Editor’s note: This commentary is by Roger Albee, who recently retired as the CEO of Grace Cottage Family Health and Hospital in Townshend. He is a former secretary of the Vermont Agency of Agriculture, Food and Markets.
[L]ike many, I grew up in a small rural Vermont community where the country doctor was “king.”
No matter the time of day or evening, he or she could be contacted, and if the problem was severe, a visit to the home was in order. The country doctors of my early youth knew and treated every member of the family, from birth to death. The minutes or hours spent with a patient was not a criteria; better treatment and wellness was the objective. The doctors were respected in the community and knew every aspect of what was needed for better health.
Rudyard Kipling, when he lived at Naulakha in Dummerston, wrote: “Doctors of Vermont carry on practice over a radius of twenty miles or more, in frequency of snow to reach patients, and often on snowshoes to proceed. They travel on mountain roads in all seasons, in all weather, at all hours, afoot, or horseback, or carriage.”
Yes, health care has changed over the years, and so has the role and availability of the country doctor of the past. Health care has become specialized and more complex, both on the regulatory side, with insurance costs and reimbursement, as well as the ability to better address community needs more broadly. The country doctor of my youth took out my tonsils, fixed a broken ankle and knuckle, removed a cyst … many problems that would be sent to a specialist today.
In recent national surveys (Merritt Hawkins in 2016), Vermont ranked as the third best U.S. state when it comes to health care and physician access. While a rating of this type is important, it hides some importance facts, and these include:
• Vermont only spends about 6 percent of its resources on primary care and only about 5 percent on community health services;
• Preventable care is the most important step that can be taken to manage health care. Many of the top risk factors leading to illness and premature death are preventable, according to statistics;
• In 2013, the U.S. spent far more on health care than 13 other high-income developed countries, driven largely by greater use of medical technology and higher prices. Despite this spending, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions.
• It is estimated that 30 to 40 percent of total health care spending is wasted in the United States, and although our country spends twice as much per capita on medical care as do other industrialized nations, we are in the last place in preventing deaths.
There is some good news in Vermont, however, at places like Grace Cottage Family Health and Hospital in Townshend. The focus on primary and preventable care, and in servicing further community needs with the resources of community health teams is redesigning the country doctor’s role of the past. A community health team is an innovative strategy using an interdisciplinary team of health care providers that have the ability to do what country doctors of the past were able to do. These teams have trained nurses, social workers, diabetes educators and nutritionists integrated with primary care physicians and advanced practitioners. These services recognize that it is the whole patient and the community that is important in health care. It is often stated that only about 10 percent of health care is due to doctors and hospitals. Most is due to community and family factors and jobs, food, education and the community. These factors today are referred to as community health care or population health. These integrated teams have the ability, not restricted by the clock, to address a wide range of medical issues and needs within the community. Initiatives like these to include an increased focus on food as medicine is helping to bring health care back to its historical focus, or roots, where the doctor was part of the local community and the attention was to the whole patient as well as to his or her family.
While this type of health care is extremely important, it operates primarily through grant funding, as preventable care and community health care is still not the real financial objective of our health care system in Vermont or the United States today. Also, when a state only spends such a small amount even on primary care, a lot needs to be done to change the economic paradigm. Country doctors of the past are a vanishing breed but attention to primary care and preventable health does save on health care costs.