Vermont continues to lose its primary care doctors — but the rate of loss is slowing, a new survey from the state’s Department of Health shows.

In 2024, Vermont had 529 people working as primary care providers; in 2022, when the Department of Health last conducted its survey, 569 physicians practiced primary care in Vermont. Even that figure represented a decline from the 634 practicing primary care physicians when the survey began in 2004.

“I don’t think this is shocking, really, to anyone. It’s not the first time we’ve seen this trend, and unfortunately, we haven’t done enough to make the trend change,” Vermont Health Commissioner Dr. Rick Hildebrant said in an interview.

Primary care doctors are also working fewer hours. The Department of Health calculated that Vermont has the equivalent of 402 full-time primary care clinicians. Only 39% of primary care doctors in Vermont work full time (which the department counts as 40 patient-facing hours for 48 weeks of the year). In 2014, it was 42%.

Hildebrandt is “very concerned” about the trend. “Efforts to address this are not happening fast enough,” he said.

At the same time, Vermont has seen a steady increase in specialists — a broad umbrella that includes most other physicians, such as anesthesiologists, orthopedic surgeons, and emergency medicine doctors.

State leaders want to better recruit and retain Vermont’s stock of primary care physicians. Access to primary care physicians remains a struggle for many Vermonters, who wait long periods for an appointment, if they can connect with a clinician accepting new patients. Advocates for expanded primary care access often cite an example from Oregon, where every dollar invested in primary care yielded $13 in savings for services like emergency and specialty care.

When patients have continuous relationships with their primary care doctor, it can significantly reduce the need for hospitalization and emergency care. They play a role in screening and prevention, explained Jessa Barnard, the executive director of the Vermont Medical Society, and they also play an essential role in coordinating a patient’s care through various specialists.

“It’s that trusted relationship over time with somebody who can help you navigate all of those systems,” she said.

Vermont is not alone in the decline. According to the health policy site KFF, the U.S. has a shortage of more than 15,600 primary care providers — a calculation based on the ratio of population to providers, which federal regulations say should be at least one doctor per 3,500 people. A 2025 study in the Annals of Family Medicine found that, since 2017, rural areas in particular had experienced an 11% year-over-year decrease in the number of practicing family medicine doctors.

In Vermont, however, KFF calculates that the state’s shortage could be solved by simply adding two more primary care docs — a reflection of how small the state’s population really is.

“Vermont actually has a higher per-capita number of primary care providers than almost every other state,” Green Mountain Care Board member Thom Walsh said in an August meeting discussing Vermont’s healthcare workforce initiatives. “The country has a shortage so our numbers overall are lower.”

Still, he noted that “access (to care) has been insufficient for a lot of Vermonters,” but simply increasing the number of providers does not necessarily improve access for Vermonters to see them.

“A felt shortage can be due to a numerical insufficiency or a structural throughput problem. Both feel on the (patient) end like an access problem, but distinguishing between a numeric shortage and a throughput problem is important,” he said. “Simply adding more numbers on a throughput problem doesn’t fix the throughput problem.”

Getting the number of family physicians to population size right is a tough balance for a small state. Primary care doctors can have anywhere between 1,000 and 3,500 patients under their care.

It’s a conundrum Sen. Ginny Lyons, D-Chittenden Southeast, who chairs the Senate’s healthcare committee and has championed primary care access, hopes this census can help shed light on.

“That report will help us look at geographic distribution needs, population-based needs, demographic-based needs,” she said. “The question about the (right) ratio of patients to docs is an important one, both for specialists and for primary care.”

Both Orleans and Washington counties saw a declining ratio of full-time primary care doctors, though a number of other counties saw that ratio actually increase, with population shifts.

Doctor demographics

Part of the family medicine decline could be because primary care is often provided not by doctors, but by nurse practitioners, physician assistants or other “advanced practice providers,” which are not included in this census.

Yet, the same shift away from primary care and into specializations is true in those professions, too, according to Barnard.

She also underscored that the Department of Health census tracks a sharp uptick in hospitalists, a specialization the department didn’t track until 2014.

“Hospitalists weren’t even really a thing several decades ago,” she said. Instead, family doctors would follow their patients into the hospital, if needed. But it has become harder for doctors to manage outpatient clinic loads and also see patients in the hospital — and thus, the need for hospital-specific general medicine practitioners.

Barnard also noted that emergency medicine has seen some of the largest gains in population, despite being one of the highest burnout specialties. Maybe it’s a reflection of people working shorter shifts in the emergency department, she said, or maybe it’s a reflection of higher volumes of patients coming into the emergency room.

It’s hard not to map the larger trends in medicine onto the data: as fewer Vermonters can see a primary care physician regularly — or at all — they’re more likely to show up in an emergency room. It’s a trend that’s associated with higher costs of care, too.

Vermonters and their doctors are both getting older. Statewide, about 30% of primary care doctors are over 60, a trend most pronounced in the state’s most rural parts.

Another demographic trend is that more and more women are working as primary care doctors, a proportion that outpaces the proportion of women working as specialists.

Barnard suggested the broader decrease in primary care providers’ hours might be linked with the increase of women working in the specialty.

National data shows that women are significantly more likely than men to cut back their hours the further they get from medical training, often because they are bearing the responsibility for childcare or the care of aging parents.

Barnard hopes that looking at the data will prompt Vermont to make careers in medicine more compatible with the needs and schedules of caretakers.

One way to do that could be to reduce the hours of paperwork and chart notes physicians have to fill out outside of their patient-facing hours. Many doctors see the advent of AI notetakers as a groundbreaking tool to lessen that administrative load and give them more time to devote to patients in the clinic.

“Through most of my career, I have known and have experienced concerning trends in medicine in general and in primary care, without any real light,” Hildebrant, the commissioner of health, said. “I have seen a light for the first time in my career in the last five years with some of the AI tools that will empower our clinicians to stop spending more than half of their day staring at a computer screen.”

This story was first published by VTDigger and is republished with permission as part of the Vermont Journalism Trust’s Community News Sharing Project.