Swiss apprenticeship system

While here in Switzerland, one of the things that I have found most fascinating and what seems to be the foundation for Switzerland’s reputation of a highly efficient society, lies in their apprenticeship program.  From a young age, adolescents begin preparing and training for their careers. And like any system that has been in place for several hundred years, it is a well oiled machine.

 In the canton of Fribourg, most children by the age of 12 have an idea of the educational path they wish to continue on. Only about 20% of Swiss adolescents end up going to high school. The rest will enter vocational or technical training which range from more traditional vocational fields such as bakers, plumbers and mechanics to graphic designers, bank tellers, retail sales and finance. Up until age 12, children attend the equivalent to the US’ elementary school. At the end of elementary school there is an exam and a meeting with the teachers and parents of the child to discuss what path the child might be interested in. There are three possible options for the child to continue on in what is our equivalent to jr. high. There is the most basic track, a general track and advanced track.  If the child has had difficulty up until this point, it will most likely be determined that the child will continue on the basic track, where he or she will learn basic subjects with an emphasis on vocational training and the opportunity to shadow several different workplaces to find the career they think they would most enjoy.  These students will then start their apprenticeship at age 16. Children who have excelled  in school are placed in the advanced courses. These children will most likely continue on to University for fields like research, medicine, law and engineering or Haute Ecole for fields like physical therapy, education, business and social work. For children who are not entirely sure which route they would like to go and have maybe at times had difficulty with certain subjects, they are placed on what is called the general path. These children have the opportunity to work their way into the advanced courses and continue on to University or Haute Ecole. It is also possible for children on any of these tracks to choose an apprenticeship at age 16. One problem with this is that children who should normally continue on to Haute Ecole or University might be taking a desired apprenticeship spot from a child who only has the apprenticeship opportunity.

 

While this might sound like it is a system where young people are blocked in, it actually isn’t. If you complete an apprenticeship and would like to further your education, after your apprenticeship is complete, you can take a year of specialized studying for what is called the « maturité ». This year helps you prepare for higher education and then if you pass the exam, you can continue your studies. You also have the option to change apprenticeships if you so desire.

A major benefit from this system is that the apprenticeships are free- as a matter of fact, the apprentices earn money while they are working. The companies that take them on, benefit as well because it is essentially free labor for them. This is a major difference from our current system in the US. For many young people in the US who are just finishing high school, even the vocational and technical programs at community colleges might seem daunting when considering the costs and school schedule required. While many students qualify for financial aid, some may not even have the skills to navigate through the FAFSA application process and may be too embarrassed to ask for help. Once the student has been awarded financial aid, often times it isn’t enough to meet housing and transportation needs. American culture puts an expectation on young people to move out of their parent’s home at around 18 or 19, forcing them to work full-time just to support themselves. With  demanding work schedules, prospective students are more likely to worry about the financial constraints associated with pursuing a technical field, much less university.  But of course loans are always an option…

So here, young people start their training while still living at home. They earn a small salary for some pocket-money and by the time they finish their training, which lasts from 3 to 4 years,  they are highly skilled workers and debt free. Students attending University are also typically debt free with the cost of about $500 a semester.  The Swiss see this as an investment in their future workers and society. It’s like they believe that skilled and educated workers will only contribute to the betterment of their communites…

What I have most noticed about the benefits of these apprenticeship programs within my own field of dentistry, is that these apprentices are not just learning the skills in their field, they are learning responsibility, work ethic, professionalism, and communication skills. When I see img_7597these kids that are dental assistants and lab techs, I am so impressed with their professionalism. They are learning every aspect of the dental office from reception, chairside assistance, ordering, filling schedules, oral hygiene education, to maintaining the office and dental equipment- these kids learn it all. They are also still in school taking classes related to their field- so they are balancing a work and school schedule with classes like anatomy and physiology, biology and even physics !

While this might seem like a gross generalization and it could just simply have to do with demographics, I’ve noticed that I have way more young working class patients than I did in the US- keeping in mind that Switzerland is not a socialist country, therefore does not have socialized medicine (that’s another blog post!) and hardly anyone has dental insurance.  While salaries are higher here than in the US, dental costs are relatively similar. The average cleaning is around 130 chf so around $110 which is still pretty expensive for a young person here.  And these young people pay it,! I think this a testament to the responsibility they learn at a young age.  

