Advocates of single-payer health care promise high-quality low-cost health care for all.

But physicians in Vermont say the state’s move towards a single-payer health care system is driving independent doctors out of business and eliminating patient choice.

Dr. Paul Reiss, a family practice physician in Williston, said only 20 percent of the doctors now in Vermont are independents, compared to 50 percent to 60 percent in the rest of the country.

“The health systems have caused it to be nearly impossible from a financial standpoint to stay in private practice. That’s not so in the rest of the country,” he said.

“If I was 10 years younger, I would have left Vermont a long time ago,” says one frustrated doctor.

According to Reiss, the dwindling number of independent doctors in Vermont traces in part to underpayment from government health care programs.

“You get paid for the work you do if you participate with Medicaid, but they pay you considerably less than commercial payers like Blue Cross or MVP, and typically less than Medicare as well. So for the same services you get less.”

Dr. Ernest Bove, a Rutland urologist who has served patients for 29 years, said underpayment from Medicare and Medicaid is hurting specialists, as well.

“Reimbursement rates make it very difficult for a specialist practice to survive in Vermont. That’s why physicians are joining hospitals and becoming employees. They can’t run a business anymore,” he said.

“Reimbursements have been flat for years and have even gone down in many instances. And your expenses keep going up. I estimate a 5 percent cycle of inflation every year … but the reimbursement rate remains flat. Plus your employees need a raise. You just can’t stay alive. That’s why people are leaving.”

For many doctors across Vermont, Medicare and Medicaid patients comprise a significant portion of the total clientele. Bove said 75 percent of his patients come from Medicaid or Medicare. The numbers just don’t work, he said.
DOCTORS OUT: Dr. Ernest Bove, a urologist from Rutland said if he was 10 years younger he would leave Vermont and establish his practice in another state.

“If I was 10 years younger, I would have left Vermont a long time ago to go someplace else to practice,” Bove said.