[This post was written by University of Vermont senior Ariana Lewis as part of a National Public Health Week collaboration with VtPHA for her Public Health Sciences Capstone Project. Thank you, Ariana!]
The state of Vermont has been experiencing a shortage in its health workforce for over 8 years, struggling to employ physicians to balance population densities in many of its counties, especially its northernmost regions. These shortages of physicians have directly affected accessibility to healthcare for many Vermont residents, mainly those occupying rural areas, and have had direct implications on the health of residents. Vermonters not having adequate access to physicians can cause a domino effect on the engagement with health facilities for the population as a whole, creating issues with follow-up appointments, routine screenings, and treatment follow-through. These inequities in access to reliable care exacerbate regional differences in health, such as chronic disease rates, higher mortality rates, and lower life expectancies.
Physician Shortages and the Impacts
Shortages in physicians in Vermont counties were reported by the Vermont Department of Health back in 2016, with rural counties such as Franklin and Essex County having over 2,000 residents per full-time equivalent (FTE). This may not seem like a taxing ratio for the primary care providers in Vermont, as the national average is between 3000-3500 residents per primary care provider, but the rurality of Vermont and many of its communities is where this ratio becomes an issue. Vermont doesn’t have an incredibly high population, but the distance between residents and medical services is significantly higher, meaning Vermont residents must travel farther to reach the few and far between providers practicing in the state. These pervasive disparities tax and strain Vermont residents and the few primary care providers in these regions, aggravating the health inequities present among rural Vermonters, such as COPD, tobacco use, physical inactivity, and illnesses resulting from a lack of nutrition. When a lack of physician dispersion in rural areas is paired with other barriers such as a lack of health insurance or transportation, these disparities for rural residents are worsened as they try to access care necessary for quality of life and promote a long life expectancy.
The COVID-19 Pandemic Impact on Existing Shortages
These same shortages persisted and were magnified by the COVID-19 pandemic in 2020, leaving residents isolated not only from family and friends but also from health resources. In 2018 a snapshot of the Vermont Primary Practitioner sites was conducted by VT AHEC to establish the practicing offices Vermont residents had access to, and while areas like Chittenden County had a surplus of practicing practitioners in the region, counties such as Essex, Orleans, Caledonia, and Lamoille had no more than 2-5 primary care sites available to the public. These differences continued into the pandemic and were worsened by the social distancing and month-long appointment waiting times to compensate for the new needs of the Vermont community. These waiting times had drastic effects on population health, especially Vermont’s youth.
Primary Care Practitioners were not the only providers Vermont was experiencing a shortage of; it faced issues with licensed mental health providers as well. These shortages of mental health providers could also be seen back in 2016, with the Northeast Kingdom counties, including Franklin County, experiencing shortages that resulted in them having ratios of 15,000-20,000 residents per psychiatric FTE. These unsustainable proportions, alongside issues with unemployment and insurance attainability, made access to mental health services a challenge for many. Additionally, appointments needed to be booked months in advance to be seen by a provider, which meant many young Vermonters went without mental health services during one of the most mentally challenging periods of their life. The Vermont Department of Health reported that in 2021, approximately 41% of Vermont youth aged 12-17 went without necessary mental health services after reporting depressive symptoms due to the existing provider shortage. The same year, the Vermont Department of Health also reported increases in mortality rates in 4 categories among the Vermont population: coronary heart disease, suicide, unintentional injury, and cancer. These increases in mortality rates show direct correlations to the issues with provider access, as these conditions are avoidable with preventative care, routine screenings, and availability of mental health services.
[These images are from the Vermont Department of Health and depict the ratios of full-time primary care providers and psychiatrists practicing in the state compared to populations in various towns and counties across the state. Full-time Equivalent references a single provider practicing in a given area in the state.]
