This commentary is by Melissa Volansky, M.D., a family physician and chief medical officer at Lamoille Health Partners, based in Morrisville.
I hope many read the excellent recent article by Colin Flanders in Seven Days decrying Vermont’s impending loss of independent physician practices. We cannot afford to lose these vital professionals.
Sadly, by pitting independent practitioners against those of us employed by larger systems, this article misses the critical point. All rural primary care faces extinction. If you think health care is expensive now, just wait until there’s no primary care at all. That is where we are headed.
As the chief medical officer of a rural federally qualified health center, I face tremendous difficulty recruiting replacements for departing providers and staff. Health centers have more resources than independent practices, but not enough to draw professionals away from larger urban and suburban areas.
Furthermore, our additional resources come at great cost. Our health care system has no problem adequately paying specialists to provide excellent care. But when it comes to highly trained and experienced primary care professionals, we are not worthy until we supply an endless stream of data to health care reform entities to prove our worth.
The cost of the electronic systems and staff to meet those requirements easily erases any financial gain available to pay employees who directly help our patients. The patients lose!
My colleagues practicing independently choose to remain outside this insanity while I choose to make the best of it. Neither of us is in a good situation.
Primary care has always provided less expensive quality care than emergency rooms, urgent cares, and inpatient hospital wards. But just like the independent physicians, our schedules are packed. When we cannot recruit practitioners and support staff, we have fewer appointments. Patients lose access! They overflow into emergency rooms and urgent cares, increasing costs.
Our patients also face high deductibles and defer care until they need expensive hospital services. We give in to patients who call, demanding specialty referrals for conditions we could treat but don’t have time. This feeds the myth that the system doesn’t have enough specialists, which will send costs soaring higher.
The medical school selection process favors those achieving the highest grades and test scores, perhaps overlooking qualified candidates with the community focus and relational skills needed to be good rural primary care physicians.
Graduate residency programs were designed to subsidize and support hospital care rather than primary care. Medical graduates carry crushing debt, leading many to choose higher-paying specialties. The resulting mere trickle of primary care graduates mostly end up in more populated areas offering more easily quantifiable amenities.
If our country wants more primary care physicians, then it must invest in the right candidates and fund more primary care training positions. Primary care must be compensated on par with specialty care. Diverting critical resources away from direct patient care toward data collection must end. Only then will we have the workforce needed to care for our patients.
In 10 years, Vermont will have drastically fewer primary care physicians, both independent and employed. We are all going to retire or leave the profession, and virtually no one is coming to take our place. Disparities exist between independent and employed physicians, but all are working in a flawed, unsustainable system. Besides pitting us against each other, what is anyone going to do about it?
