The Montpelier Bridge

Adults in central Vermont may wait months to see a primary care provider — and still they’re better off than people in many other regions.

Local primary care clinics are scheduling new adult patients into late summer, autumn, and well beyond. Some are no longer adding names to their waitlists.

“Desperately looking for a primary doctor for my daughter. She hasn’t had any luck after looking for months!” wrote one Montpelier resident on Front Porch Forum last November.

Yet by U.S. standards, the area is in good shape. A 2021 report by the Robert Graham Center, which studies primary care policy, ranked Vermont first in the nation by the number of primary care physicians per 100,000 people.  Similarly, in 2022, the number of direct patient-care physicians in family practice/general medicine per 100,000 population was 55.8 in Vermont, according to the Association of American Medical Colleges (AAMC). By comparison, Maine had 57.3, while New Hampshire had 40.6, Massachusetts 23.4, and New York 21.6.

The federal Health Resources and Services Administration also does not consider central Vermont particularly shorthanded; the area scores low on a Health Professional Shortage Area scale. (Areas northeast and east of Montpelier do carry a federal designation of ‘Medically Underserved Area,’ denoting a lack of access to primary care services.)

“There’s no contradiction. The point is, [in] the areas that are designated as shortage areas, the waiting lists would be even longer,” said Marvin Malek, a primary care physician at Central Vermont Medical Center (CVMC) and a board member of the Vermont chapter of Physicians for a National Health Program.

“This is what is considered acceptable in this country,” he added.

Up to 18 Months

Long delays for medical care are nothing new in Vermont. A 2022 investigation spearheaded by the state’s Agency of Human Services found that Vermonters often faced extraordinarily long wait times to see specialist medical providers.

According to the report, no state entity oversees measuring health care access across Vermont. In addition, data have not been reported for wait-times at non-hospital-affiliated primary care practices or federally qualified health centers.

To learn how long a new patient can expect to wait to see a primary care provider, this writer called primary care clinics affiliated with CVMC, identifying herself as a reporter with The Bridge. (By contrast, the state’s investigation took a secret-shopper approach.)

While some receptionists declined to provide information, those who did described wait times ranging anywhere from this June to as long as 18 months from now.

“Access to primary care is a challenge here locally, across the state and region,” CVMC communications director Jay Ericson told The Bridge in an email.

Ericson cited workforce shortages as well as a lack of housing and childcare for staff as among the challenges to providing primary care services.

Vermont is losing primary care physicians. As of 2020, the most recent posted data, there were 2,633 licensed physicians here, of whom 426.3 full-time equivalents (FTEs) were practicing primary care (including family practice, internal medicine, ob/gyn, and pediatric primary care). That marked a decline from 2018 and 2016.

After a primary care practice closed last year, Ericson said, CVMC absorbed nearly 800 patients. The result was longer wait lists, he said, and “extended time for new patient appointments from weeks to months.”

Other providers besides doctors can and do provide primary care, however. In Vermont, there were 247.5 primary-care FTE nurse practitioners and 93.3 FTE physician assistants as of 2019 and 2020, respectively.

A National Problem

Underinvestment in primary care has long been a problem in the U.S. The country spends just 4.7% of its health care budget on primary care, while peer countries spend nearly three times that, according to data cited in a 2024 study by the Commonwealth Fund.

The study compared the U.S. with Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom. The U.S. came in next to last for the percentage of residents — 87% — who reported having a regular doctor or place to go for care. (At 86%, only Canadians ranked lower.) Adults aged 42 or younger were worse off than older adults. And few Americans reported having access to home visits by their primary provider — a common practice in the other countries.

This spring, the AAMC released a report estimating a current nationwide shortage of 20,800 primary care physicians. Depending on factors such as federal support for physician training, growth of managed care, and retirements, that number could nearly double by 2036.

Providers face relatively low pay, which can make it harder to repay student loans, and a practice routine Malek describes as “extraordinarily burdensome.”

Between patients and payers, providers juggle multiple competing agendas, he explained. Electronic record-keeping and correspondence eat up time. On top of seeing patients and writing up the visit, providers must also respond to patient queries through portals; review lab results; and read specialists’ notes.

“The software part of it is really, really time consuming,” Malek said. “Almost all providers I know in primary care are finishing up their notes in the evening.”

Is Change In Sight?

In its 2022 investigation report, the state recommended formally tracking wait times and extending future studies to include primary care, among other measures. A new federally funded family medicine residency is being planned in Vermont, one that will train new doctors and potentially other providers too, according to a 2023 article in the Valley News.

As for CVMC, Ericson said a new team is supporting provider recruitment and that two primary care physicians will be joining the Mad River and Waterbury practices this fall. Later this year, he added, the medical center will offer patients the ability to self-schedule appointments.

But, Malek said, no one state can solve the problem on its own.

“Since we don’t have an organized healthcare system, but just a whole privatized set of competing institutions, there’s no planning, like [for] how many primary care [training] slots should there be in the United States,” he said.

Federal lawmakers are aware of the supply problem, with Senator Bernie Sanders among those pushing for change.

In other countries, “there’s a workforce plan to prevent this kind of thing from happening,” Malek said. “It doesn’t have to be this way. We can do better. But we need a national plan.”