[F]ormer patients of the recently retired local doctors Robert Backus and Robert Tortolani sometimes stop them in the street or call their homes for advice.
In a recent interview, the two men said they are concerned about their patients and believe the health care system in Vermont is in crisis.
“It’s a bad situation, and Bob and I are equally worried about the state of health care, not only in this state or country,” Tortolani said. “Health care has been devalued on just about every level you can think of. This is what we created. We created a monster.”
The main issue is the shrinking number of doctors, nurse practitioners and physicians’ assistants. The doctors worry that a bond between patients and doctors will become more rare as the focus moves away from the type of delivery local communities here are used to getting.
They say the shortage in staff will also cause additional stress for those in the field.
The two doctors both had private primary care practices. Backus, whose practice was located at Grace Cottage Hospital in Townshend, retired in March. Tortorlani, whose practice was at Brattleboro Memorial Hosptial, retired in July.
Backus admitted the Obamacare approach had its flaws especially in Vermont and “was not totally thought out before it was implemented.”
“But the data says it’s been working pretty well,” he said. “Increasingly well. But then we have a change in administration and three legs of the chair are immediately taken out of it. So it’s going to crash.”
Backus said Tortolani already had his practice in Brattleboro when he started at Grace Cottage in the 1970s and Tortolani had been “very supportive” of him. Both men found Windham County to be a good place to settle into their medical careers. Backus even went so far as to call his coming to the area “love at first sight.”
‘Life was simpler’
Tortolani began his practice in Brattleboro in 1973 after working as a doctor at Copley Hospital in Morrisville. In between those two jobs, he held a part-time position in Stowe, where Maria von Trapp had been one of his patients.
“That was interesting,” Tortolani said. “Nice lady.”
Life was simpler in the beginning of his career, and before it, by his account.
“Things have changed a lot,” Tortolani said, remembering his father using 3-by-5-inch index cards for medical records as a doctor in the small town of Plainville, Conn., from the 1930s to 1960s. “I don’t remember there being any security issues back in those days. No [Health Insurance Portability and Accountability Act] violations. None of that stuff.”
Back then — at the time of the Great Depression, when Tortolani’s father would get paid in animals and vegetables — rather than call, patients would come and wait for the doctor in the reception area. It could take hours before they were seen and no one raised concerns about outside parties hacking into their medical records.
On Wednesdays, Tortolani’s father hit the links.
“Back in those days, doctors played a little bit of golf,” said Tortolani, who “always” thought he wanted to be a physician — never anything other than a family physician.
Tortolani recalls his annual tuition being $3,000 for medical school and $3,500 for college.
He considers himself lucky because his parents could help and he graduated without debt. If he had to pay the price now to attend those institutions, he’s not so sure he would have been in the same situation. He worries young doctors will steer away from opening their own practices out of fear of financial instability.
Backus had gone through similar schooling then held a couple jobs at Brattleboro Memorial Hospital. He also went on ambulance calls as part of the squad that included the founding members of Rescue Inc.
“I was a busy boy in those days,” he said.
Backus credited Dr. William Grossman, a pathologist at BMH, with encouraging him to go to medical school. Grossman, now deceased, wrote a recommendation to the University of Vermont for Backus.
Tortolani was a U.S. Army physician in the Vietnam War and Backus was in the Peace Corps. So it’s no surprise they both have felt a commitment to continue serving families in practices they had operated for decades in Windham County.
Tortolani remembers being asked why he wanted to go into primary care and being told it’s not a challenging field.
“Ha-ha,” he said, getting a laugh from Backus.
A privilege and a blessing
Andrea Seaton, director of the Foundation Office and community relations at Grace Cottage, described the doctors as “quintessential people-people.”
“You just thrive on relationships,” she told them. “When you think about the ripple effect on families in this area, it’s amazing.”
The two doctors each responded with a word summing up their work. For Backus, it was a “privilege.” For Tortolani, it was a “blessing.”
Tortolani emphasized his ability to make continuity of care and treatment from infancy until death priorities at his practice. Backus is known for going to patients’ memorial services.
“It’s important for me,” he said. “It helps me weep. It helps me forgive myself. It helps me be a better physician.”
Backus enjoyed every minute of practicing medicine, he said, but once he retired he felt the weight of the world lifted from his shoulders. Now, he has more time to spend with family.
“I am more worried about what is coming,” he said. “I think there’s a change in the medical students’ outlook.”
An investment in the future
Many students compare wages earned by doctors dealing in specialties versus family practice. “And it’s a no-brainer,” said Backus. He feels the Vermont House of Representatives had been “totally responsive” but the Senate not so much when he made a presentation last year to urge the University of Vermont, the medical society and practicing physicians “to get their heads in the same direction” in terms of creating incentives for graduates to work in primary care.
“I believe that the Legislature is going to have to consider putting money into this,”
Tortolani added. “Let’s say 10 medical students each year. You’re going to fund that $5 million. They will be in primary care for five to 10 years. I think that’s where it’s at. Maybe the Legislature doesn’t think it’s a worthwhile venture. But I think they should.”
Besides the shortage of doctors and the feeling of burnout many of them face, Backus worries about “overworking and overstretching” the network of physician assistants and nurse practitioners. He also wants women to have the same respect and opportunities for promotion and pay as men.
“We need to respect them and treat them right,” he said. “That’s how we’re going to keep them.”
Tortolani called attention to Vermont’s shrinking workforce and the average age being the second oldest to Maine in the United States.
“We’re probably going to be No. 1 as young people leave this state in droves,” he said. “Vermont has always had a kind of drain of a lot of its students leaving after college and not coming back until their later 30s.”
Challenges are abundant
Tortolani said older patients tend to have more complicated issues and need to be seen by a doctor more often. The rural nature of the area also presents transportation troubles.
The two doctors expressed concern that the electronic heath-record keeping is creating a lot more work for physicians and keeping them away from developing important relationships with their patients.
“There’s a lot of things they find they have to do meaningless,” Tortolani said. “It’s the administrative burden we’ve talked about for years and years and years. I’ve been very, very worried about the fact that my colleagues in medicine aren’t as happy as they used to be.”
Backus finds the data collecting can bring about six to 10 additional hours of work each week for a doctor. He said some places are hiring scribes now, increasing the price of health care but providing no better product than in the days of paper.
But Backus believes there are possible remedies.
“All this is fixable with a system,” Backus said. “I don’t care if you call it Medicare For All.”
He suggested changing computer systems so they would benefit the patients and changing the health care system so residents paid a tax through their states “and those people let the state people run the system and hold them accountable.” He called Canada “a great teacher for us.”
“We could learn from them and incorporate it,” he said.
