Sen. Richard Westman

Sen. Richard Westman

On Jan. 10, the rural Health Task Force Workforce Subcommittee issued its report on workforce needs in Vermont.

Its conclusion: Vermont’s health care providers are facing a crisis. The study found personnel shortages at multiple levels in hospitals, federally qualified health centers, independent physician practices, long-term-care facilities, in designated agencies, among adult day providers and in home health agencies.

The numbers they found are staggering.

Over the last couple of weeks in the Senate Health and Welfare Committee, my morning committee, we have been digging into the numbers contained within the report.

The shortage among primary care doctors and nurses of all kinds is striking. The state’s demographic issues and the system itself are, in combination, exacerbating an already difficult health care workforce situation.

The number of licensed health care professionals by the state is down significantly from 2010 to 2018. For example: We have 9.1 percent fewer licensed primary care physicians, 24.5 percent fewer registered nurses, 8.1 percent fewer licensed practical nurses and 6.1 percent fewer licensed nursing assistants.

These hard facts in the report are disturbing enough but the survey results looking forward are equally as concerning.

The Vermont Talent Pipeline Management survey of 2018 predicts that, by the end of the year 2020, we will be facing 3,900 nursing-related job vacancies. In addition, the Area Health Education Center has estimated that presently we have a shortage of 70.5 primary care doctors across the state.

Health care organizations have been filling needed positions with expensive traveling health professionals. Here are a few cost estimates related to what health administrators call “travelers” that are contained in the report.

“In FY19, 11 of 15 Vermont hospitals reported spending $55.6 million on traveling staff (nurses, technicians, locum tenens). This was a 111 percent increase from FY15.

“Vermont nursing homes spent $12.2 million on traveling nurses in FY18. This was a 158 percent increase from FY14.

“In FY19, Vermont home health agencies spent $10.5 million on contracted services (including labor). This was a 20.2 percent increase from FY14.”

The report estimates that traveling health professionals cost the system twice as much as employed staff. Traveling health care professionals are a significant growing expense to the health care system.

This is also true of the system’s ever-increasing vacancy rates, which have forced organizations to pay for more overtime. It’s no wonder health costs and health insurance rates increased so much this past year for all of us.

The percentage of health care professionals over 60 years of age is also skyrocketing. Between dentists and primary care doctors alone, the estimates are that 35 percent of them are over the age of 65.

The report also contains a number of recommendations that we need to take seriously and act on quickly. One of the things I found most interesting in the report is that, of the students who applied to nursing degree programs, only 58 percent of the eligible students were enrolled into a program. The fact that we aren’t educating enough individuals to fill the vacancies we have and that we aren’t taking all the students who are eligible and want to go to school in these professions needs to change quickly.

These shortages are particularly concerning as Vermont moves to increase reimbursements for primary care with the new ACO system being encouraged by Vermont’s only ACO, which is OneCare.

If we are really going to move toward more primary care and away from high-end specialists in health care, we’re going to need to increase the pipeline of people coming into these professions. Otherwise the attempts to realign the health payment system toward primary care aren’t going to be successful.

Richard Westman, a Republican from Cambridge, represents Lamoille County in the Vermont Senate. Email letters to

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