Vermont faces physician shortage

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(Host) Vermont faces a shortage of primary care physicians just as these doctors are being asked to do more to manage chronic diseases.

The Vermont Medical Society says one reason for the shortage is that payments to physicians have not kept pace with rising costs.

VPR’s John Dillon reports:

(Host) The most recent Health Department survey found that just four of the state’s 14 counties have an adequate supply of primary care doctors.

Paul Harrington is the executive vice president of the Vermont Medical Society. He told the House Health Care Committee recently that Medicare and Medicaid don’t reimburse doctors enough to cover the cost of care. Harrington says that’s especially critical in Vermont.

(Harrington) “Vermont physicians probably have a larger Medicaid caseload than their peers in other states. So their total income is going to be less because that low reimbursement represents a larger percentage of their total patient population.”

(Dillon) Doctors leave medical school with an average debt of $150,000.

Dr. Stuart Williams is a family doctor in Berlin. He says the high debt load can determine where a doctor chooses to work.

(Williams) “I think the largest issue has to do with income expectation, particularly with physicians coming right out of training and saddled with exorbitant debts and not being in a position to take any kind of financial risk as far as establishing their own business.”

(Dillon) The physician shortage is growing more acute just as primary care doctors are getting more work to do. Vermont has launched a chronic care initiative that gives primary care physicians greater responsibility to treat and manage chronic diseases.

Middlebury Representative Steven Maier chairs the Health Care Committee.

(Maier) “At the same time we have doctors, primary care practices, being stressed under the current system, at the same time we’re trying to give them more work in terms of chronic care. That’s where want it to take place. That will save money in the long run. That’s why I think it’s so critically important to me and to us here in the Legislature that we figure out ways of supporting primary care practices as we move forward.”

(Dillon) Dr. Williams says he’s tried to practice chronic care management throughout his 27-year medical career.

He says there’s always more to learn. But he sounded a little worried when committee members asked about the new chronic care initiative.

(Williams) “Unfortunately, we have the sense that this chronic care initiative could just turn out to be another intrusion or complication to actually our service to patients.”

(Dillon) The budget proposed by the Douglas administration would raise Medicaid reimbursements for doctors and hospitals. And Health Committee chairman Maier says he wants to look at different ways to pay doctors so they are rewarded more for managing chronic care.

For Vermont Public Radio, I’m John Dillon.

Note: On Switchboard Thursday night, Fran Stoddard hosts a discussion on the physician shortage in Vermont.

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