Vt. doctors having a tough time

By SUSAN ALLEN Staff Writer

Many Vermont physicians are concerned about bureaucratic hassles that interfere with patient care, low reimbursement rates and other problems they face in trying to provide medical care, according to an informal survey of 300 of Vermont’s primary care doctors.

So significant are the challenges, the survey found, that some physicians are considering retiring early or changing careers. The findings are especially troubling because they come on the heels of a 2004 survey by the Vermont Department of Health that found a shortage of primary care physicians in Vermont, with only four counties reporting an adequate number based on population.

“The results were unequivocal. The level of dissatisfaction is disturbingly high,” said the survey’s sponsors in a report to be released Monday. “Primary care physicians are working longer hours for the same or less money, at the same time as administrative overhead costs are rising.”

“There is this underlying sense that if things don’t start changing for the better, our health care system could be in some trouble,” said Cornelius Hogan on Saturday.

Hogan, former secretary of Human Services, was one member of a team who conducted the informal statewide survey. Also participating was Montpelier physician Deborah Richter, Townsend doctor Bob Backus and other health care providers from around the state.

Richter has been an advocate for single payer health care reform, and in 2005 co-wrote with Hogan and another author the book “At a Crossroads; The Future of Health Care in Vermont.”

Richter said the idea for the latest survey sprang from conversations among individual physicians about these issues. Several doctors decided to poll their colleagues to see how widespread their concerns had become.

The survey was sent to all 840 primary care physicians. About 300 returned the material.

The doctors were asked to respond to negative statements on a scale from “completely disagree” to “completely agree.” The responses clearly indicated that many physicians feel unnecessary paperwork was taking time away from patient care, physicians were being second-guessed by managers, under-reimbursement was putting pressure on their practices, and doctors are considering retiring early, changing careers or moving out of state if conditions don’t improve.

At least one physician was critical of the survey, writing on the form: “These are slanted/biased questions.” But most who wrote comments expressed similar thoughts: “I have no hope about this.” “Practice closed and moved out of Vermont.” “I’m spending equal time with patients and paperwork; see patients 8 to 4 and paperwork from 4 to 11; and seeing fewer overall patients during this time because of calls, paperwork and etc.”

The issue of reimbursement generated the most concern, with 275 of the 300 respondents generally or strongly agreeing finances are putting a strain on their practices.

“Our goal was to systematically understand what the docs were trying to tell us. I think we achieved that,” Hogan said. “There is this underlying sense that if things don’t start changing for the better, our health care system could be in some trouble.”

The sponsors said their survey shows that morale among many physicians is poor, and health care reforms are asking even more of already strapped doctors. “If unchecked, the combination of lower compensation, higher attrition and fewer entrants into primary care portends lower quality, higher costs and poorer population health,” the group said.

Paul Harrington, executive vice president of the Vermont Medical Society, said Friday he had not seen the survey. But Harrington said the results are not out of line with what he hears from physicians in all practices, not only family doctors.

“The message is consistent with what the Medical Society has heard from all physicians in the state,” he said. Doctors face increased demands upon their time with patients, and are being under-reimbursed for their efforts.

He said CIGNA health care is taking over a larger share of the Vermont health insurance market, and that company’s reimbursement rates are lower than some other companies.

“It’s going to get worse, and there is no light at the end of the tunnel,” Harrington said.

Hogan said his group is not using this survey to renew the call for single-payer health care reform in Vermont. But he said some changes are needed to guarantee that physicians remain in Vermont and Vermonters have access to affordable, quality care into the future.

The group put forward suggestions it plans to take to lawmakers in Montpelier this week. The Medical Society also has a list of proposed changes.

Hogan’s steering committee recommends that hearings address these concerns at the state and national level; changes focus on reducing administrative burdens facing doctors; efforts to attract primary care physicians to Vermont be accelerated; universal forms, codes and regulations be implemented, as well as uniform reimbursements; and more.

The Medical Society is calling on the state to increase recruitment by providing loan assistance to medical students; increase Medicaid reimbursement rates to doctors; create a pre-trial screening panel to review malpractice claims; and other suggestions.

House Speaker Gaye Symington said Saturday that the Catamount health care reform passed by lawmakers in the last session is designed to expand coverage to more of the uninsured, providing payment to physicians who might otherwise be treating the uninsured for free. She said legislators would take concerns into account as work improving Catamount kicked into high gear at the Statehouse.

“The Legislature is listening. Certainly part of their work will be listening to folks from the Medical Society and physicians and employers about their ongoing concerns and trying to iron out any glitches or make things work as well as we can,” Symington said. “They will be continuing to say, ‘How can we make this better and how can we continue to address the needs we didn’t solve with Catamount.'”

Hogan said some of these changes could happen without significant effort, such as implementing uniform forms and reimbursement rates. In fact, he said, some have been under discussion since the 1992 reform debate.

“People have talked about this for a long time, but nothing has happened,” Hogan said. “It’s overdue, and these changes could simplify these people’s lives.”
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