Can't wait when we all get to use our "affordability credits" to wait a year to see a doctor at a federal health clinic...
Article published Jun 28, 2009
Doctor shortage proves painful to state
By BRENT CURTIS Staff Writer
Much of the state is short on primary care providers at a time when the nation as a whole is searching the same pool of doctors.
Since the start of the year, Rutland County, for example, has lost three primary care doctors and three more are over age 60 and planning to retire within the next few years, said Rutland Regional Medical Center President Thomas Huebner.
"We have the biggest shortage of primary care doctors in the state," Huebner said, pointing to a 2008 state Department of Health report that indicated that all but a tiny portion of the county faced a "severe need" for primary care physicians.
And that study was conducted before the departure of three primary care doctors earlier this year.
The loss of those doctors is more than just an inconvenience for their patients. With the demand for primary care in Rutland County exceeding the supply – which Huebner said is short by about four doctors – patients are forced to wait longer to see doctors who are overburdened. Also, many doctors in the region aren't accepting new Medicare or Medicaid patients – most physicians can only accept so many state-insured patients due to low government reimbursement rates – which compels many patients to put off doctor visits until their needs are acute and they end up in the hospital.
It's a fallback practice for those who can't find primary care doctors that Huebner and other health care professionals say ends up costing hospitals, insurance companies and ultimately those paying for insurance more.
And the primary care problem hardly is unique to Rutland or to Vermont for that matter.
Elsewhere in the state and nation, primary care physicians are in short supply.
Dr. Ted Epperly, president of the American Academy of Family physicians, said the United States is about 15,000 primary care doctors short of demand — a 30 percent shortfall across the board for all 50 states.
If current trends persist, the AAFP predicts the deficit will grow to 40,000 over the next 10 years.
That estimate is no surprise given that only 17 percent of U.S. medical school graduates in 2008 expressed a preference for family medicine. The AAFP said the small percentage of primary care-minded graduates represented an "all-time low" among emerging students.
Even in Vermont, where the University of Vermont prides itself on ranking in the top 5 percent of all medical schools for primary care, access to family medicine is spotty.
In addition to Rutland County, large swaths of the Northeast Kingdom along with large portions of Grand Isle, Franklin, Lamoille, Addison, Orange, Washington and Windham counties were labeled "severe need" areas by the Department of Health. Many other areas of the state were listed as "limited need" areas.
In fact, the only sizeable areas with adequate supplies of primary care, according to the most recent state study that compares full-time equivalent hours with regional populations, were portions of Chittenden, northernmost Orleans, southern Addison, much of Windsor, central Windham and most of Bennington counties.
The reasons for the doctor shortage, which has been gradually worsening over the years, are well documented. Much of the problem boils down to money. Medical students who opt to specialize rather than enter primary care practices stand to make significantly more because specific procedures earn higher reimbursements than generalized care and diagnoses. For medical students leaving school with debt loads often topping $150,000, the decision to enter primary care practice often means a degree of financial hardship, according to survey-based research conducted in Vermont and nationwide.
Those same surveys show that primary care physicians tend to work longer hours than specialized doctors and must juggle larger caseloads with the reams of paperwork that accompany most procedures in modern medicine.
In Rutland, Huebner said those symptoms are particularly acute due to high ratios of Medicaid and Medicare patients in the community. Reimbursements from the two government programs are well below the cost of medical procedures.
Vermont can be a tough place to recruit new doctors who can often find higher wages in other states, according to the Vermont Medical Society.
"What Vermont has going for it is quality of life," said Paul Harrington, executive vice president of VMS. "Nothing trumps a desire to be here because there are other places where doctors do earn more."
On top of that, Harrington said Vermont has a higher ratio of Medicaid patients and an ever increasing number of Medicare patients due to a graying population.
The pay scale puts Vermont at a disadvantage when it comes to recruiting new doctors – and it makes keeping them here a challenge, as well.
Since the primary care shortage is a national problem, other states constantly are trying to lure doctors away from Vermont.
To keep physicians here, hospitals around the state utilize their own recruiters who not only try to bring doctors to their facilities but work toward a balance of doctors in private practice in the surrounding communities as well.
Hospitals have an interest in the medical community beyond their own walls because a shortage of primary care doctors means more patients arriving in the emergency room suffering from ailments that a family physician could have detected and dealt with at a less acute and less expensive stage.
"We're all in this together," said Donna Izor, vice president of physician services at Central Vermont Medical Center.
