BENNINGTON — Lower pay than in many other states and a lack of urban attractions are among the hurdles Vermont faces in recruiting physicians and other medical professionals.
The problem was highlighted recently by the decision to close the Shaftsbury Medical Associates practice with the pending retirement of Dr. David King, after no physician could be recruited to continue the clinic, which is not associated with a large health care group.
“We are definitely in a period where we are seeing physicians aging out of practice and not the supply coming in to replace them,” said Dr. Trey Dobson, chief medical officer with Southwestern Vermont Medical Center. “There is already a shortage, so the next several years are going to be difficult for bringing in primary care for our area.”
“We have made some headway,” Dobson said. “We’ve recruited in five or six physicians over the past couple of years, but it’s hard to catch up with those who are retiring.”
Beyond their medical role, primary care physicians also perform the crucial work of mentoring new physician assistants and nurse practitioners in practices or health clinics, he said.
SPECIALISTS
Concerning specialists, Dobson said recruitment barriers in Vermont can be compensation rates, to an extent, but the issue often is that they “want to live in a semi-urban area,” not a rural community. A related barrier is when a physician’s spouse can’t find the type of employment they’re seeking outside of a more populous urban center.
A reason for optimism involves the significant expansion of remote work options that began abruptly with the COVID-19 pandemic, and that many longtime urban dwellers scrambled to either move to places like Vermont or purchase a second home here.
In the Bennington area, it has proved difficult to recruit specialists in oncology, dermatology, urology and neurology, Dobson said, adding that “those are the specialties where we have a gap,” which can result in some long wait times for patient appointments.
In addition, many specialists, predominantly in areas like cancer treatment, prefer to be where their patients can be involved in clinical trials at a larger facility, such as the University of Vermont Medical Center.
“But we are working hard, and I am always optimistic,” Dobson said.
Vermont is also far from alone in the U.S. in having to address a shortage of physicians and other practitioners, he said.
“I’m confident we will be successful; it just takes time,” he said. “I say that because we have been successful since 2020 in recruiting primary care physicians.”
STATEWIDE INITIATIVES
Stephanie Winters, the deputy executive director of the Vermont Medical Society, said the organization has supported increasing pay incentive and loan forgiveness programs, in part because the state offers considerably less in those areas than neighboring states.
For instance, New York offers higher average pay levels and higher rates of student loan forgiveness for physicians and others working in health care.
“Workforce shortage is a real concern [for the medical society],” she said, and the group has put forth proposals to the Legislature, some of which have been adopted. Those proposals include providing funding for initiatives or programs, and for regulatory changes that reduce costs for physicians and practices in Vermont.
“We have a primary physician prioritization campaign that we laid out last fall and brought to the Legislature,” Winters said. That includes striving to “keep our current workforce and to attract new workforce,” along with “increasing Medicaid payments, so that practices can be viable, especially for primary care.”
The medical society favors reducing “the administrative burdens that we place on medical professionals,” she said. “Really trying to go at this from all angles, because it’s not just one magic beam that’s going to fix our workforce issue.”
LEGISLATIVE ACTION
In Act 183, the Legislature recently included workforce recruitment incentives that focus in part on health care, said state Rep. Michael Nigro, D-Bennington 2-2, who worked on the legislation as a member of the House Committee on Commerce and Economic Development.
He said much of the focus during the recent session was on assistance for other primary care workers, such as nurses, nurse practitioners and physician assistants, but there is support for doing more to ease the state’s recruitment disadvantages concerning doctors, as well.
Attracting those other health care practitioners “could help relieve the strain” of the physician shortage, he said, adding that the intent is to address workforce recruiting issues throughout the health care system in Vermont.
Although Act 183 deals with all sectors of the workforce, “almost a third of it focuses on health care,” Nigro said. “I know the [House] Committee on Health Care has a significant focus on this. [Lawmakers] are certainly talking about it.”
The Commerce Committee worked in collaboration with the Health Care committee on the recently enacted bill, he said.
Another piece of the legislation, he said, allows the Green Mountain Care Board to exclude consideration of investments in workforce development from budget spending plans for hospitals and health care organizations.
“This is to allow for innovation,” he said.
STATED PURPOSE
Act 183 provides, among other provisions, for creation of the Vermont Health Care Professional Loan Repayment Program, which can provide loan repayment.
The bill also provides in fiscal 2023, $500,000 from federal American Rescue Plan Act pandemic relief funding “for medical technicians, child psychiatrists, and primary care providers.”
Among other things, it also provides $2.5 million for grants to health care employers to establish or expand partnerships with Vermont nursing schools to create nursing pipeline or apprenticeship programs, or both; $2 million for fiscal 2023 from ARPA funding to the state for loan repayment for nurses and physician assistants; and $2 million for fiscal 2023 for “emergency interim grants to Vermont’s nursing schools over three years to increase the compensation for their nurse faculty and staff, with equal amounts to be distributed in each of fiscal years 2023, 2024, and 2025 to increase the compensation for each full-time-equivalent member of the clinical and didactic nurse faculty and staff,” and more.
“The General Assembly values all health care workers, at every level and in each component of the health care system,” the bill states. “The General Assembly also acknowledges the many struggles faced by health care workers and that the pandemic has placed further strain on an already taxed system ... To retain and recruit health care workers in Vermont, it is the intent of the General Assembly to invest in multiple solutions aimed at reinforcing our health care workforce in the present and sustaining our health care workers into the future.”