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The Commons
Voices / Viewpoint

A vanishing breed in health care

Community doctors return to a time-honored Vermont medical model

Roger Albee recently retired as the CEO of Grace Cottage Family Health and Hospital. He also served as secretary of agriculture, food, and markets for the state of Vermont from 2007 to 2010.

Photo 2

newspapers.com

Doctors' ads from the Oct. 12, 1899 issue of the Vermont Phoenix.

Originally published in The Commons issue #458 (Wednesday, May 9, 2018). This story appeared on page E3.


Like many, I grew up in a small rural Vermont community where the country doctor was king.

No matter the time of day or evening, our doctor could be contacted, and if the problem was severe, a visit to the home would be in order.

The country doctors of my early youth knew and treated every member of the family, from birth to death, and the minutes or hours spent with a patient was not a criterion; better treatment and wellness were the objectives. The doctors were respected in the community and knew every aspect of what would be needed for better health.

In his history The Vermont of Today, Arthur F. Stone reported that Rudyard Kipling, when he lived at Naulakha in Dummerston, “observed that he had seen doctors in Vermont carry on a practice over a radius of twenty miles, frequently being obliged to drive through eight feet of snow in order to reach their patients and finding it necessary at times to dig their horses out of drifts, before they could proceed.

“Even though Mr. Kipling spent one winter in Vermont, became intimately acquainted with at least one general practitioner and is known to possess exceptional powers of observation, it is rather remarkable that he should have discerned so quickly and clearly that Vermont’s so-called country doctors were, perhaps, most representative of all that is best in regard to the medical profession in the State.”

Yes, health care has changed over the years, and so has the role and availability of the country doctor of the past.

Health care has become specialized and more complex, both on the regulatory side, with insurance cost and reimbursement, as well as the ability to better address community needs more broadly.

The country doctor of my youth took out my tonsils, fixed a broken ankle and knuckle, removed a cyst — many treatments that would be referred to a specialist today.

* * *

In recent national surveys (Merritt Hawkins in 2016), Vermont ranked as the fourth-best U.S. state (tying with Michigan) when it comes to health care and physician access. While a rating of this type is important, it hides some important facts, and these include:

• Vermont spends only about 6 percent of its resources on primary care and only about 5 percent on community health services;

• Preventative care is the most important step that can be taken to manage health care. Many of the top risk factors leading to illness and premature death are preventable, according to statistics;

• In 2013, the U.S. spent far more on health care than 13 other high-income developed countries, driven largely by greater use of medical technology and higher prices. Despite this spending, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions.

• It is estimated that 30 to 40 percent of total health-care spending is wasted in the United States, and although our country spends twice as much per capita on medical care as do other industrialized nations, we are in the last place in preventing deaths.

* * *

There is some good news in Vermont, however, at places like Grace Cottage Family Health and Hospital in Townshend. The focus on primary and preventative care, and in servicing further community needs with the resources of Community Health Teams is redesigning the country doctor’s role of the past.

A Community Health Team comes as the result of an innovative strategy; it is comprised of an interdisciplinary team of health-care providers who can do what the country doctors of the past were able.

These teams have trained nurses, social workers, diabetes educators, and nutritionists, integrated with primary-care physicians and advanced practitioners.

These services recognize that it is the whole patient and the community that is important in health care. It is often stated that only about 10 percent of health care is provided by doctors and hospitals. Most is due to family, jobs, food, education, and the community.

These factors today are referred to as community health care or population health. These integrated teams have the ability, not restricted by the clock, to address a wide range of medical issues and needs within the community.

Initiatives like these include an increased focus on food as medicine, which is helping to sway health care back to its historical focus or its roots, when the doctor was part of the local community and paid attention to both the whole patient and the patient’s family.

* * *

While this type of health care is extremely important, it operates primarily through grant funding, as preventative care and community health care is still not the real financial objective of our health-care system in Vermont or the United States today.

Also, when a state spends such a small amount even on primary care, a lot needs to be done to change the economic paradigm.

Country doctors of the past are a vanishing breed but attention to primary care and preventative health does save on health-care costs.

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