American Academy of Pediatrics - Vermont Chapter

Dec. 1, 2015 

Four of Franklin County’s 11 pediatricians will close their practices – or already have – in coming weeks, leaving an estimated 6,000 young patients scrambling for access to primary health care due to what pediatricians say is an increasingly difficult financial environment for independent primary care practitioners in Vermont.

According to John DiMichele, M.D., a pediatrician at Mousetrap Pediatrics’ St. Albans office who is leaving the practice in January, the decision to leave Vermont was difficult, but ultimately unavoidable due to low Medicaid reimbursement rates. 

“I often thought I would work here until retirement, I love my patients and enjoy working with my colleagues,” said Dr. DiMichele, whose departure from Mousetrap puts the practice at a deficit of two pediatricians, as it has so far been unable to recruit a replacement for another that left practice earlier this spring.  “But the cuts to Medicaid this year have made it impossible to continue practicing.  It is not reasonable that Medicaid reimbursement rates pay less than what the service costs us to provide and less than what Medicare pays for identical codes and identical work.” 

The American Academy of Pediatrics Vermont Chapter (AAPVT) says that the loss of 36 percent of the county’s pediatricians highlights the many financial challenges faced by pediatricians and other primary care practitioners in the state, with low and declining Medicaid reimbursement rates serving as a primary culprit. 

“There is no doubt that this year’s 20-percent cut to the already too-low Medicaid rates will be the proverbial straw-that-breaks-the-camel’s-back for many practices in the state,” said Barbara Frankowski, M.D., president of AAPVT and a pediatrician at the University of Vermont Medical Center.  “In my 30 years in health care, I don’t ever recall as big of a threat to access to care, and really the entire health care system, as this.”  

Kristen Connolly, M.D., a pediatrician at Franklin County Pediatrics, whose closing later this month will account for two of the county’s four pediatrician losses, cited these “enormous pressures” in a recent letter to Green Mountain Care Board Chairman Al Gobeille. 

“I feel incredibly lucky and proud to be a part of Vermont’s pediatric community, one that has consistently demonstrated commitment to t\he idea of accessible, quality primary care,” wrote Dr. Connolly. “Right now, access to care for children is being threatened and we are reaching a breaking point that demands urgent action.”

Not only has the difficult practice environment led to an immediate shortage of pediatricians in Franklin County, and the AAPVT fears across the state, but Vermont’s difficult recruiting environment means that deficit is unlikely to be filled any time soon, said Dr. Connolly.

“Many of Vermont’s pediatricians are nearing retirement age and the odds of being able to recruit and retain young physicians with massive educational debt to primary care, especially in rural settings where Medicaid insures the majority of children, seem insurmountable in the current climate,” wrote Dr. Connolly. “As we have decreased supports that allow primary care practices to remain viable, we are losing access to much-needed care.” 

Ironically, said Dr. Frankowski, low Medicaid reimbursements rates, even in a time of admittedly tight state budgets, may end up costing the state more money. 

“Primary care such as what we provide is among the most cost-effective care we have in the health care system,” said Dr. Frankowski.  “Conditions are caught and managed before they become chronic and more expensive, or even prevented altogether.  And when people don’t have a primary care doctor, they end up using more expensive or disjointed forms of care, such as emergency rooms and walk-in clinics for even fairly routine conditions like earaches, rashes or the flu.  It just doesn’t make any sense to push people away from primary care and into more expensive types of care.” 

“Unless something is done quickly, this is a situation that could get much worse before it gets any better, both in Franklin County and across the state,” surmised Dr. Frankowski.