Malek: Will Doctors Really Flee Vermont?

October 01, 2012
http://vtdigger.org/2012/09/30/malek-will-the-doctors-really-flee-vermont/#comment-41243

by Marvin Malek, MD MPH, who is an internist who works at Central Vermont Medical Center in Berlin.

In their efforts to thwart Vermont’s health reform effort, opponents of reform are peppering the media with scare tactics. Prominent on this list is the assertion that if we proceed with the reform effort, huge numbers of physicians will exit the state.

As a practicing physician, I know that our decisions on where to live and practice involve many factors. Most important are the specifics of the clinical setting available: Compatibility with other practitioners, frequency of night call, the expected financial prospects, etc. But other factors also matter: family ties, the crime rate, a pleasing natural environment, ease of transportation, quality of the schools and comfort with the local climate are on what is often a long list of factors.

The financial question is clearly important. Act 48, the health reform law, specifically states that its goal is for adequate compensation to ensure a sufficient number of physicians in each specialty area. To achieve this, physician compensation will need to remain reasonably competitive with other states across the country. Key leaders of the reform effort are well aware of this fact.

Vermont’s effort to address the multiple crises in the U.S. health care system is at an early stage. But our process is far more inclusive and comprehensive. And it has a much greater chance of success than what emerged last year in the toxic atmosphere of Washington, D.C

Act 48 also mandates meaningful liability reform. Liability reform is supported overwhelmingly by physicians, and its passage will be an important signal to physicians that our concerns are being addressed as part of the reform process.

Vermont does not exist in a vacuum. The health care system in the U.S. is in a state of gradual implosion. Both financial compensation and professional autonomy are likely to diminish considerably over the next decade throughout the U.S.

Essentially all of the cost control in the federal reform bill (“Obamacare”) comes from transforming how physicians are paid. This will entail much closer monitoring of physician practice. Vermont’s reform will also attempt to transform the system of physician payment. This will be a challenge. But in Vermont, we have extensive physician involvement toward a goal of creating a single payment system that simultaneously attempts to value quality and efficiency without adding unduly to physicians’ administrative burdens. The result will be far less complex than the multiple systems that will be imposed by numerous insurers elsewhere in the U.S.

In contrast to most other states, input from Vermont’s physicians is a key element in the reform effort. The first meeting of the Technical Advisory Group to the Green Mountain Care Board met on Sept. 25, and an ongoing process is under way to ensure its input in the future. Physician representation on the Green Mountain Care Board’s advisory panels — and on the board itself — has to be characterized as excellent by any standard.

The U.S. health care system is a colossal, costly failure: Financial barriers to care are far greater here than in any other developed country, costs are vastly higher — double the international average, and measures of public health place us in a class with Croatia and the Slovak Republic. Vermont’s effort to address the multiple crises in the U.S. health care system is at an early stage. But our process is far more inclusive and comprehensive. And it has a much greater chance of success than what emerged last year in the toxic atmosphere of Washington, D.C., and also compared to the Darwinian free-for-all we’re likely to see in other states.

Vermont’s physicians are watching the reform effort closely. We have been invited to participate in the reform process, and many of us are doing so. Physicians know that the unfettered autonomy physicians in private practice experienced in the 1950s is a relic of the past. Throughout the country, physicians need to work as part of a team, facing ever more challenging expectations and pressures. To the extent our reform succeeds, the practice of medicine will be more pleasant and rewarding in Vermont compared to other states, and our compensation will be fair. The overwhelming majority of physicians will give the Vermont reform effort a chance — and I predict that we will be glad to have done so.