PLAINFIELD, Vt. – Ronald Pitkin, 84, remembers the day in the early 1960s when his brother Belmont got a gash in his leg while the two were cutting firewood. They went to the office of the town physician, Dr. Frank Corson.
Corson worked alone, and Pitkin was drafted to be his assistant. “He told me ‘You’re going to have to scrub up.’ I was the operating room nurse that day.”
Now Pitkin gets his health care at The Health Center, a sleek, modern clinic that houses primary care, dentistry, psychiatry and other specialties under one roof. It’s one of eight facilities in small towns around Vermont that charge based on patients’ ability to pay. They provide primary care to about 25 percent of the mostly rural state’s residents, and experts say they’re a key part of the reason why Vermont leads the country in primary care doctors per capita.
“This is a terrific health care center,” Pitkin said recently as he waited for a checkup with the center’s senior physician, Dr. John Matthew. “It’s more care, and help in general, for less dollars than just about anywhere.”
With Vermont leading the way, five of New England’s six states rank in the top six for primary care doctors per capita, according to data from the Association of American Medical Colleges. The sixth, Connecticut, ranks 12th. Several factors contribute to New England’s relatively strong position. Among them: strong public health programs ensuring that high percentages of residents have health coverage, meaning fewer doctors deliver uncompensated care. Massachusetts, which enacted a universal health care program in 2006, has about 97 percent of its residents carrying health coverage. In Vermont it’s about 94 percent.
The high rates of people already insured means “we will not experience the same (influx of newly insured patients) in Vermont as in other states that have very high rates of uninsured people or low Medicaid eligibility,” said Mark Larson, commissioner of the Vermont Department of Health Access.
Even in New England, though, the picture is “far from rosy,” said Dr. Joseph Gravel, president of the Massachusetts Academy of Family Physicians. Starting family physicians at his Lawrence office make $130,000 a year; specialists can make three or four times that much, Gravel said. With many new doctors facing student loan debts in the hundreds of thousands of dollars, the incentives are clear.
And the need for care is increasing, too, as the general population ages. Maine has the nation’s highest median age; Vermont is second.
“It seems like not only is Maine’s general population aging, but a significant percentage of primary care practitioners is also getting to an age of retirement,” said Vanessa Santarelli, CEO of the Maine Primary Care Association, which promotes and supports 20 federally qualified health centers across the state.