Izor, and other recruiters around the state, offer incentives such as electronic medical records, startup loans and hospitallist services – hospital employed doctors who oversee a primary care physician's patients during hospital stays – to ease the financial, paperwork and time burden that family physicians shoulder.
But all acknowledge that the real answer to the problem lies at the state and federal level, where Medicaid and Medicare reimbursement levels are set – and all too often are cut.
During the last legislative session, budget realities prompted legislators to cut Medicaid reimbursements by 2 percent.
In the Legislature's defense, Rep. Steve Maier, D-Middlebury, said legislators exempted a number of procedures common to primary care physicians from those cuts and he said the Legislature increased Medicaid reimbursements for some primary care procedures.
"We know there's a shortage and we know that quality primary care saves money for the system in the long term," said Maier, who is chairman of the House Health Care Committee.
The Vermont medical community is also looking at changing the way that primary care is delivered. Through a blueprint model originally developed to handle chronic care for patients, three pilot programs are underway in Burlington, Bennington and St. Albans that will provide a small supplemental sum for each primary care provider in the pilot. More importantly, the blueprint pilot establishes a team approach that would surround primary care doctors with physician assistants and specialists, who the pilot's drafters hope will assist family physicians and relieve some of their time and caseload burden.
Huebner said he is seeking to make Rutland the fourth pilot site for the blueprint.
In the meantime, the RRMC president said he's looking ahead to the opening of a federally qualified health care center at 69 Allen St. later this summer.
The center, which will serve as a satellite for the main FQHC center in Castleton, is starting small with just a single doctor, but Huebner said he has applied for funding to expand the practice by building a center on land owned by the hospital.
There are eight other FQHC centers in the state – the one in Springfield is the newest – and 34 satellite offices. The centers' greatest asset is something of a commentary on the underlying problem confronting other primary care doctors – they are paid a much higher reimbursement for Medicaid and Medicare patients.
The FQHC facilities operating in the state cover a majority of the state's 14 counties.
But independent U.S. Sen. Bernard Sanders, who has advocated for additional centers for years, said he won't be satisfied until two more centers are added in Addison and Bennington counties.
Sanders said this week that he has had recent success expanding the FQHC program, which will create 126 new health centers nationwide this year.
"We have 60 million people out there with no doctor of their own," he said. "What we need to do and work on is making sure that every person in the nation has access to a doctor."
Article published Jun 28, 2009
Doctor shortage proves painful to state
By BRENT CURTIS Staff Writer
Much of the state is short on primary care providers at a time when the nation as a whole is searching the same pool of doctors.
Since the start of the year, Rutland County, for example, has lost three primary care doctors and three more are over age 60 and planning to retire within the next few years, said Rutland Regional Medical Center President Thomas Huebner.
"We have the biggest shortage of primary care doctors in the state," Huebner said, pointing to a 2008 state Department of Health report that indicated that all but a tiny portion of the county faced a "severe need" for primary care physicians.
And that study was conducted before the departure of three primary care doctors earlier this year.
The loss of those doctors is more than just an inconvenience for their patients. With the demand for primary care in Rutland County exceeding the supply – which Huebner said is short by about four doctors – patients are forced to wait longer to see doctors who are overburdened. Also, many doctors in the region aren't accepting new Medicare or Medicaid patients – most physicians can only accept so many state-insured patients due to low government reimbursement rates – which compels many patients to put off doctor visits until their needs are acute and they end up in the hospital.
It's a fallback practice for those who can't find primary care doctors that Huebner and other health care professionals say ends up costing hospitals, insurance companies and ultimately those paying for insurance more.
And the primary care problem hardly is unique to Rutland or to Vermont for that matter.
Elsewhere in the state and nation, primary care physicians are in short supply.
Dr. Ted Epperly, president of the American Academy of Family physicians, said the United States is about 15,000 primary care doctors short of demand — a 30 percent shortfall across the board for all 50 states.
If current trends persist, the AAFP predicts the deficit will grow to 40,000 over the next 10 years.
That estimate is no surprise given that only 17 percent of U.S. medical school graduates in 2008 expressed a preference for family medicine. The AAFP said the small percentage of primary care-minded graduates represented an "all-time low" among emerging students.
Even in Vermont, where the University of Vermont prides itself on ranking in the top 5 percent of all medical schools for primary care, access to family medicine is spotty.
In addition to Rutland County, large swaths of the Northeast Kingdom along with large portions of Grand Isle, Franklin, Lamoille, Addison, Orange, Washington and Windham counties were labeled "severe need" areas by the Department of Health. Many other areas of the state were listed as "limited need" areas.
