Rural communities across the country face a shortage of doctors of all kinds, and Vermont is no different.
But as technology advances, and patients get more comfortable with video conferencing, health care officials say telemedicine might be one way to address the shortage.
Dr. Kyle Hagstrom, a psychiatrist at the Brattleboro Retreat, is sitting down in front of a computer. Hagstrom is having a meeting with Dr. Jarred Zucker, the newest full-time staff member at the Retreat.
Zucker lives in Brooklyn, New York. And even though he's working full time for the southern Vermont psychiatric hospital, he's not moving up to New England.
That's because Zucker is a telepsychiatrist.
He sees his patients remotely, but takes part in the same meetings and trainings that the other doctors at the Retreat do.
Dr. Mark McGee, chief medical officer at Brattleboro Retreat, says the Retreat has been experimenting with telemedicine over the past year and this month the hospital hired three new telepsychiatrists who live in New York City and Rhode Island.
"It really no longer matters where the clinician is," says McGee. "It really is about bringing the clinician to where the patient is. And what that allows us to do, is to really ensure that when patients are in need of care, and they come to us for care, that we can provide that care when they need it."
Vermont's psychiatric hospitals have the same challenges that are facing primary care services — psychiatrists are getting older and retiring, and younger families are not moving to Vermont.
McGee says staff shortages put pressures on the whole system and affect patient care.
He says telemedicine is one way to broaden the application pool when staff positions open.
"In a remote place such as southeastern Vermont, recruitment and retention is a challenge," McGee says. "And so by being able to expand our medical staff to fully robust and healthy levels, we're able to really decrease the individual burden of each individual member."
Over the past few years, McGee says the cost of purchasing and maintaining telemedicine equipment has come down.
The security is also much better, he says, and internet speeds have improved to the extent that complex medical imagery can be uploaded in real time.
And most importantly, McGee says, patients are ready for this brave new world.
"These are relatively ubiquitous technologies that many of us use on a daily basis," says McGee. "It really has broken down the barriers of acceptance that may have existed previously.
"And so what we have discovered is that that perception, that barrier, no longer exists anymore. And that the technology is so pervasive that people accept it as a part of modern life."
Last year, Gov. Phil Scott signed a bill that requires insurance companies to cover telemedicine service inside people's homes.
And as the state moves away from a fee-for-service model, and pays physicians instead for better outcomes, telemedicine could be one way to help increase doctor visits and improve care.
Devon Green, the vice president of government relations for the Vermont Association of Hospitals and Health Systems, says telemedicine will become an important tool for Vermont's rural hospitals as the health care system changes.
"Vermont is moving into value-based care, where doctors are getting reimbursed for their outcomes, as opposed to just their services that they're providing," Green says. "So it's more incentive to provide preventive care and having more touch points, instead of just coming in a couple of times of the year just to ensure that there's no crisis and it doesn't bloom into an emergency.
"Vermont's rural nature makes telemedicine a useful tool to do that. It makes it easier for doctors to communicate with their patients more often."
A shortage of psychiatric beds in the state have led to patients spending too long in hospital emergency rooms. Kathleen McGraw, Brattleboro Memorial Hospital's chief medical officer, says telemedicine gives hospitals a way to at least get treatment to these patients earlier.
McGraw says Brattleboro Memorial Hospital is close to signing a deal with the Brattleboro Retreat to bring telepsychiatry services into the emergency department.
"The need for more availability of psychiatric beds within the state of Vermont still exists and this doesn't change that," says McGraw. "What this does is it gets treatment sooner to those patients. And hopefully in the long run it will reduce their length of stay.
"If they're treated a little bit sooner in our emergency department and can get started with the care that they need, then maybe they won't need to be in that bed that they get to eventually for quite as long."
Brattleboro Memorial Hospital is also using telemedicine to treat stoke victims through a contract with Dartmouth-Hitchcock Medical Center.
McGraw says the technology and acceptance of telemedicine is moving faster than the regulatory and billing debates, but she expects the services to only increase in the coming years.
The Brattleboro Retreat is a VPR underwriter.