Luskin: Primary Care Doctors Needed

Aug 29, 2017

Vermont, like the rest of the nation, is facing an imminent shortage of primary care doctors.

Even though primary care is the single most cost-effective health care available, it continues to be the lowest paid of medical specialties, making it difficult to attract young physicians graduating with hefty medical school debt, especially in underserved areas. Currently, all fourteen counties in Vermont have medically underserved areas.

In the mid 1970’s, a group of citizens in southeastern Vermont formed the Valley Health Council in order to recruit a much-need a primary care physician to the West River Valley through the National Health Service Corp, a federal program. The Valley Health Council could hire a doctor who’d received a National Health Service scholarship that paid medical school tuition; in return the new doctor would provide primary care in a medically underserved area.

I know about this program because that’s how my husband came to practice in Townshend in 1984. For three years, the Valley Health Council paid his overhead, and the federal government paid his salary. When his pay-back was over, he was debt-free, and he stayed.

Medical school debt itself can be crushing; setting up a practice expensive; earning a living in primary care challenging. Yet it has its rewards. Tim’s now been practicing in Townshend for thirty-three years, though he’s no longer self-employed. Changes in healthcare regulation and financing made that impossible. He’s employed at Grace Cottage, a hospital-based primary care practice, where he’s now caring for children of babies he delivered, and those babies’ grandparents as well.

This is unparalleled continuity of care. But like thirty per cent of Vermont’s primary care physicians, Tim’s now past sixty, and he’s nearing retirement. Vermont must figure out a way to attract a new generation of primary care practitioners – and soon.
Eight per cent of Vermont’s primary care physicians may retire this year, and it takes seven years for a primary care physician to complete training.

Instead of putting small communities through the process of qualifying for the federal program as the Valley Health Council did forty years ago, perhaps Vermont could create and administer its own state scholarship program. In return for tuition, graduates would practice in Vermont after residency.

We know this model can work: like Tim, once their medical school debt is repaid, these doctors may decide to stay.