Luskin: An Aging Breed

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Vital Signs: Vermont Charts A New Course For Health Care

(HOST)  This week, VPR presents Vital Signs, our series on Vermont’s overhaul of health care.  Commentator Deborah Luskin thinks that universal health coverage would be great for patients – if there were enough physicians to go around. First hand experience tells her that family practitioners willing to go into rural practice are an aging breed.
(LUSKIN)  I met Tim Shafer on August 4th, 1984, at the annual Grace Cottage Hospital Fair. He was the new, young doctor in town; he’d been in practice about five weeks. At the time, he was one of the two family physicians who covered the emergency room after a full day in the clinic. Grace Cottage is Vermont’s smallest hospital with only 19 beds – and a 24-hour ER.  My first impression of Tim was, "This man looks tired." So on our first date, when Tim talked about marriage, I told him to ask when there was a third doctor in town. We’ve been married twenty-five years now, and there are more doctors in the call schedule, but Tim’s still tired.
For all that he loves medicine and his busy practice, he’s no longer the young man who can function without sleep for days on end. Nor does he want to. But recruiting new primary care doctors is difficult.
There just aren’t enough medical students choosing family practice because it requires the longest hours for the least pay. And for a doctor just starting out, money matters: $200,000 of medical school tuition on top of undergraduate loans and living expenses means most new physicians begin their professional lives in serious debt.
The majority of those who do chose family practice take jobs in urban and suburban areas, where hospitals can afford emergency room personnel. This means a primary care physician’s on-call duties generally do not require getting out of bed to give hands-on care, as Tim or one of his colleagues does every night. Rural medicine remains a lonely frontier. Neither advances in medicine nor communication technology can change geography or climate: rural doctors must act on their own when they care for the sick and injured in the middle of a stormy night.
Of the seven primary care doctors currently at Grace Cottage, two are in their mid-forties; two are in their late-fifties; and three are sixty or more. This is part of a statewide trend. According to the Primary Care Workforce Report published last November, one in five of Vermont’s primary care docs is over sixty, and more than a quarter of them have been in practice for twenty years or more. Many of these physicians will be retiring just when Vermont’s universal health care initiatives launch.
The shortage of primary care doctors is not unique to Vermont; current projections indicate a significant, national shortage of physicians. Ironically, just as people receive coverage, there will be a universal shortage of doctors for them to see.
There are some initiatives Vermont could implement to recruit and retain a new generation of family docs. These include increasing training capacity, increasing debt reduction, and decreasing the administrative burdens of providing care.
Tim still loves the face-to-face, hands-on part of his job. But after nearly thirty years of broken sleep, he’s ready to pass his beeper on to younger colleagues – if only they could be found.

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