With Single-Payer on the Horizon, a New Survey Finds Vermont Docs Unhappy About Care System 

Ever wonder why your blood pressure goes up at the doctor's office? It's not too surprising, given that you spend 45 minutes reading year-old magazines in the waiting room, then another 15 minutes sitting on tissue paper in your underwear before your doctor finally drops in to the exam room for no more than five minutes.

Well, guess what? Vermont's docs aren't any happier about their time crush than their patients are. At least, that's one of the major findings in a new report, published June 7, by the Vermont Medical Society Education and Research Foundation. The "2011 Physician Needs Assessment" was put together from interviews with a broad cross-section of Vermont physicians working in a variety of medical disciplines.

Among the report's key findings: Vermont's physicians say they don't have nearly enough time to devote to each patient because more and more time is spent attending to non-medical — i.e., financial, regulatory and administrative — business. In effect, doctors are forced to see more patients than they want to each day just to keep their doors open.

Will Vermont's recent adoption of a single-payer health care system, the first of its kind in the nation, do anything to address the problem? Too early to tell, suggests Paul Harrington, the Vermont Medical Society's executive vice president. The new law acknowledges the shortage of primary-care physicians in Vermont — currently at 25, and expected to grow to 63 by 2015. However, because Vermont competes on a national stage for medical professionals, a lot will depend upon the details of how the single-payer system is implemented, particularly in terms of doctors' reimbursement rates.

One primary care physician quoted in the report describes herself as "a hamster on a wheel just seeing the volume of patients needed to keep lights on. I’m not enjoying work."

Vermont physicians also express concerns about losing their say in policy making that directly affects their profession. "A theme that resonated throughout the interviews was the fear of physicians losing their traditional role as keepers of their professional ethic," the report reads. "The biggest threats to this traditional role include government and regulatory policies, increasing professional isolation, and the growing number of physicians making the transition from private independent practice to being employed.”

Finally, physicians say they feel that Vermont's overall medical workforce is in jeopardy, as shrinking reimbursement rates for patients on government-sponsored plans "threaten the viability of many physician practices.

"The generally lower physician reimbursements found in Vermont," the report continues, "the downward trending payments for care provided to patients receiving government-sponsored health care and general uncertainty over health care reform have combined to create a difficult financial environment that threatens the viability of many physician practices."

One medical specialist quoted in the report said he's decided to relocate to another state because his practice is no longer financially viable in Vermont. He "can’t afford new blood pressures cuffs, let alone the federal requirement to have an electronic medical record. His peers are all signing on as employees of hospitals, but that’s not something he wants to do. He doesn’t want a corporate bottom line determining what care is given."

Incidentally, all these findings are consistent with what Seven Days reported last week in the story, "Why So Many Independent Vermont Doctors Are Joining Hospitals, Or Closing Up Shop."