Seven Days

On a Friday in February, 27-year-old Andrew Charlestream went to the emergency room at the University of Vermont Medical Center with searing abdominal pain. A doctor diagnosed him with kidney stones, then sent him home with pain medication and instructions to follow up with a urologist in two to three days.

That Monday, Charlestream, who lives in South Burlington, called the urology clinic at the medical center. The person who answered the phone told him the schedulers were busy but that someone would be in touch soon. He waited, but the call never came. So he started phoning the clinic every day, repeatedly, only to be told the same thing: Someone would be in touch to schedule his visit. By the end of the week, he still didn’t have an appointment.

“I’m sitting here, puking every night because I’m in so much pain, missing work, spending the majority of my days on the phone to get to talk to someone,” he said.

Two weeks after Charlestream’s emergency room visit, he said, the pain had become unbearable, and he went back to the emergency room for more medication. Finally, after one month and more than $2,000 out of pocket, he called the medical center’s Office of Patient and Family Advocacy, and a caseworker helped him get an appointment with a urologist that week.

As it turned out, Charlestream needed surgery to remove the kidney stones. He’s convinced he would have been spared a considerable amount of agony, and money, if the urology clinic had seen him promptly, as the ER doctor had ordered. “It’s hard to find words other than ‘utter frustration,'” he said.

Wait times for specialty care — neurology, urology, gastroenterology and other branches of medicine — have long been a problem at the UVM Medical Center, the hub of the sprawling UVM Health Network, which now includes six hospitals in Vermont and northeastern New York.

Eighteen months into the pandemic, the situation has reached a crisis point. Now, patients sometimes wait up to a year to see specialists.

Seven Days asked UVM Medical Center for the average number of days new patients wait to be seen in each of its 85 specialties. The hospital refused to provide data for all but two areas: urology, which is now scheduling two months out; and ear, nose and throat, where the current delay ranges from 20 days to see a pediatric specialist to 175 days for an ear specialist. In public filings to state regulators, the medical center reported wait times using a different metric — the percentage of new patients seen within two weeks of scheduling an appointment — which fails to capture the most egregious scenarios or offer any sense of the typical, nonurgent patient experience. Nor does it account for the weeks and months some people, such as Charlestream, must wait before they can even schedule an appointment.

Hospital leaders admit that serious problems exist, and patients shared with Seven Days the frustrating and sometimes devastating consequences of those delays. Twenty-nine-year-old Ashley Moore, who lives in East Calais, was referred to a neurologist in January for her chronic migraines and learned five months later that the earliest available appointment would be a Zoom consultation — in January 2022. A UVM Medical Center employee, who requested anonymity because of her job, found out in February that she would need to wait seven months before a gastroenterologist could see her for a severe digestive problem that had already forced her to miss weeks of work.

In September 2020, 79-year-old Peter Regan was referred to a UVM urologist, but two months later, he hadn’t even gotten a call to schedule his appointment. He instead went to a urologist at Northwestern Medical Center in St. Albans, which isn’t affiliated with the UVM Health Network, where he was diagnosed with metastatic prostate cancer.

“I’m not a complainer,” said Regan, who lives in Shelburne and worked for 45 years in the marketing department of Hazelett in Colchester. “But where I come from, you respond to the customer. This just wasn’t right.”

These lengthy waits, according to health care experts and medical center staff, are the result of an overburdened system. Staffing levels throughout the medical center, from the support specialists who field calls from patients to the physicians who treat them, have not kept pace with the UVM Health Network’s growing pool of patients, which has expanded to roughly 1 million over the last 10 years.

When something goes awry in one part of the system, the effects ripple outward: Delays in getting MRI and CAT scans often prolong the wait to see a specialist, since some doctors require imaging before they will schedule a consultation. Meanwhile, those patients become sicker and ultimately need more intensive treatment, which also pushes exhausted health care workers to the brink.

UVM has not been alone in its subpar performance. Between 2014 and 2017, the lag between a referral — when a primary care provider directs a patient to a specialist for further treatment — and an appointment rose by 30 percent in 15 U.S. metro areas, according to a study by the health care recruiting and consulting firm Merritt Hawkins. UVM Medical Center leaders have historically blamed a nationwide physician shortage, which has become increasingly acute: A recent report from the Association of American Medical Colleges projects that the U.S. will face a shortfall of up to 139,000 physicians by 2033. To meet current patient demand, the UVM Health Network says it is seeking to hire 75 more physicians, including 57 specialists for the Burlington hospital.

But critics inside and outside the UVM Medical Center say these external forces are only part of the picture. Staff point to the chicken-and-egg blight of low morale and high turnover at every level of the institution; others question whether the hospital network has become too vast and unwieldy to be efficient. Of the two dozen patients Seven Days interviewed for this story, nearly all who finally managed to see a specialist at UVM Medical Center said they received excellent care. The problem, they said, was getting an appointment in the first place.

“We know we have challenges right now, and we’re doing everything in our power to improve,” said Dr. Stephen Leffler, who has been the medical center’s president and chief operating officer since 2019. “It’s not where we want it to be, and it’s not what our patients want and need right now.”

For people in acute distress, months of waiting can be insurmountable. Last summer, a 90-year-old woman suffering from incontinence caused by an impacted bowel learned that she wouldn’t be able to see a UVM proctologist for almost three months. Her daughter, who requested anonymity to protect her mother’s privacy, said that her mother kept a meticulous record of her interactions with her health care providers.

One of her typed notes, dated August 26, 2020, reads: “I tried to make appt with gastroenterologist … they were booking in December, but they wouldn’t give me an appt until they received the referral … They did say that by the time they got the referral, they will be booking for February. This is the worst medical setup I have ever heard of!”

She got an appointment in late November. But her life was already a misery, her daughter said, and she decided that she was done waiting. On September 2, 2020, the woman killed herself.