Doctor in the House?
Kudos for your comprehensive article on the appalling wait times for appointments and treatment at the University of Vermont Medical Center ["The Doctor Won't See You Now," September 1].
We are among the families who have dealt with this frustration for years; most recently, my husband, who has debilitating vertigo, was given an ENT appointment more than four months out. He also waited six months for treatment at the Interventional Pain Medicine clinic, and we've been waiting since the middle of July to speak with a doctor in neurophysiology about test results. We've called five times and gotten no response.
I hope this article provokes public outrage and action by UVM Medical Center before the only treatment we can get is from Doctors Without Borders.
Problem Predates Pandemic
Thank you, Seven Days, for calling attention to this serious problem ["The Doctor Won't See You Now," September 1]. Wait times for specialty care at the University of Vermont Medical Center are excessive, and the problem has existed for years. Cost-quality-access is the iron triangle of health care provision today. Concern for the size of the hospital budget has hampered the recruitment of the number of specialty physicians required to provide timely access to adequate care in Vermont.
'Help When You Need It'
[Re "The Doctor Won't See You Now," September 1]: I want to let you know about my recent experiences scheduling appointments with specialists at the University of Vermont Medical Center.
I had a cracked toenail on my big toe and needed to see a podiatrist. When I called, based on a referral from my physician, I was told that the soonest appointment was in January 2022. I needed help quickly. But I could not get it from the medical center. While in Maine on vacation, I called an independent provider when I drove by their office. They saw me the next day and took care of my toenail. It would have been hell to wait until January of next year.
I have the same problem with a consult on osteoporosis — I was also told I had to wait until January 2022. I made an appointment with Dartmouth-Hitchcock, and that is in November. Neither is timely.
How can health care be considered good quality when you can't get help when you need it?
[Re "The Doctor Won't See You Now" September 1]: Few things are more important, if not crucial, to keep before the public's eye in Vermont than medical care. I thank Seven Days for doing that. However, my experience has been different from those profiled in your story.
In my young and middle years, I rarely saw a physician. In fact, I don't recall ever taking a sick day from work. But now that I'm ensconced in the "golden years," things have changed: I've had some serious health moments, all treated well by physicians and clinical staff at the University of Vermont Medical Center. (And many of those ladies and lads with MD after their names do not lack for a rich sense of humor.) I've not been held waiting long. Ever.
I'm grateful for the article and hope it helps those in medicine in Vermont to be ever more thoughtful, caring and welcoming to those they serve.
UVM Medical Center Responds
[Re "The Doctor Won't See You Now," September 1]: Amid an ongoing global pandemic, the University of Vermont Health Network has experienced abnormally high patient volumes and intense patient needs. Our patients come to us when they need us most, and long wait times for care, as well as the toll they take on our people, are unacceptable. We must do better.
We've been transparent and vocal about our access challenges — including in three recent and separate interviews with Seven Days, among other media outlets. We've also made data available to the media and our regulators to highlight the situation.
There are several factors contributing to this pressure. Nationally, many patients delayed care during the pandemic, resulting in more serious health problems. There are acute shortages of doctors, nurses and technicians. In our region, we have a long-standing need for additional mental health treatment capacity and a shortage of outpatient operating rooms.
We are taking comprehensive action to address these issues, including intensifying efforts to recruit and retain frontline staff and physician specialists while adding temporary staff to ease the burden on our people. We're also proposing new equipment and new or upgraded facilities in upcoming certificate of need applications.
Throughout the pandemic and this surge in demand, our doctors, nurses and staff have risen to meet the needs of our patients, and I am incredibly grateful to them.
This situation is urgent, and we are taking decisive action to address it. Our focus will remain on providing the high-quality care our patients expect and deserve.
John R. Brumsted, MD
Brumsted is president and CEO of the University of Vermont Health Network.
