Many states across the country have a need to attract more primary care physicians, but Vermont's situation has an additional twist - a sizeable number of the state's primary care doctors are expected to retire in the next few years.
Paul Harrington is the executive vice president of the Vermont Medical Society. He says about one-third of Vermont's nearly 1,900 physicians work in primary care - per capita, that's about the national average.
But he says thirty percent of the state's primary care doctors are over the age of 60, which means the shortage will get worse in just a few years.
"The average age of physicians, like the population, continues to age,” says Harrington. “We're going to certainly need more primary care physicians. The current population is aging out of their practice."
Harrington notes that the state has embarked on an ambitious program to emphasize preventative care to help lower health care costs and improve the health of individual patients.
Primary care doctors are a key part of this initiative, and without enough of them, Harrington doubts these reforms can succeed.
"The whole model that we're going towards of promoting better coordination of care requires a strong relationship with a primary care physician and it is going to fail unless we have an adequate supply of primary care physicians," said Harrington.
Kevin Mullin is the chairman of the Green Mountain Care Board, a regulatory board that oversees virtually every aspect of health care in Vermont.
Mullin says in many countries around the world, two-thirds of all doctors are primary care physicians. That’s double the U.S. rate. He says he thinks that’s one of the reasons why health care costs are often lower in those countries.
“We have a system where we have two specialty care doctors to every one primary care doctor,” said Mullin. “If we had more primary care in Vermont I think that you would see some of the costs going down."
What steps could be taken to attract more primary care doctors to Vermont?
Mullin says one strategy could be for the state to offer to pay the medical school tuition for students who make a commitment to practice in Vermont for a number of years after they graduate.
This could be a significant investment, because tuition for a single student could amount to as much as $300,000.
"That we would do a commitment with someone up front that their education would be paid for if they made a commitment to stay in the state for x amount of years,” said Mullin. “I mean those are the type of things that I think we're going to have to do to create that better supply of doctors here."
The Green Mountain Care Board is also expected to look at proposals that would require accountable care organizations and Vermont's hospitals to make a greater investment in primary care programs.