[W]aiting to see some doctors at Vermont’s hospitals can take weeks, or even months, a problem that reflects the struggle of Vermont’s medical system to attract and retain a robust workforce.
At the beginning of the year, the wait to see a cardiologist at three of Vermont’s rural hospitals was more than 100 days, according to data from state regulators.
At North Country Hospital in Newport, and Northeastern Vermont Regional Hospital in St. Johnsbury, the wait for the third next appointment with a psychiatrist was 63 and 45 days, respectively.
At Southwestern Vermont Medical Center in Bennington, hospital officials reported patients would need to wait nearly 200 days to see a dermatologist.
The data, collected by the Green Mountain Care Board, which is in charge of regulating hospital spending, is incomplete because it was provided by hospitals on a voluntary basis.
Many did not provide the board wait time estimates for some specialists, or don’t employ doctors in all of the specialties tracked by the regulators. The data also only reflects wait times as of March 1 of this year.
But health care experts say the data still show that in many areas, Vermont’s hospitals continue to scramble to maintain enough doctors and other medical staff, which is creating an access problem for patients.
“It just reinforces my belief that we have to do more to actually bolster our workforce,” Kevin Mullin, the chair of the Green Mountain Care Board, said of the data.
“It’s nothing that jumps off the page and shocks me,” he added. “When I visit different hospitals, it’s not uncommon for them to say ‘Look we’ve been looking for a urologist for a year now.’”
There is no statewide standard, or official benchmark for what wait times to see doctors should look like. But Mullin said that ideally, it should only be a few days.
“If you have a melanoma, you don’t want it to linger, you want it dealt with,” he said.
“Those are things that we have to do better as a state on, to make sure that there are those doctors. And unfortunately there’s no one magical switch that fixes all the problems.”
Hospital officials and regulators in Vermont stressed that while the wait to see some specialists and primary care doctors may be weeks or months, people with pressing medical conditions and emergencies can almost always be seen immediately.
Mike Fisher, the state’s chief health care advocate, says his office frequently receives calls from patients who have been told they need to see a specialist, but can’t find one “in a reasonable amount of time.”
“They have to wait weeks or months to get the care they’ve been told they need to get,” Fisher said.
“It’s not only frustrating, but really fear-inducing for Vermonters who are in this situation.”
Hospitals around the state have sought to staff up in response to the need to improve access. But for many, drawing specialists has been a challenge.
Rutland Regional Medical Center has been searching for a urologist for five years. The hospital only has one on staff, and earlier this year, wait times for the third next available urology appointment were 71 days.
Many rural hospitals across the country are struggling to attract doctors. More competitive pay, urban lifestyles and larger medical communities, often encourage doctors to settle in metropolitan areas.
“It is one of the things that’s a challenging thing for all of us in Vermont in rural hospitals, trying to get enough physicians and advanced practice clinicians,” said Claudio Fort, Rutland Regional’s president and C.E.O.
In some cases, the hospital has been successful in recruitment, and cut down wait times. In March, when Rutland Regional only had one neurologist, the wait for the third next neurology appointment was almost four months. But since hiring a second neurologist, Fort estimates the wait is now about 40 days.
In the case of attracting some specialists like urologists and gastroenterologists, another challenge for Rutland’s hospital is that it isn’t equipped for some procedures that newer doctors are trained to perform.
Many urologists, for example, now use robotic technology to carry out some procedures — but not at Rutland Regional.
“A hospital like us, they don’t have a surgical robot,” Fort said.
Vermont is not alone in its struggle to recruit and retain employees in the medical field and long wait times to see some doctors are common across the country. They can even be lengthy in bigger cities.
Merritt and Hawkins, a consulting firm that focuses on physician recruitment, which recently conducted a study on wait times to see physicians in cities, found that in 2017, the average wait time to see a gynecologist in Philadelphia was 51 days.
In Boston, the average patient waits about 45 days to see a cardiologist and 109 days to see family medicine doctor, the study found.
Jeff Tieman, president and CEO of the Vermont Association of Hospitals and Health Systems, said he doesn’t think wait times in Vermont are much different than those seen in most rural hospitals across the country.
“I’m not concerned that we’re an outlier,” Tieman said. “I’m just always concerned when there’s an access challenge for anyone in Vermont that needs care.”
At the University of Vermont Medical Center, the state’s largest hospital, based in Burlington, waits to see some doctors can also be lengthy.
As of March, some of the hospital’s specialists, including cardiologists, ear nose and throat doctors, gastroenterologists and psychiatrists could only see between 20% and 30% of patients requesting appointments within 10 days.
In response to long wait times for child psychiatrists at the hospital, the Community Health Centers of Burlington, a nonprofit health care provider in the city, began a pilot program last year to offer children psychiatric consultations.
At the time, the wait for children seeking psychiatric care at UVMMC was six to nine months, according to the community health provider.
“If my kid was having trouble, that is just not acceptable,” said Dr. Peter Gunther, the chief medical officer at the community health centers.
Dr. James Ulager, UVMMC associate vice president for clinical operations, who is overseeing efforts to improve wait times, said the hospital hopes specialists will eventually be able to see 80 percent of patients within 10 days.
“They’re not where we want them,” he said of current wait times. “I am increasingly optimistic that we have a strategy to start to address them.”
While with some specialities, hiring more doctors could cut down on patient waits, he said that there are other solutions to improve access to care.
Next year, the hospital plans on rolling out a new program that will improve communication between primary care doctors and specialists. With the program in place, more primary care doctors would be able to seek advice from specialized doctors about treatment for patients, which could help cut down on specialist appointments.
But with long waits at the hospital, the Community Health Centers of Burlington is considering bringing on other specialists to help the city’s crowded health system.
“Whether or not the Community Health Centers of Burlington will need to hire a gastroenterologist or a neurologist, we’re thinking about that,” Gunther said.
“We wouldn’t do that in any way to be insulting to our partners at the university, but in terms of care, it may be the right thing to do.”
“It’s a matter of access,” he added.
