Guest editorial: Free tuition & how Vermont deals with doctor shortages

Last week New York University said it would offer free tuition to all of its medical school students. The reason is two-fold: first, to encourage more doctors to choose lower paying specialties, and, second, to address the impending shortage of physicians.
It is a battle driven by a changing set of circumstances and expectations. Becoming a doctor is still considered a prestigious occupation, but the competition for these elite students has expanded to include STEM careers, careers that can be more lucrative than the medical profession and careers that don’t require the time and expense of medical school and residencies.
There is also the work-life balance issue, and location of the jobs. STEM jobs are not as demanding time wise as the medical profession, and the STEM jobs are also located in cities that are more appealing to today’s millennials.
It’s an issue of top concern for the medical profession. The American Medical Colleges group estimates the country will be short somewhere between 42,600 and 121,300 doctors by 2030. Given the time it takes for a student to go through undergrad, medical school and residency, to successfully address this shortage would mean taking action today.
Vermont is not immune from the same challenges. We are facing the same potential shortages, and we have an even more pronounced demographic issue than most other states. Even the University of Vermont Medical Center struggles to fill the ranks of its physicians, let alone nurses and other health care providers. Rural Vermont’s struggles are even more difficult.
When we consider the state’s aging population, which is more expensive to treat, and when we factor in the increasing number of mental health patients, and the problems associated with the need to treat opioid addiction, the need to ramp up the number of health care providers — including doctors, mental health professionals, nurses, substance abuse professionals, child psychiatrists, etc., is obvious.
Part of this challenge is being addressed with the state investing $5 million to figure out how to get and to retain mental health and substance abuse disorder professionals. The $5 million was earmarked in this year’s budget and intends to consider scholarships, loan repayment programs, and bonuses to attract the talent necessary.
The Scott administration, led by the Agency of Human Services Secretary Al Gobeile, is being directed to meet with a group that includes the University of Vermont, the Vermont State Colleges Systems, primary care doctors, consumers and the Area Health Education Centers program.
The intent is to reorient part of the educational system — at the higher ed level — to stress the importance of careers in substance abuse and mental health. The group’s results are to be reported back to the Legislature before any action is taken.
The Legislature’s decision to appropriate the $5 million [to be used over four years] is a good one. Vital, in fact. Health care — writ large — is a growing profession, and for Vermont to ignore the opportunity and need would be injurious at every level.
But this should be the beginning of a larger discussion. As a nation, we’re expected to have a shortage of as many as 120,000 doctors by 2030, but about half that shortage is expected to be among primary care physicians.
That’s particularly problematic for Vermont. As the state considers its shift to the all-payer model, where doctors are paid according to outcomes and not through the traditional fee-for-service method, the emphasis shifts to the primary care physicians. If Vermont follows the national example, how will we fill the primary care physician shortage?
It’s a conversation that needs to be front and center as Vermont struggles to meets its workforce needs. The Legislature was smart in appropriating the start-up money; but that should be the opening bid. Tasking our education and health care professionals to find the path forward should be a public exercise that should be transparent and high profile.
Not only is this effort crucial to these professions, it is full of opportunities.
Emerson Lynn, St. Albans Messenger

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