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DH clinics in Upper Valley put freeze on primary care appointments for new patients

  • Dartmouth-Hitchcock Medical Center in Lebanon, N.H., as seen from the air on Dec. 9, 2017. (Valley News - Charles Hatcher) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Charles Hatcher

Valley News Staff Writer
Published: 5/2/2022 11:08:17 PM
Modified: 5/2/2022 11:06:45 PM

LEBANON — Dartmouth Hitchcock clinics in the Upper Valley are not currently accepting new primary care patients. Though some other affiliates of the Dartmouth Health system continue to have openings.

“Right now, we are taking a pause on scheduling new appointments,” Dr. Ed Merrens, Dartmouth Health’s chief clinical officer, said in a Friday interview.

Merrens said the pause was necessary for several reasons, including an increase in demand from new residents who have recently moved to the Upper Valley and the workforce shortage that has worsened amid the COVID-19 pandemic. He also said that Dartmouth Hitchcock care teams are working through a backlog of patients who may have delayed care earlier in the pandemic.

In addition to recruiting more primary care physicians, DH also is seeking medical assistants, licensed nursing assistants and nurses for primary care, Merrens said. Health care providers have more options in terms of the type of work they do, he said. For example, some are choosing to provide telemedicine, he said. He also said patients want to be able to communicate with their care team in different ways, through in-person appointments, as well as texting, messaging and talking on the phone.

The appointment freeze includes clinics at Dartmouth Hitchcock Medical Center and on Heater Road and in Lyme; and DH-staffed clinics in southwestern Vermont — including those in Bennington, Manchester Center and Wilmington.

Merrens acknowledged that the pause might raise some concerns. But, he said, it’s “not an issue of not (being) willing to spend money.”

DH uses national benchmarks to determine compensation in a way that aims to retain, recruit and reward people for their work, he said.

He did not say how long the pause would last.

“It won’t be forever,” he said, adding later that he expects it will be a “short-term thing on the order of months.”

Meanwhile, some patients are finding it difficult to find a primary care provider. Taylor Long, a 37-year-old Windsor resident, left her job at Dartmouth College last year to take a new one in communications at Vermont Law School last year.

As a result of the job change, Long no longer has access to Hanover-based Dartmouth Health Connect, which offers primary care to college employees and their adult dependents, some employees and dependents of King Arthur Baking Co., and Medicare beneficiaries.

Long now has health insurance through Cigna and has been looking for a new primary care provider. She tried a number she found online for the Lebanon-based Dartmouth Hitchcock’s primary care service, but was told DH clinics in the Upper Valley are not taking new patients.

Though she’s continuing her search outside of the Upper Valley’s largest provider of health care services, Long said she’s now concerned that a prescription she has for an antidepressant will run out in July, before she’s able to get in for an appointment.

“It is a bummer especially after going to the Health Connect system, which worked great,” Long said in an interview last week.

As a direct primary care clinic, Dartmouth Health Connect charges no co-pay to patients, and offers 24/7 access to a doctor and same-day appointments.

“It is funny to me (that it’s the) major medical center in this area that’s not taking patients,” she said of Dartmouth Hitchcock.

DH officials said they are talking with the system’s care teams to assess the situation, Merrens said.

“We want to provide the right care,” Merrens said. “We want to be able to do it well.”

Part of that conversation is about how to address situations like Long’s, where patients don’t yet have a primary care provider but need refills of medication while they await one, Merrens said.

“We wouldn’t want someone to stop important therapy,” he said. … The “last thing we want is for people to have to seek urgent care (or) emergency care” for something that a primary care provider could treat.

The pause in scheduling new primary care appointments does not include DH clinics in Nashua, Manchester and Concord, according to DH spokeswoman Cassidy Smith. Those clinics sit in the more populous southern part of New Hampshire where DH has made it clear that it aims to expand its patient base.

Merrens noted that while DH’s own Upper Valley clinics aren’t accepting new patients, there “are availabilities within the DH system.”

Alice Peck Day Memorial Hospital, a Dartmouth Health affiliate in Lebanon, has some availability for new primary care patients, as does Mt. Ascutney Hospital and Health Center in Windsor, another DH satellite, he said.

“There are a number of factors impacting different locations in different ways, including labor market shortages, challenging recruitment for limited number of primary care physicians, adequate regional housing and varying degrees of pandemic recovery at each site,” Merrens said in a Monday email.

Little Rivers Health Care, a federally qualified health center with clinics in Bradford, Vt., Wells River, East Corinth and Newbury, is accepting new primary care patients, Dr. Fay Homan, a family medicine doctor who practices in Little Rivers’ Wells River clinic, said.

Given the role that primary care has in helping people to manage chronic conditions and in helping to catch illnesses earlier, Homan said she finds it “troubling” that DH’s Upper Valley clinics are having access issues.

“Cutting back just on new patients in primary care doesn’t serve the system as a whole of trying to get good care and less expensive care to the most people,” she said.

DH officials did not respond by deadline to questions about whether the pause in scheduling appointments extends to specialties beyond primary care.

Homan noted that federally qualified health centers such as Little Rivers can’t turn away new patients as “part of our deal with the government.”

FQHCs elsewhere in the Upper Valley, include Randolph-based Gifford Health Care, Springfield (Vt.) Medical Care Systems and Ammonoosuc Community Health Services, which has an office in Woodsville.

For her part, Long took to Facebook in search of suggestions of a new primary care provider. She said she tried Mt. Ascutney Hospital and Health Center in Windsor. While the critical access hospital, which is a member of the Dartmouth Health system, is accepting new patients, only male providers were available when Long called.

“I would prefer to see a woman,” Long said. But “If in my search I can’t find anyone … I may circle back to them.”

She filled out a new patient intake form for White River Family Practice, a private practice in White River Junction, that she said is accepting new patients. (A voice message left for the practice’s office manager on Monday wasn’t returned by deadline.)

Long said: “We’ll see.”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.


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