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Vermont primary care workforce shrinking as administrative burdens squeeze access
Summary
A presenter told a legislative committee that Vermont is losing primary care clinicians, with an aging physician workforce, declining FTEs and panel sizes and growing administrative work—notably prior authorizations and EHR documentation—that reduce capacity and patient access.
A presenter told a legislative committee that Vermont’s primary care capacity is shrinking as clinicians age, reduce hours and shoulder mounting administrative work, and that team supports and aligned payment models are needed to preserve access.
The presenter said the state’s inventory of primary care includes federally qualified health centers (FQHCs), rural health centers, VA clinics, hospital-based practices and independent single-site practices, and that among patients with claims in the state claims database roughly 92% of patients in Blueprint-designated patient-centered medical homes and 90% in other practices had a primary care visit during the year.
Why it matters: Committee members were warned that an aging workforce and lower clinician FTEs will reduce capacity just as demand grows with an older population. The presenter said physician FTEs have declined over the last decade while specialist FTEs have increased, and that the state now faces an estimated shortfall of about 114 primary care FTEs compared with suggested benchmarks.
The presenter highlighted several drivers. She cited workforce aging—noting the share of primary care physicians over age 60 rose from about 9% in 2002 to about 32% in 2022—and said many clinicians are working less than full time, which reduces measured FTEs. She also raised workload from documentation and prior authorizations: clinicians reported completing about 21 prior authorizations per week and spending about 15 hours each on prior authorization work; practice-level reporting showed around 52 provider hours and 27 staff FTE hours per week spent on prior authorization tasks.
The committee pressed on accountability and measurement. One committee member pushed back on tying payment to reporting: “Why on earth is primary care the only one that’s responsible for all of this brokenness?” the committee member asked, saying other parts of the health system face quality measures without the same scrutiny. The presenter replied that if payment changes, stakeholders generally expect measures to ensure funds are used effectively and emphasized the need to align expectations across payers.
On documentation burdens, the presenter cited evidence that for every hour of direct patient care clinicians spend nearly two hours on EHR and desk work. She said technology such as scribe tools—recently the subject of separate legislation—could help reduce that work. The presenter also referenced prior legislative work (Act 111 of 2014) and Medicaid pilots under ACO arrangements, saying Medicaid’s temporary removal of some prior authorizations did not increase net costs while easing burdens for providers.
Access and equity: The presenter noted survey results showing roughly 90% of Vermonters report having a personal health care provider (vs. 83% nationally) and that about 8% in Vermont reported delaying care due to cost (12% nationally). She cautioned those figures may shift as more recent subsidy and Medicaid changes take effect.
Next steps: The presenter said the group will re-survey provider members this fall to update prior-authorization data and will bring more clinician testimony to the committee. The meeting paused for a short break and scheduled two bill walkthroughs, with the remainder to be taken up tomorrow if needed.
