A group of Vermont clinicians, including trainees, recently retired doctors, and board members of the Vermont Medical Society, has raised concerns about the impact of recent budget cuts on patient care and clinician well-being. The clinicians say hospitals are being forced to reduce costs without increasing revenue, leading to staff and service cuts that threaten access to care.
The clinicians argue that current strategies to reduce hospital costs are unintentionally harming the very access they aim to improve. They note that hospitals are being asked to see more patients with fewer supports and in shorter appointments, while also being required to cut staff and services to balance budgets.
The group urges the Vermont Legislature and the Green Mountain Care Board, the state’s primary hospital regulator, to closely monitor the impact of recent decisions on employee retention, patient outcomes, and access to services. They also call for regulatory parameters that more directly address the cost of care rather than relying heavily on net patient revenue, which limits the amount of care hospitals can provide.
The clinicians say a multiyear budget process would allow hospitals to invest in operational improvements rather than expecting significant cost reductions within a year. They submitted a letter to the Green Mountain Care Board that includes input from over a dozen clinicians working at more than half of the state’s hospitals, including critical access and midsize hospitals, and the academic medical center.
One physician reported discharging more patients who are struggling or unable to care for themselves at home but do not have an acute medical condition. The physician said their hospital can no longer afford to be a safety net for people living on the margins, adding, “It increases the moral injury of delivering care.”
Multiple physicians shared examples where staffing reductions caused by budget constraints led to limited capacity to accept transfers for specialist care, procedures, or critical care, forcing small hospitals to transfer patients far from home or out of state. One hospital cut its team of social workers, who had connected patients with substance use disorder treatment, housing support, and other community resources, and helped schedule follow-up appointments. A clinician said, “Now we have a packet of phone numbers that we give to patients.”
A surgeon at a critical access hospital said budget cuts have limited the hospital’s ability to hire support staff and backfill positions that help patients manage their care. Without these resources, “many patients will have worsening chronic conditions and likely higher ED (emergency department) visits and admissions,” they said. “This is not hyperbole. I see this with my patients.”
A primary care clinician recently retired from their practice five to 10 years early because of the movement away from value-based care and a lack of support staff, saying, “I gave up my patients of 30 years. … I am a casualty of the system.”
At another primary care office, the medical director said clinicians in their practice routinely see more than 20 patients in a day and expressed concern about shorter patient visits, saying, “Patients are already upset with less time with their PCP and take it out on us, which in turn detracts from actual patient care and erodes our ability to eff.”
