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From the Publisher: Brain Drain

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©SEBASTIAN KAULITZKI | DREAMSTIME
  • ©sebastian Kaulitzki | Dreamstime

I've had some bad migraine headaches in the last 40 years, but none like the one that sent me to the emergency room on April 13. The first sign of it — a fuzzy line through my field of vision — came just before dinner, but I soldiered on through the meal because it was my birthday. And there was cake.

Later that night, I woke up feeling nauseated. My partner, Tim, found me on the bathroom floor, conscious but unable to communicate.

I remember a few hazy moments from the ensuing ordeal: Tim trying to get me to respond to a question about calling 9-1-1. Lots of people packed into the bathroom. The sound of an engine idling; at one point I was in an ambulance in front of our house. Many hours later I woke up in an emergency room bed at the University of Vermont Medical Center. Everyone, including the EMTs, thought I'd had a stroke.

When three CT scans and an MRI ruled that out, I received a familiar diagnosis: complex migraine. I'd had these before, and always with weird and worrisome cognitive symptoms, but never over a period of multiple hours that I couldn't account for later.

My discharge papers included instructions to follow up with my primary care physician at the Community Health Center. I was able to get in to see my wonderful doc there two weeks later. After examining me thoroughly, he said I should see a specialist at the UVM Medical Center.

I can't remember which came first: The 24-page questionnaire from the department of neurology, where only one of three doctors is accepting new patients, or the $23,000 bill for my night at the hospital, $2,226 of which is not covered by insurance.

I called the neurology department, and the receptionist explained: I would have to fill out all of the paperwork, and they had to receive and review it before she could actually schedule an appointment for me. At that time, mid-May, they were booking into late November.

Completing the form required some research. My first migraine, in 1988, happened when I was working in the newsroom at the Burlington Free Press. The last time I was hospitalized for a headache, also at UVM Medical Center, was in 2017.

Last Friday, at least a month after I mailed off my medical history, I realized I still hadn't heard back from the neurology department. So I called. Yes, they had gotten the paperwork. Yes, they were supposed to have contacted me. Yes, they could schedule my appointment now — for February 15, 2022. Oh, and by the way, it would be a virtual consultation.

Ten months after a $23,000 trip to the hospital, I would finally get to talk to a specialist about the underlying medical problem that brought me there — on Zoom.

By then I'd have a brand-new deductible to pay down, too.

"You call this a health care system?" I blurted out to the receptionist, noting the absurdity of having to wait almost a year to see a doctor on the payroll of the medical facility that treated me — the only hospital in town! Without blaming her, I also noted the inefficiency and potentially astronomical expense of relying on the emergency room for care in the meantime.

She was kind and explained that UVM Medical Center was desperately seeking doctors in certain areas, including neurology.

Ophthalmologists, dermatologists, child psychiatrists: "We have a number of specialties that we're working hard to recruit," echoed Dr. Stephen Leffler, president and chief operating officer of UVM Medical Center, in a phone call. He confirmed that most of these staffing issues predate the pandemic and last year's ransomware attacks.

The good news: Four new neurologists are on the way to Vermont — three this month, one in November — and the hospital is actively headhunting to fill six more vacancies in that department. The bad news: "Ten years from now, we're going to have a shortage of many kinds of doctors," including anesthesiologists, Leffler noted. "It's going to get worse."

This "national problem," as he called it, could be eased with different emphases in med school and federal funding for additional residency spots in teaching hospitals. Someone in the U.S. government should be planning for the health care impacts of the big demographic shifts ahead, he noted.

Meanwhile, here in Vermont, "We're very concerned about access, and when we hear stories like yours, it makes me really want to work harder to do better," Leffler said. He assured me that the emergency department likely consulted with a neurologist the night I was in the hospital and, if my condition worsened between now and my appointment, I could be "rushed to the front of the line." He also recommended the cancellation list.

That doesn't change our current reality, though: Some UVM Medical Center patients can't get help when they need it, and that amounts to rationed health care — the go-to criticism of socialized medicine.

Federal privacy laws make it almost impossible for journalists to investigate these service shortcomings — specifically to ascertain how many patients are waiting months for appointments and procedures. We hear about it only when people tell us their stories. I'm sharing my own medical drama because I have a hunch I'm not alone.

If you or someone you love has had a similar experience, please let us know by filling out the form below. I'll have plenty of time to read up and look for patterns that merit our attention while I'm waiting to get my head examined.

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