Unfortunately the difficulty in applying this system in the US would be organizing local industries and  education systems to work together. It is something that would have to start from the ground up and would take several years to implement. As with many industries, from dental hygiene to electricians, each state has their specific laws, regulations and certifications regarding each field. If it were something that started at the state level not national, it seems like it might be possible. I guess it would kind of be like dual enrollment but for kids who maybe don’t intend on going to University, they could enroll in programs like drafting and design, marketing,  office administration, hvac (air condition, refrigeration and heating),etc which high school students can already do in many parts of the country but for positions like marketing and office administration,  companies would have to be willing to eliminate the requirement of  a 4 year degree to many entry-level positions. And quite frankly there aren’t many options at least not where I am from in Florida and there are gpa requirements which in my opinion entirely defeats the purpose- these programs should be available for kids who might not be academically driven. There should also be more options that include fields like cosmetology, dental assisting, nursing assistant, etc. And for fields like plumbing or electrician, currently  you have to be 18 years old and sometimes require  a high school diploma or GED.  Maybe I should just run for president and put this system into place- it’s not like you need any experience for that job. 

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Multigenerational Cohousing

Our approach to dealing with issues affecting the elderly in the US is about to become more important than ever. According to the U.S. Census Bureau, by the year 2050, the elderly population is expected to increase to 86.1 million people. Some of the problems this age group face include age segregation, access to care, decreased activity, and overall decreased quality of life. While there are plenty of other problems the elderly face, I mention these specific ones because collectively they represent a cultural attitude on the way we care for our elderly in the U.S. It’s difficult not to paint this issue with a broad brush but research has shown that in fact, Americans have a problem with how we view aging.

 

My husband’s grandmother, Tita, lived what I believe to be an ideal life for an aged person. She lived independently for over 20 years after her husband passed but it was not without the help of her family and friends. Because the social/family structure is so strong in Europe, age segregation is less prevalent as the elderly are an integral part of the community. IMG_5659 My brother in law, his wife, and their 3 children have lived in very close proximity to Tita for the past 15 years. During this time, Tita often cared for her 20 great grandchildren, cooking large meals for all of the family and friends passing by, and even helped out from time to time with the family business that my brother in law runs. Having her grandson and his wife so close, was Tita’s saving grace. She was able to stay at home well into her 90s because of the security of having family so near while still maintaining her independence. She would help the 3 great grandchildren that lived across the way with their homework every day after school, she was an avid reader, enjoyed gardening, and was not afraid to take on chores that required a little elbow grease. She was always moving, except for her 45 min 4 o’clock nap, and maintained a healthy diet. She sought medical care when she needed it and never had to worry about how much a doctor’s visit or medications were going to cost because the elderly in France don’t have to worry about going into debt over medical issues. There was a sense of security in every aspect of her life, from feeling safe in her own home to knowing that she could rely on a public system put in place if she needed it.

Its funny how in America we spend almost our entire lives striving for independence and privacy and for the majority of us, we end up in communal housing at the end of our lives anyway. Americans are known for being individualistic and our need of “personal space.” The idea of living in close proximity to one another for the sake of truly being in each other’s lives has for the most part been widely unaccepted. But times are a changin’, and baby boomers are envisioning are very different retirement. Research has shown time and time again that staying active, lifelong learning, and social interaction are key components to a high quality of life for the elderly. And so, many of today’s baby boomers are embracing multigenerational cohousing. They are choosing to live in communities that are open to all generations, not just 55+Screen Shot 2016-04-10 at 9.15.12 PM, to continue to be involved in a multifaceted community. The cohousing concept originates from northern Europe, where it has been in place since the 1950s. The residents of these communities typically live side by side in their own living spaces i.e. an apartment or house, and share a common living area where they will come together for meals or events such as a holiday or to watch a sports game. This type of co living is great for anyone looking for a sense of community but especially for single parents and the elderly. Single parents who may not feel that they have adequate support being on their own can benefit from having  other adults around to help keep an eye on their children and the elderly benefit from this interaction with the children by staying engaged and participating in healthy activities together such as gardening, crafting, or other interactive activities . And of course the benefit for the children is huge- exposure to multiple generations on a daily basis promotes empathy  and fosters a sense of awareness about their own selves and longevity. I’m certain that Tita remained active largely in part to having her children, grandchildren, and great grandchildren around often. Her sister and brother also lived close by and she had many friends in the region. Everyone from the different age groups had something to contribute- from looking after the great grandchildren to lively adult dinner conversations, there was an array of activity that led to a rich and full life.

Baby boomers are slowly but surely changing the way we view the elderly in this country and as they force us to take a look at our age segregation problem, many of the social issues that the elderly face, are not placed high on our agenda of needs to be met. Are we more likely to sweep these issues under the rug that our elderly face because we simply do not interact with them more often? Would we be more empathetic to their needs such as high cost of medical care (access to care), housing, and affordable healthy food options if we were living side by side and had daily interactions/reminders of elderly needs? I think baby boomers believe so and as the dreaded assisted living facility or nursing home looms, this generation is setting the stage for how they live out their final years as they change the face of the cohousing movement.

