearing problems. This is evidenced by the following table, which displays the percentage of each age group affected by illness type:

A few of the respondents did indicate they have encountered mental health issues such as depression and anxiety, even though questions regarding mental health status were not included on the survey. It is recommended that future surveys assess the presence of mental health disorders, performance anxiety and substance abuse issues among musicians in order to accurately represent their incidence in the community.

Difficulties Receiving Services and Care

As indicated in the results, 34% of respondents, 19% of their spouses/significant others and 3% of their children are currently taking prescription medications. 23% of respondents are having difficulties obtaining prescription medications and 98% of those are having difficulties due to the cost of the medications. Predictably, again, 71% of those having difficulties obtaining prescriptions do not have health insurance coverage.

21% of respondents are having difficulties obtaining vision care, 39% are having difficulties obtaining dental care and 15% are having difficulties obtaining hearing testing. 69%, 73% and 75% of these do not have insurance.

Respondents gave additional comments regarding services they are having difficulties receiving, including basic, preventive care:

"As a woman, I have had trouble for years and now especially...needing to get to a Gynecologist......still haven't been able to pay for the Dr. bill from having my daughter so I can't see my doctor and seek a good female doc. today, yet (I) can't afford it."

"I have never had a checkup since I was a kid. I’ve been lucky enough to sell a painting or play a gig enough to get a tooth pulled or any other pressing situation/development."


Preferences Regarding Clinic Type and Clinic Services

43% of respondents would like to see care for their spouse/significant other in the clinic and 21% would like to see care for their child. As Graph 2 depicts, the majority of respondents would like to be able to obtain prescriptions, general sick care, dental and lab services through the clinic with X-rays and eye care also receiving high responses.

Respondents also sent comments regarding additional services they would like to see in the clinic with several mentioning alternative/holistic health care and Chiropractic care.

"It would also be good to provide alternative health care at an affordable cost, which is unavailable through most health plans. Chiropractic, Acupuncture, Oriental herbs & teas, homeopathy, etc would be very useful to many musicians, who, like myself, are wary of western medicine practices."

The University of North Texas Musician’s Health Survey found that 41% of classical and 44% of non-classical musicians used Alternative Health Practitioners.

The need for health care services from practitioners who understand the needs of musicians and care targeted to the health care areas which often affect musicians and their ability to perform was mentioned many times.

"I think this would be wonderful especially if the doctors have more additional knowledge in dealing with conditions more prominent to musicians (respiratory problems!)."

"It would be very helpful to have a physician specialize on the natural motions of a musician, workshops (i.e. Alexander technique)."

"I would be interested in seeing doctors who know about musician’s injuries, understand the injuries effects on the profession and know or have experience in diagnosing musician’s specific injury problems that stop them from playing."

Approximately one half of respondents would rather receive care in a clinic, "which treats musicians only" and the other half receive care in a clinic, "which treats musicians and the general population." A couple of respondents suggested making the clinic client base as broad as possible in the interest of feasibility and stability:

"This proposed clinic is a good idea, but I don't see the need for a separate treatment facility for musicians. And trying to set up and maintain this sort of thing is going to be difficult. As long as musicians have access to good care and treatment in some established facility available to the general public, that would be a significant improvement over no access to treatment at all."

Based on experience with the musician community, it can be speculated that the respondents who would like to receive care in a clinic for "musicians only" most likely suffer from illnesses which are common to the musician population and would require the expertise of a physician who is knowledgeable regarding the care of these illnesses. In addition, it can be speculated that respondents who are suffering from illnesses more common in the general population would be comfortable receiving care in a clinic, which also treats the general population.

78% of respondents would like to see both walk-in and scheduled appointments in a musician’s clinic. 54% of respondents would like to see day appointments, 46% would like to see evening appointments, 34% would like weekday appointments and 22% would like weekend appointments.


Respondents’ Locations and Transportation

Most respondents live in South Austin (33%) with the next closet response being North Austin (24%). 88% of the respondents use their own cars for transportation with the responses for the other modes of transportation being minimal. It appears that South Austin would be the most convenient location for a musician’s clinic but transportation to other areas of Austin doesn’t seem to be a concern, if necessary.


Eligibility Questions

The most common question from respondents involved the eligibility criteria for a musician’s clinic.

" What would be the stipulations and criteria for qualifying? Hopefully, for the sake of the average musician in Austin, it wouldn't be based on income from professional music work."

"My question would be how do people qualify as "musicians"? Is it a percentage of income? That would make a significantly smaller population in Austin, since it's so hard to get paid anything for gigs."

"Could the clinic be for the music community as the SIMS foundation is? My husband is a musician and I run a music based organization. We have 2 children and absolutely no health insurance, nor could we afford it. So if it was for the music "community" that would be optimal."

These comments indicate a need for flexible eligibility criteria.


Use of the Clinic

90% of the respondents indicated they would use the musician’s clinic. 82% of those who indicated they would not use the clinic are covered by private insurance. Many positive and enthusiastic comments were received from respondents.

"This is an excellent idea that is a long time coming....for years I had no insurance, and thank goodness nothing traumatic occurred during that time. Musicians, and artists in general, sacrifice a great deal in terms of financial security in choosing the creative life, adequate medical care should not be a matter of what lifestyle you may have chosen. Best wishes for success."

"I love this idea! We all are under served and living day-to-day with little health care."

"Any steps in making general medical care more available and more economical for musicians would be appreciated."

"Hurry up with it!"