It’s hard not to be aware of the shortages of physicians in Bennington. Our recent struggles to sustain pediatric call coverage and the consequent problems in delivering obstetric care highlight how the physician shortage has affected us dramatically in our hometown. So what’s the deal? Why don’t doctors want to come to such a beautiful place as Vermont to practice?
There are a number of reasons. Vermont is a beautiful place, with a sense of community, superb education, abundant recreational opportunities, and a health-care system that is both low cost and high quality. While I am biased, I believe the quality of life in small communities in Vermont offers much of what many Americans think of as core values.
The problems for physicians are largely economic. This is a hard topic for doctors to talk about, because in comparison we remain affluent members of society. However, the actual earning capacity of doctors has been declining for over a decade. At the same time, the indebtedness of graduating physicians has climbed to an average over $180,000. Physicians also do not begin earning any income until they are 30-35 years of age.
We are now in an era of physician shortage. That means doctors can choose an area to work where they can repay their debt quickly and practice in a supportive environment of colleagues and hospitals that are up-to-date and have modern technology to support the practice of medicine. Vermont has lost its competitiveness on the national scene. Government payments in Vermont for Medicare and Medicaid are extremely low, making the practice environment here much less appealing than in other states. New physicians can settle in most other states and repay their debt more rapidly, enjoying a better lifestyle than they could obtain in Vermont.
The national shortage of physicians is due to extremely poor planning in the 1990s. The baby boomers ironically contain the bulk of practicing physicians, and will shortly be the source of retiring physicians, and a huge group of patients needing care. Current estimates state that America will be 200,000 doctors short by 2020.
Hospitals, health systems, and communities in Vermont cannot survive without a steady supply of new and well-trained doctors. In many communities, the local hospital has begun employing physicians so they can keep critical local services available. Small hospitals are also struggling economically, but they will reorganize their economic priorities because they will fail faster without an adequate doctor supply to use their facilities. In the long run, rural communities like those in Vermont will only see this problem resolved when payment methodologies driven by the federal government change.