Some veterans in the Nashville region are waiting a long time to see a doctor.
In Hopkinsville, Ky., just over the state line, a quarter of primary care appointments are scheduled for more than a month away, according to data from the Veterans Health Administration. In Dover, Tenn., even more are scheduled that far out — nearly half of all appointments.
Officials at the Tennessee Valley Veterans Affairs System, which provides health care for tens of thousands of veterans in Tennessee and Kentucky, say they're working on ways to fix the problem. It's the latest hurdle as VA clinics around the country try to reduce wait times, following national scrutiny in 2014.
To understand the long wait times in Hopkinsville and Dover, someone has to first understand what's going on in a city about 35 miles away from both of them.
Clarksville has a growing veteran population — in part because it's right next to Fort Campbell — and the VA clinic there is severely overcrowded. Nurses are packed into small rooms. One bathroom has been turned into an office. Patients are sometimes seen in the conference room.
"We're literally like sardine cans," said Robert Lim, who oversees primary care clinics for the Tennessee Valley VA. "You can't go around any place without bumping into somebody."
That also means that there's no room to put another doctor or nurse practitioner.
By early last year, he says some veterans were waiting four months for a primary care appointment. That could be having an annual physical, getting a prescription refilled or seeing a doctor because they came down with bronchitis. One doctor at the clinic was seeing 70 percent more patients than he was supposed to.
So the VA decided to draw a line: For the past year, the Clarksville clinic hasn't been taking new patients.
It sounds extreme, but Lim says it was the best option. Otherwise, the clinic would be neglecting its current patients.
"We all decided, 'Let’s concentrate on the ones we have,' " he said.
Patients Spilling Over
Still, he admits it's not a long-term solution. The Clarksville clinic used to see 50 new patients every week. Now, many of those veterans are filling up the smaller neighboring clinics in Hopkinsville and Dover.
"The demand is so high, as a matter of fact, even the Hopkinsville clinic is saturated. [The] Dover clinic is saturated," Lim said.
That's reflected in the wait time data that the VA collects: In Dover, the average wait time for a primary care appointment has risen from one week to three weeks since 2015.
Don Bailey, commander of the American Legion in Dover, is not happy about this trend.
"If I can't get seen in Dover, then I get referred to Nashville," he said. "Now I'm driving two hours to the Nashville hospital to get seen and then spending two hours to drive back, which is a total burden to the veteran when we've got a clinic right there in Dover."
Veterans tend to like the quality of care at the VA once they get there, he said. "The hard part is getting to 'there.' "
How To Fix It
There are some long-term solutions in the works, said Robert Lim.
A larger clinic in Hopkinsville is opening this summer. Dover is starting the process to get a larger one, too, and it's hoping to hire another provider soon, on a temporary basis, to address the backlog of patients.
The biggest relief could come from a new building in Clarksville. The VA is planning to build one that's three times the size of the current overcrowded clinic — which means it could start seeing new patients again.
But the new facility won't be finished until 2017, and the challenge will be staying on top of patient growth until then.
Last year, amid all the other woes at the Clarksville clinic, two nurse practitioners retired. The VA had to scramble to fill those positions, and Lim is worried the strain will burn out other staff at the clinic.
At the very least, Lim said, the VA is trying to make sure patients have options.
“It’s not optimal," he said, "but we definitely have not ignored the veterans."