Dr. John Brumsted: Investing in the Health of Our Communities

During the Covid-19 pandemic, we’ve seen what it looks like when our health care system — our people, our facilities and our technology — is pushed to the limit. We know the Covid-19 crisis is not over, and the UVM Health Network is continuing to respond to the challenges posed by this virus. 

But we must begin charting a course to become stronger and more resilient, not only for the next pandemic, but also so we can continue to meet the needs of our patients and communities. That’s why the network is turning its attention to important, forward-looking projects including investments in patients, providers and facilities.

Recent trends underscore the critical need for these investments:

Pent-up demand. 

Prior to the pandemic, demand for services was exceeding capacity at almost every level. But Covid-19 forced us to suspend non-emergency services, and many patients chose to delay care. Now, we are seeing the results of delayed care — unprecedented demand and increased intensity of patient need. Our providers are working day and night to meet this demand, and we have come together as a network to pursue creative solutions. But these pressures have taken a toll on our providers and staff.

Population growth. 

Vermont’s population has grown 2.8 percent since the 2010 census, and Chittenden County — already the most populous county — is growing faster than the rest of the state, at a rate of 7.5 percent since 2010. In fact, by 2040, it’s estimated that 35 percent of the state’s population will be living in the Burlington metropolitan statistical area, comprised of Chittenden, Franklin and Grand Isle counties. As growth continues — particularly among the over-65 population, who require far more health care than younger groups — the need for health care services will continue to increase.

Health care staffing is in crisis. 

The entire country is experiencing a workforce crisis, and health care is at the tip of the spear, given the necessary specialized training and national competition for a relatively small pool of expertise. We cannot hire enough doctors, nurses and other essential personnel. This problem is exacerbated by the need for modern, high-quality facilities that allow practitioners to do their best work.

Those trends are fueling or worsening crises in access to care:

Lack of access to psychiatric care. 

In 2011, Tropical Storm Irene destroyed the state-run Vermont State Hospital in Waterbury. In the 10 years since, our state’s leaders have invested in new inpatient and community-based mental health care services, but demand continues to eclipse capacity, particularly for inpatient care. In our emergency room at UVM Medical Center and in ERs across the state, we are seeing the effects of an inadequate mental health care system — patients waiting for the care they need, other patients impacted by the lack of services for psychiatric patients, and staff under extreme stress.

Lack of access to surgical care. 

We lost use of the Fanny Allen outpatient surgery center last year due to air-quality issues. There was a significant backlog in outpatient surgery before that due to a general lack of facilities in the area, and the backlog has grown in the past year. We had been planning to replace Fanny Allen even prior to the pandemic and air-quality issues. We cannot continue to tell patients they cannot receive necessary outpatient procedures.

Lack of access to some other types of specialty care. 

We also are seeing backlogs in outpatient specialty services such as dermatology and ophthalmology. For example, we’re currently able to see only about half of new dermatology patients within two weeks at UVM Medical Center.

To address these acute needs, we are proposing a number of investments. All require Green Mountain Care Board approval:

• A new psychiatric care facility at Central Vermont Medical Center
• A new outpatient surgical center in the Burlington area
• A new facility for ophthalmology and dermatology services in the Burlington area
• Renovation and expansion of UVM Medical Center’s emergency room
• Renovation and expansion of UVM Medical Center’s neonatal intensive care unit

While these efforts are Vermont-focused, our New York affiliates are seeing similar trends and we have plans to address their challenges.

Vermont is a low-cost, high-quality health care state. We are the lowest-cost state in the nation for Medicare, and that’s something to be proud of. 

But for this to continue, we need to make investments. This also applies to health care reform: We are working to align care and providers to support wellness as much as illness, and to combat chronic health conditions. This work requires time and investment — for instance, developing state-of-the-art primary care facilities like our new adult clinic in Essex.

The work I’ve detailed here won’t exclude other priorities. Rep. Dave Yacovone pointed out, in a recent opinion piece in this publication, that more investments are needed in overdose prevention and community mental health. I could not agree more, and I’m proud of the work our experts and partners do to address this need today. Nothing in what we are proposing will preclude that. The communities we serve have needs, and we, as a nonprofit health system, exist to meet those needs.

This commentary is by John R. Brumsted, M.D., president and CEO of the University of Vermont Health Network, and was originally published on VTDigger.org.