In fact, the only sizeable areas with adequate supplies of primary care, according to the most recent state study that compares full-time equivalent hours with regional populations, were portions of Chittenden, northernmost Orleans, southern Addison, much of Windsor, central Windham and most of Bennington counties.
The reasons for the doctor shortage, which has been gradually worsening over the years, are well documented. Much of the problem boils down to money. Medical students who opt to specialize rather than enter primary care practices stand to make significantly more because specific procedures earn higher reimbursements than generalized care and diagnoses. For medical students leaving school with debt loads often topping $150,000, the decision to enter primary care practice often means a degree of financial hardship, according to survey-based research conducted in Vermont and nationwide.
Those same surveys show that primary care physicians tend to work longer hours than specialized doctors and must juggle larger caseloads with the reams of paperwork that accompany most procedures in modern medicine.
In Rutland, Huebner said those symptoms are particularly acute due to high ratios of Medicaid and Medicare patients in the community. Reimbursements from the two government programs are well below the cost of medical procedures.
Vermont can be a tough place to recruit new doctors who can often find higher wages in other states, according to the Vermont Medical Society.
"What Vermont has going for it is quality of life," said Paul Harrington, executive vice president of VMS. "Nothing trumps a desire to be here because there are other places where doctors do earn more."
On top of that, Harrington said Vermont has a higher ratio of Medicaid patients and an ever increasing number of Medicare patients due to a graying population.
The pay scale puts Vermont at a disadvantage when it comes to recruiting new doctors – and it makes keeping them here a challenge, as well.
Since the primary care shortage is a national problem, other states constantly are trying to lure doctors away from Vermont.
To keep physicians here, hospitals around the state utilize their own recruiters who not only try to bring doctors to their facilities but work toward a balance of doctors in private practice in the surrounding communities as well.
Hospitals have an interest in the medical community beyond their own walls because a shortage of primary care doctors means more patients arriving in the emergency room suffering from ailments that a family physician could have detected and dealt with at a less acute and less expensive stage.
"We're all in this together," said Donna Izor, vice president of physician services at Central Vermont Medical Center.
Izor, and other recruiters around the state, offer incentives such as electronic medical records, startup loans and hospitallist services – hospital employed doctors who oversee a primary care physician's patients during hospital stays – to ease the financial, paperwork and time burden that family physicians shoulder.
But all acknowledge that the real answer to the problem lies at the state and federal level, where Medicaid and Medicare reimbursement levels are set – and all too often are cut.
During the last legislative session, budget realities prompted legislators to cut Medicaid reimbursements by 2 percent.
In the Legislature's defense, Rep. Steve Maier, D-Middlebury, said legislators exempted a number of procedures common to primary care physicians from those cuts and he said the Legislature increased Medicaid reimbursements for some primary care procedures.
"We know there's a shortage and we know that quality primary care saves money for the system in the long term," said Maier, who is chairman of the House Health Care Committee.
The Vermont medical community is also looking at changing the way that primary care is delivered. Through a blueprint model originally developed to handle chronic care for patients, three pilot programs are underway in Burlington, Bennington and St. Albans that will provide a small supplemental sum for each primary care provider in the pilot. More importantly, the blueprint pilot establishes a team approach that would surround primary care doctors with physician assistants and specialists, who the pilot's drafters hope will assist family physicians and relieve some of their time and caseload burden.
Huebner said he is seeking to make Rutland the fourth pilot site for the blueprint.
In the meantime, the RRMC president said he's looking ahead to the opening of a federally qualified health care center at 69 Allen St. later this summer.
The center, which will serve as a satellite for the main FQHC center in Castleton, is starting small with just a single doctor, but Huebner said he has applied for funding to expand the practice by building a center on land owned by the hospital.
There are eight other FQHC centers in the state – the one in Springfield is the newest – and 34 satellite offices. The centers' greatest asset is something of a commentary on the underlying problem confronting other primary care doctors – they are paid a much higher reimbursement for Medicaid and Medicare patients.
The FQHC facilities operating in the state cover a majority of the state's 14 counties.
But independent U.S. Sen. Bernard Sanders, who has advocated for additional centers for years, said he won't be satisfied until two more centers are added in Addison and Bennington counties.
Sanders said this week that he has had recent success expanding the FQHC program, which will create 126 new health centers nationwide this year.
"We have 60 million people out there with no doctor of their own," he said. "What we need to do and work on is making sure that every person in the nation has access to a doctor."
