[D]octors are buried in paperwork, overburdened by student loans, worried about patients finding doctors and concerned about the shortfalls of the state’s mental health system.
That’s according to a recent survey by the Vermont Medical Society, the state’s largest member organization for primary care doctors. The organization has about 2,000 members, or about three-quarters of doctors in the state, and is loosely affiliated with the American Medical Association.
Because it’s a survey, the Vermont Medical Society data contains response bias, whereby the most agitated members tend to submit responses. But many of the 117 doctors who completed the survey clearly agreed on issues related to administrative burden, student loans, access to primary care physicians and beds for Vermonters in psychiatric crisis.
Among the findings:
• Ninety percent of respondents said “documentation and administrative issues” interfere with their abilities to serve patients well, and 32 percent said they don’t have enough time to spend with their patients.
• Eighty-six percent of respondents said conforming with insurance companies’ “reporting quality measures” are an administrative burden, and 85 percent said such quality measures should be consistent across different insurance companies, including the government.
• Seventy-eight percent of respondents are worried that patients with new health insurance won’t be able to find “adequate” care because there is a shortage in doctors, and 93 percent say Vermonters in psychiatric crisis should not be forced to stay in an emergency room for more than six hours.
• Ninety-three percent said there should be some form of tuition assistance, loan forgiveness, or deferment plans to help alleviate medical school loan debt, and 32 percent, or 47 doctors, are considering early retirement because of the medical practice environment.
Dr. Tania Bertsch, who teaches primary care at the University of Vermont College of Medicine, called the administrative burden on family doctors “considerable.”
She said the burden doesn’t stop medical students from staying in school, but affects their decision to specialize.
Additionally, Bertsch said Vermont is already suffering from a lack of primary care doctors, and high student loan debt from medical school makes it hard for students to go into primary care and make money.
“Access to care is already an issue and is likely to get worse as there are a number of primary care physicians getting close to retirement,” she said. “The pipeline for physicians to replace these retiring doctors is down to a trickle.”
Justin Campfield, a spokesperson for Vermont Medical Society, said he often talks to doctors who are frustrated with spending their own time, without pay, dealing with insurance companies that don’t want to authorize procedures for their patients.
“They know the patient; they know the science behind the treatment they’re providing, so that’s kind of frustrating for them,” Campfield said. “A lot of time after they’ve given a patient the treatment, there’s a lot of paperwork going back and forth with the payers, and that’s mainly government payers.”
Doctors are also finding it hard to make money because the amount Medicaid pays them to see patients are so low, according to Campfield. In Franklin County, four pediatricians have left their private practices, leaving six pediatricians to serve a county of 48,000 people, according to Campfield.
“Two of them are closing because they’re unable to be profitable as two pediatricians in Vermont,” he said. “Another is closing because they were not able to recruit a new doctor. Another one was leaving to go practice in North Carolina.”
Al Gobeille, chair of the health-insurance-regulating Green Mountain Care Board, said he knows that doctors have many of the problems described in the survey. He pointed to a 2013 report between the Green Mountain Care Board and Vermont Medical Society describing rural access to doctors.
“A very significant factor pushing physicians away from primary care and making recruitment of replacement physicians difficult is the growing burden for documentation and administration demands from both public and private sector (payers),” the report said.
“The aggregate burden of complying with the demands from multiple agents other than the patient in need is mentioned more than any single factor contributing to the stress and exhaustion of primary care practitioners—more than the income discrepancy between primary care and specialty physicians,” the report said.
Rural communities have “considerable and near-term” challenges in recruiting independent family doctors, the report says, and the recruitment issues mean rural areas will rely more and more on mid-level providers such as physician assistants and nurse practitioners.
