Shortage of primary care doctors threatens Vt. health care reforms

Published: Jan. 2, 2020 at 3:32 PM EST
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To bring down the rising cost of health care in Vermont, the state is switching to an 'all-payer' model, which focuses on preventative care. But the graying of Vermont could make that more difficult.

Demographic challenges are nothing new for Vermont. People are aging and taking up more time and money in the health care system.

"We don't have that younger healthier population to backfill the pool that we need in order to have the health care at a price we can afford," said Gov. Phil Scott, R-Vermont.

Recent workforce data shows a need for 69 primary care physicians in Vermont. Right now, out of the state's 319 medical residents, only 18 are in family medicine. And 36 percent of Vermont's primary care doctors are over the age of 60.

Health care regulators say Vermont lacks primary care providers because in order for new graduates to pay off crippling medical school bills, many turn to specialty care where they can make more money.

"We've made it just too darn expensive to get through medical school, and that cuts off your supply right in the beginning because people can't afford to do it.," said Kevin Mullin, the chair of the Green Mountain Care Board.

In the all-payer model, physicians, hospitals and providers sign on under a single network called an accountable care organization. The plan is to eventually have every Vermonter served by OneCare, the for-profit accountable care organization set up to facilitate the state's all-payer system. Next year, they estimate a quarter-of-a-million patients will be part of the system.

OneCare CEO Vicki Loner says the flexibility of the all-payer model lets doctors see patients in groups or use technology that saves time and money.

"You can use telemedicine, you can make a phone call, you could send an email, you could have various different modes of communication with individuals that takes less time for the physicians," she said.

Vermont lawmakers this session will hear recommendations about potential solutions to the workforce shortage. Those include allowing health care providers licensed in other states to practice here and shortening up the residency period for nurses so they can start seeing patients sooner.

Regulators like Mullin are intrigued by those ideas but they say it's going to take more than that. He says medical schools, lawmakers and health care providers need to work together to make it easier to fill the primary care need.

"If we continue on the current trajectory, it doesn't matter if it's the all-payer model or a fee-for-service model or what have you, it can't work. Without quality doctors doing primary care work, it's just going to be more expensive to the system," Mullin said.

The Green Mountain Care Board on Jan. 15 expects to discuss some possible solutions during a meeting with primary care doctors, medical school officials, and staffers from Sen. Bernie Sanders' office.