The Rise of Telemedicine in VT
With these present shortages, there was hope that the new age of technology would provide some relief by making available services such as telehealth for individuals to attend therapy appointments and receive acute care and prescriptions that didn’t require in-person visits. Blue Cross Blue Shield of Vermont reported these increases in the use of telehealth services as they had just under 500 claims for telehealth services in February of 2020 before the pandemic hit, and in 2021, they had a drastic spike to 29,000 claims for telehealth services. Two-thirds of these claims were for over-the-phone mental health services, and although these calls didn’t balance out the disproportionate access to mental health services, they provided relief for many who couldn’t make it to a mental health provider or could no longer attend sites due to COVID restrictions. Yet, there are disparities that need to be considered when such solutions are implemented to address the provider shortage. Telehealth clearly had a positive impact on the accessibility to providers for many Vermonters, especially mental health professionals, but it still comes with systemic barriers for many populations. Such barriers included reliable internet services that allow residents to access online health portals and telemedicine calls. Many rural Vermonters experience issues with unreliable internet and cellular services, making telehealth a possible incongruous fix to the provider shortage, as rural areas were disproportionately affected by these disparities.
The Unintended Benefits of Telemedicine
These services can’t be discredited for the evident benefits, as providers have reported that the switch to telemedicine visits has helped them further bond with their younger clientele and given them insights into their lives that wouldn’t be available during routine office visits. For many Vermont youth, the ability to receive care from their home during the pandemic showed immense benefits for the patient’s comfort and the practitioner’s ability to address other components of their patients’ lives that could be having direct impacts on their health. Providers also noted that many of their patients found it easier to talk about more difficult subjects related to their health on the phone, showing a clear benefit in the established distance of these visits.
Needed Remediations
Vermont has put populational health at the forefront of state priorities for years. Even during the pandemic, the state managed to have some of the lowest transmission rates in the country, demonstrating the importance of health that residents value. For these reasons, the shortage of physicians is surprising yet unambiguous given the lack of financial and program-related incentives available to physicians practicing in Vermont. Due to the low provider ratio in the state, Vermont doesn’t qualify for federal incentive programs offered to physicians, such as loan repayment programs. Vermont offers its own form of loan repayment programs through AHEC but has yet to equate to the programs and incentives physicians could receive if they practiced in other states with more forgiving ratios. Incentives, job security, and a manageable workload are some of the key drivers that keep medical professionals provided for and encourage them to continue practicing. If these motivational components and security aren’t offered to practicing physicians in Vermont, we can’t expect a change in the quantity of medical professionals as these benefits are the impetus of a motivated and reliable health workforce. It is estimated that a surplus of medical professionals will be needed in the Vermont workforce to repair the current shortages and compensate for the individuals leaving due to retirement and attrition. To put it into perspective, the Vermont Business Roundtable’s Research and Education Foundation conducted a survey that evaluated various medical centers across Vermont and identified the number of individuals at these respective centers who would be leaving the workforce within the next year (2026). These individuals were identified as needed replacement positions, positions that would need to be filled to replace those leaving the medical industry. It was then calculated how many professionals would be needed to remediate the present shortages in Vermont; these were identified as new positions. VBR estimated that for Registered Nurses alone, Vermont would need to see an intake of over 2,000 new RNs to not have a shortage present in relation to the Vermont population. This increased need is why recruitment and retention for medical professionals in Vermont should be a top priority, working to incentivize these roles and increase accessibility to the public.
[This is a graphic from the VBR Research and Education Foundation’s Nursing Needs Assessment from 2024-2026. This graphic depicts the Foundation’s estimate of needed new and replacement positions for various health professions.]
Conclusion
The shortage of healthcare professionals in Vermont is not only a pressing concern but one that threatens the health and well-being of residents across the state. The increasing inaccessibility of health services has had unfavorable impacts on many of Vermont’s most vulnerable populations, such as youth, the LGBTQ+ community, and people of color. Compounded disparities, such as increased cost of living and growing costs of healthcare expenditure, have made it progressively more challenging for minorities to access necessary care. Consequently, these disparities are the very reason repairing the healthcare workforce should be one of the utmost priorities of the state to preserve populational health. Additional programs and incentives need to be incorporated into the benefits offered to practicing professionals to accommodate the inevitable loss of health workers in the state as the mean population age climbs higher and higher. If we progress towards more accommodating ratios for providers and patients, Vermont stands the chance to qualify for federally funded programs that would provide even more financial relief and opportunity to the health workforce.
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