This commentary is by Richard Bernstein, M.D., of North Ferrisburgh, who practiced family medicine at the Charlotte Family Health Center between 1975 and 2013. During that time, he was an attending physician in the Department of Family Practice at the University of Vermont Medical Center and a clinical assistant professor at the University of Vermont College of Medicine, teaching medical students at his office in Charlotte.
Back in my pre-retirement days, when I was a practicing family physician in Charlotte, I noticed a curious disparity in the availability of specialists in Vermont and New Hampshire.
Patients requiring referrals to the University of Vermont Medical Center would have long wait times before they could be seen. I could get them in quicker by leaning on personal relationships with independent providers outside the UVM system.
But more often than not, when I felt they needed to be seen even sooner than that, I would call Dartmouth Mary Hitchcock Medical Center and find an atmosphere far more accommodating to referral requests.
This disparity was a running joke in our office, and I saw more than one new patient who said, “I’m coming to you because I heard you’re the guy who will send me to Dartmouth. It will take months before my doctor can get me into the Medical Center in Burlington.”
Apparently, what was true then is still true today, 25 years later.
The medical center is not indifferent to this situation. A few years ago, my neighbor related that his primary care doctor told him he should see an orthopedic surgeon to consider hip replacement. The earliest appointment he could get in the Burlington area was four months out. Because he was in pain and having trouble walking, I advised him to call Dartmouth. Instead, he called the orthopedic office in Burlington and asked if they could suggest anyone he could see at Dartmouth. A couple of hours later, he received a phone call from the Burlington office saying they just had a cancellation and could see him in three weeks.
The problem was brought home to me again just now. A close friend has suffered from generalized joint and tendon pain since contracting Covid last spring. After two steroid treatments provided only temporary relief, his primary physician recommended referral to an arthritis specialist and called both UVM and Dartmouth.
Last week, my friend got a call from UVM offering the first available appointment — at the end of May. Just today, however, he got a call from the scheduler at Dartmouth, asking if he could come in on Dec. 14.
Why does this problem exist? Certainly it is not due to an inadequate number of doctors in Vermont. Vermont actually has the fifth-highest per-capita number of physicians in the country — right behind the District of Columbia, Massachusetts, New York and Maryland.
If the problem is not lack of personnel, then it is surely an administrative problem in the misallocation of physician resources.
The University of Vermont Medical Center describes a three-part mission: patient care, education of health care professionals, and medical research.
Medical research comprises a large part of this so-called three-legged stool. A publication from UVM’s Larner College of Medicine boasts that the organization receives $90 million to $100 million annually in medical research funding.
When UVM doctors are in the lab doing research or in the hospital teaching, they are not in the office seeing patients. Furthermore, when physicians travel, they are also not available for patient care. Some physicians are paid by drug and medical device manufacturing companies to test their products and present information to other physicians.
In 2019, according to ProPublica, a UVM cardiologist received $183,000 from a medical device company. A UVM endocrinologist received 31 payments for travel and speaking. An orthopedic surgeon received 88 payments for consultation, travel and lodging.
Undoubtedly there are many reasons for the medical center’s inability to meet its patients’ needs for timely care. Hearing public presentations about the UVM Medical Center, however, I have always been impressed by the number of times retiring CEO John Brumsted works in the phrase “academic medical center,” as if to immunize the organization from public criticism of its clinical practice.
Surely, we Vermonters are proud of our nationally recognized medical center and its research. That is, however, until some sort of illness strikes, and we find ourselves unable to find timely medical care for our families. At that point, who wouldn’t prefer a big building full of available doctors with a real person who answers the phone and says, “Will next week be soon enough?”
In 2019, VTDigger reported that Vermonters spent $6.5 billion on health care, with about half going to hospitals. This works out to $10,442 per person per year.
This is a lot of money to ask of us, and in return, we may ask some things of the medical center’s new CEO. What is the difference between Burlington and Dartmouth? How would things have to change if patient care at UVM were truly priority No. 1? And considering the price we pay, why is it not?