Dear Editor,
Bruce Hamory’s recommendation to the Green Mountain Care Board to reduce doctors’ time with patients is completely off base. The report’s conclusion that the state will have enough primary care providers is based on primary care providers (PCPs) seeing three patients per hour, and many internists, who see more complex patients, currently see a patient every half hour.
I have been practicing general internal medicine for 37 years and in Vermont for 28 years. During this time, I have seen the complexity of my patients increase and the demands on the doctor increase, making it less likely that decreasing the time with patients would be a successful model or solution. It will fail.
We do not have enough primary care physicians in Vermont despite what Hamory’s data might support. We are now seeing doctors retire younger, or reducing their clinical time due to burnout. We chose this profession, rather than subspecialty medicine, because we like continuity of care with our patients — getting to know them, keeping them healthy, diagnosing diseases when they are sick, coordinating their care, and caring for them at the end of their lives. Time with the patient is needed to do this well, and short of that, we lose the satisfaction of the profession we chose.
Recruitment of new physicians, both primary care and specialists, to Vermont is becoming more difficult as there are better opportunities elsewhere. Thus, we must support the physicians and providers that we have, as we cannot afford to lose a single one. We need to unburden all physicians and providers from unnecessary administrative burdens such as unnecessary prior authorizations, allow flexible work hours, and extend the clinical careers of many doctors now retiring earlier due to burnout.
Our ability to recruit is threatened by our state economics —lower physician salaries than elsewhere, high cost of a house combined with high property tax, and lack of availability of single-family homes. Most professionals moving to Vermont do not imagine themselves living in apartments. Communities that continually block building of new homes in areas near hospitals (NIMBY attitude) are making recruitment difficult. This ultimately impacts the ability for patients to get health care here in Vermont due to physician shortages.
Increasing panel sizes and diminishing time with patients is no solution to a physician shortage. Our inability to attract talent due to economic factors is certainly playing a role. The system does not run well without physicians. We cannot think that the current physician and provider workforce can do more, as most physicians I encounter are already pushed to their limit.
Frank Landry, South Burlington
Landry is an internal medicine physician who has practiced in Vermont since 1996. He served as the governor of the Vermont chapter of the American College of Physicians from 2003-2007. Landry has been in private practice since 2000.
