Emergency physician says fee-for-service incentives are squeezing urgent access to primary care

Dr. Dave Murman, an emergency physician and member of the Green Mountain Care Board, told board members that current payment incentives are undermining timely access to primary care and pushing patients to emergency care. “Patients are continually frustrated because they feel like they can't make appointments,” Murman said, describing routine delays of two to four months for nonurgent visits and frequent inability to secure urgent same‑week care.

Murman framed the problem as rooted largely in the fee‑for‑service model and productivity metrics that reward filled schedules. “If we're paying in a fee for service structure, we're incentivizing schedules to be full as far out as possible,” he said, adding that practices avoid leaving open slots for urgent visits because unfilled time reduces revenue and harms measured productivity.

The physician gave multiple patient…