Broadening Vermonters’ access to primary care has been a top priority in Montpelier this year. But, building the pipeline of doctors and nurses and dentists who can be that first line of health care for patients is proving to be its own challenge.
After the governor’s proposed 2027 budget cut more than $1.2 million in funding for an organization designed to bring more people into the health care workforce, primary care providers and lobbying groups representing them raised the alarm.
In their recently approved March budget, House lawmakers built back in some of the slashed workforce funding, but as the budget now makes its way to the Senate, lobbyists for primary care organizations are saying the spending is still not enough to meet Vermont’s expanding need for more health care workers.
“Developing that workforce pipeline that wants to go into primary care and wants to work in rural areas is very important to ensure that people who live in those communities have access to primary care services,” explained Katie Schwartz, the director of the Vermont Area Health Education Center or AHEC, the organization at the center of the budget battle. AHEC is part of a national effort to expand the health care workforce in rural areas.
At the core of its work, Vermont AHEC runs an educational loan repayment program for primary care providers in rural areas. Physicians, physician assistants, an array of nursing roles and even dentists are eligible for help paying back their student loans.
AHEC also works to find and place doctors in small, rural settings that may not have the resources to dedicate to recruitment.
Another core tenant of Vermont AHEC is its program at UVM’s Larner College of Medicine, a special, additional curriculum medical students can take with a particular focus on common rural primary care needs, such as oral care, substance use disorder care, virtual care or connecting with community health resources. These AHEC students are also eligible for loan repayment if they meet certain criteria, like staying to work in rural parts of Vermont.
But local chapters of AHEC posit that this work of recruiting rural primary care providers begins early. AHEC puts on programming for middle and high school students, as well as undergrads, to seed interest in health care careers. One such program pairs medical students with young mentees who can shadow the training doctors and discuss health careers.
“That rural pipeline model really is important to exposing people, especially individuals with rural backgrounds, to health care careers,” Schwartz said.
Yet the $500,000 annual allocation for these pipeline support programs did not make it into the House’s 2027 budget.
That’s the largest sum AHEC is hoping will wind up back in the budget, Schwartz said.
In the House’s budget proposal, approved in March, lawmakers did build back some, but not all, of what had been cut in the governor’s original budget proposal. The new budget includes $550,800 for AHEC’s education loan repayment and $50,000 for its doctor placement programs.
“We were disappointed that the Governor’s proposed budget eliminated funding for the effective programs run by (AHEC) — from interesting middle school students in health careers to loan repayment programs for primary care professionals,” Jessa Barnard, the executive director of the Vermont Medical Society, wrote in a statement, adding that the organization intends to work with the Senate to “fully restore” the funds for the pipeline programs.
Doing without the annual $500,000 allocation for those early career pipeline programs could jeopardize AHEC’s ability to keep offering the programs altogether, Schwartz said.
“It will have statewide impacts,” she added.
The cuts would also reduce the amount of money Vermont is able to draw down from the federal government. The Vermont AHEC program is jointly funded by federal dollars, state funds and contributions from local organizations, like Vermont’s community hospitals and the medical school. The federal dollars require a local match.
As community hospitals’ margins shrink and their ability to make a matching contribution becomes more difficult, the state match has become an even more crucial component of accessing the federal dollars, Schwartz said.
Now, the state budget heads to the Senate for consideration. On Friday, the Senate Health and Welfare Committee heard the first overview of the current budget proposal. Primary care advocates are hoping the Senate will add back in more money for health care workforce programs.
At the same time, the House Health Care Committee is taking up a bill from the Senate, S.197, that aims to increase patients’ access to primary care by shifting the way Vermonters pay for those services away from a fee-for-service model. It’s work that advocates argue can’t happen without an investment to also build out the workforce.
“It becomes imperative that the Vermont Legislature continue to invest in primary care through a multifaceted approach,” reads a letter from an array of organizations including the Vermont Medical Society, Vermont State Dental Society, the Vermont Nurse Practitioners Association and others. That multifaceted approach, they wrote, includes the work of payment reform, but also the workforce development that comes from programs like AHEC.
“Ensuring Vermonters have access to high quality, accessible primary care services will take a number of approaches,” Barnard also added, “but key among them are efforts to train and recruit primary care clinicians.”