 

 

 

 

 

3-D printers… are we there yet?

In June 2013 I heard a segment on NPR  about 3-D printed hands that were developed to help children born with amniotic band syndrome. My first thought was, this would be great in dentistry, I’m sure it already exists. I was envisioning a wave of 3-D printed crowns and bridges sweeping the industry- not to be confused with milling machines which some view as a 3-D printer. Milling machines are a subtractive process while 3-D printing is an additive process using a stereolithographic technique which adds layers upon layers of a photopolymer resin, light curing the layers together.

A year later I still didn’t see 3-D printers in the dental field. I did some research and came across a company called envisiontec. They manufacture 3-D printers which make night guards, models, surgical guides, and lo and behold… temporary crowns for about $0.17 a piece. If the printers had been reasonably priced, the potential to make inexpensive crowns was just around the corner. I contacted the company and discovered that a  permanent biocompatible material had been developed and was in its clinical trial phase, waiting FDA approval. While the mat

NextDent-CB-Liquiderial itself is inexpensive, the printer and required components are not. There are 3 components needed to make a 3-D printed crown: the printer which runs between $25,000-$70,000, the digital impression scanner (desk top or wand) about $30,000, and the cad/cam software around $20,000. The cost of these components combined was more than what any clinic in the public sector would be willing to pay just to make a crown for an underserved patient. In the private sector the return on investment could be seen through dental assistants spending less time pouring up models, savings on impression material, cost of shipping models to the lab, and obviously seating the permanent crown the same day which eliminates subsequent appointments for crown delivery on the schedule. Of course this would come at a cost for the patient (which I believe patients would happily pay) but what I was envisioning was a less expensive crown for an underserved patient. I could see the potential for this to be used on mobile dental vans, health departments and third world countries. Often times patients will wear a temporary for much longer than the recommended 2-4 weeks, sometimes for several months and I have even seen cases where the patient has worn a temporary for several years! The resin based crown seemed like a good middle ground between a temporary and porcelain or porcelain fused to metal and something that might be more affordable, not to mention more accessible if it could be fabricated right on site which often times having underserved patients return for multiple appointments is a major struggle.

The digital impression scanner in its own right is amazing. There are several on the market, 3M, 3 shape, itero, sirona, etc. These scanners are able to scan the teeth in under 3 minutes creating a digital impression and some can do this in full color without requiring a contrast medium (powder). If the dentist doesn’t have a 3-D printer, he/she can still use the scanner. The dentist can scan a section being prepped for a crown or bridge, scan said section after prep, and with the touch of a button, send the file to the lab. The process is the same for night guards, surgical guides, etc. As we round the corner of the digital age, traditional alginate impressions will soon seem as antiquated as film radiography.

Is technology changing too quickly? Before envisiontec could get their permanent biocompatible material FDA approved, there was already a new printer, Rapidshape/Nextdent, on the mFormlabs-F2-straight-on-Hartarket which makes 3D printed ceramic crowns using a process similar to sintering (3D printing metal). While these printers and their necessary components are still very expensive, I do believe that in the future we will see the same quality printers but for much less. The Formlabs 2 printer is a great example of a less expensive 3-D printer yet one that is unavailable in the medical industry simply because it is not an approved “medical device.” It uses the same stereolithographic process as the other printers and runs about $4,000. Prices like this could certainly make 3-D printed crowns available to the masses and as previously mentioned, as commonplace as the digital X-ray.

We are fast approaching a new era in the healthcare industry, technology is advancing daily where one innovative product is quickly superseded by the next. Its an interesting and exciting time for sure, in all industries not just healthcare. I mean, I think I heard we are about to go to Mars?

la dolce vita…

In the next couple of months I will have the opportunity to learn about and compare the different health care systems of Europe and the US. Topics to be explored include technology, access to care, sustainability, historical and cultural observations, just to name a few.

As a Registered Dental Hygienist (RDH) I see the flaws and strengths of our system every day through the accounts of my patients. There are of course patients who are visions of health, however, the majority are saddled with medical debt, prescription drugs, preventable diseases, and obesity.  This country has the capability to cripple ones life through the very system that is meant to give one full viability. Yet here we are- convinced we have the best medical system in the world.

Soon I will have the opportunity to work in the health care industry in a foreign country. With an open mind and unbiased approach, I will write about my findings. Is the quality of life really higher in Europe…? Do they really have la joie de vivre? La dolce vita?

Follow me as I take a comparative look at these cultures and health care systems. And while you are at it, enjoy the scenery!

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