Porter Medical Center faces doctor crunch

August 6, 2007
MIDDLEBURY — Porter Medical Center’s staff of physicians include a number of elder statesmen like Robert LaFiandra, who has practiced internal medicine in the Middlebury area for the past 36 years. But in the coming years, the hospital will face a doctor crunch as LaFiandra and several others retire, and the hospital is trying to figure out how to fill their shoes.
“Finding people to replace me and other people of my generation is going to be a difficult problem for everybody,” LaFiandra said. He plans to retire from full-time work around the summer of 2008, but continue to practice medicine on a limited basis.
He isn’t the only one. About half a dozen other physicians will also be retiring from full-time practice within the next three to five years, or are already in semi-retirement and will stop practicing medicine completely, according to Fred Kniffin, president of the medical staff at Porter Medical Center.
“It’s going to be a huge loss when these doctors retire,” Kniffin said.
The current staff includes 68 physicians. According to Porter spokesman Ron Hallman, the hospital also has about 38 “consulting staff,” mostly specialists from Chittenden County who are asked for their advice by members of Porter’s active staff and who may play a role in the care of a patient but generally do not spend much, if any, time in the hospital.
Kniffin said that the physicians nearing retirement will be missed at the hospital in partly because they now serve many patients from the Addison County area, and for other reasons as well.
“Then there’s the less tangible loss that these are the founding fathers of our current medical staff,” he said. “It’s going to be hard to replace their leadership.”
James Daily, president of Porter Medical Center, said that facing the retirement or semi-retirement of several senior doctors in a short time period will be a challenge.
He compared the coming doctor crunch to other major transitions, like several building projects at the hospital over the years, such as the new North Wing that now houses the surgical care center and birthing center. The construction of the North Wing began in June 2005 after years of planning and fund-raising, and the wing opened in stages last November. At 28,770 square feet, the $16.8 million project roughly doubled the size of the hospital.
“As challenging as (the North Wing project) was, to work with the demographics of our medical staff and make sure we get the physicians we need, as well as maintain the right numbers of other professional and technical people who may be in short supply, may be even a greater challenge than putting bricks and mortar together and having a nice facility emerge,” Daily said.
Kniffin, who has worked at Porter for 17 years himself and is now the emergency room director, said that this will be the first time in his memory that the hospital has lost so many physicians in a relatively short time. “We’ve lost providers and we’ve had shortages, but I can’t recall a cohort of folks like this,” he said.
Kniffin said that the hospital would have to more actively recruit new medical staff to pick up the slack. “In the long run, that’s the only way we’re going to fill those voids.”
Doing so may be expensive for the hospital, because some of the doctors they would replace, like LaFiandra, are self-employed, but the new doctors recruited by the hospital would most likely work for the hospital itself. However, Hallman said that the financial impact of the new hires would probably balance out since their new salaries would be offset by the hospital no longer having to pay the salaries of the retired doctors. In addition, those doctors may also bring in extra revenue to the hospital.
According to LaFiandra, the hospital is already working on bringing in new blood. “They’re actively recruiting,” he said. But he agreed with Kniffin that the financial side of things would be a challenge. The rising cost of medical school has meant that hospitals need to offer higher and higher incentives for new doctors, particularly those in their medical residency, LaFiandra said.
“The problem is, most (medical) residents have a debt load of $150,000 to $200,000 when they come out of their residence,” he said.
Hallman pointed out that the new doctors wouldn’t have to pay the expenses of starting up their own practices since they’d be working for the hospital.
Beyond the financial considerations, Porter faces another issue. More doctors nationwide are choosing to become specialists rather than general practitioners, partly because fields like oncology tend to be more financially rewarding than primary care. According to a 2006 report by the American College of Physicians, only 27 percent of medical students in their third year of residence planned to pursue a career in general internal medicine, half the number of just six years before.
“One of the problems for our community and the state and country is that the physicians who practice primary care … are not producing residents who go into primary practice,” LaFiandra said.
Porter has a relationship with the Vermont Recruitment Center and the nonprofit Bi-State Primary Care Association, organizations that assists in identifying and recruiting physicians.
Daily said that when Porter recruits it has some natural advantages, such as the quality of life for professionals in Addison County.
“The area certainly sells itself in a sense,” he said.
He was optimistic that the hospital would eventually attract the doctors it will need, and the local area and the newly renovated hospital are both powerful assets.
“You combine that kind of facility with a place to live that sells itself, and hopefully, as we get into a time when competition for tomorrow’s physician is going to get intense, that we’ll be able to recruit the best physicians to come here to our community,” Daily said.

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