Support Primary CareProviders
[Re "The Doctor Won't See You Now," September 1]: How sad that "moral distress" is tearing the fabric of nursing and other practice support areas at the University of Vermont Medical Center. The administration's proposed solutions — 180 nurse hires, 57 specialists, another MRI and a new surgical center — appear to offer (distant) hope. But such multimillion-dollar investments may fall short due to "if you build it, they will come" syndrome. Wasn't one goal of building the Ambulatory Care Center to centralize specialty practices, many of which are now spread across the county?
How did our medical system become so dependent on specialty care? Since many specialty referrals come from primary care providers — family medicine, pediatric and internal medicine physicians; physician associates; and advanced practice nurses — it's worth looking at factors affecting referral decisions. Salary studies show that primary care providers' annual income trails all other physician groups.
Other issues — such as mandated (often onerous) electronic record systems, health insurance paperwork, payers' reimbursement, productivity expectations and patients' demand for specialty care — may play a role in decision making and could hamper using basic diagnostic tools: obtaining a thorough medical history (listening to your patient), performing an appropriate examination, deciding whether testing is warranted, initiating a treatment and, finally, engaging in watchful waiting.
We're grateful that we have specialists able to handle higher levels of care. However, if our medical system fully supported primary care providers, the demand for specialty care could be lessened.
I thank Seven Days for the story about wait times at the University of Vermont Medical Center ["The Doctor Won't See You Now," September 1]. It is interesting that Green Mountain Care Board member Jessica Holmes was so "discouraged" by the wait times that even she, a regulator of the system, "sought care elsewhere."
As a patient in Vermont's hospital system, I've been forgotten in doctors' offices, waiting rooms and even in a surgery prep room, where I was simply left for several hours until I finally unplugged the intravenous tube and reintroduced myself. These experiences turned me into an activist for single-payer health care in Vermont. In that role, I have been continually admonished by state government, other health care "experts" and the anti-tax crowd about those supposed long wait times in single-payer systems.
UVM Medical Center invests far too much of the money we give it through fees and taxes in six-figure (or higher) salaries for high-powered CEOs and other executives. As this article illustrates, UVM Medical Center has been following the eternal American business model of raising our costs and shortchanging the frontline staff to pay those executives.
I'm sure that the upcoming state investigation will report little or nothing wrong with the system. It's always someone else's fault, never the system's. After all the deliberate misinformation we've been fed about wait times, it's good to see the truth of what's going on come out. Now, do we have the courage to change it?
Single Payer, Anyone?
[Re "The Doctor Won't See You Now," September 1]: I seem to recall that two of the biggest arguments against a single-payer health care solution were lack of choice and long wait times. Glad we dodged that bullet.
[Re Staytripper, "Top Picks: Seven PYO Apple Orchards Worth the Drive," September 1]: So disappointed to see you miss Chapin Orchard in Essex Junction!
It is true that Steven Goodkind is a retired director of the Burlington Department of Public Works, as stated in the editor's note to his recent letter, "'Run, Gene, Run'" [Feedback, September 1]. But it is more relevant, given his negative comments about Mayor Miro Weinberger, that he be described as "a 2015 candidate for mayor of Burlington who lost to Weinberger, 68.27 percent to 22.35 percent."
Lief was business partners with Burlington Mayor Miro Weinberger at the Hartland Group.
I find it fascinating that in the same advertisement where R.J. Reynolds Tobacco states, "Lucky Strike has been making it happen since 1871 ... Here's to another 150 years," it also discloses: "Smoking cigarettes causes Lung Cancer, Heart Disease, Emphysema, and may complicate Pregnancy." So, in essence, its products have sickened and killed people for 150 years.
Tobacco giant Philip Morris International says it will stop selling cigarettes in the United Kingdom within the next decade, and its new CEO says he plans to lead the company's "smoke-free" transformation. Does R.J Reynolds' advertisement suggest it really wants to be selling Lucky Strikes 150 years from now?
Dr. Nevin Zablotsky