UVM family medicine director urges broad steps to bolster primary care workforce

Dr. Gordon Powers, introduced by the committee as program director for the University of Vermont family medicine residency program, told lawmakers that retaining primary care physicians in rural Vermont requires multiple strategies beyond single payment reforms. Powers said training, incentives and practice supports are all needed and described a residency pipeline that keeps roughly "60% of the graduating" trainees in state.

Powers acknowledged payment reform legislation discussed by the committee—S.197—and called it "a step in the right direction" while stressing it would not by itself remove administrative burdens or unreimbursed work that push providers away. "I think it all needs to happen at the same time, honestly," he said, outlining the need for better reimbursement, technology to reduce administrative load and incentives such as loan repayment and AHEC scholarship programs.

Committee members asked how Vermont compares with neighboring states and whether academic medical centers undervalue primary care in favor of research. Powers said federal research funding priorities and academic incentives shape the pipeline, and he emphasized state-level programs like AHEC and loan-repayment as effective tools for recruitment and retention.

Members also raised questions about scope of practice and whether advanced practice providers should serve as clinician of record in inpatient settings. Powers said training pathways differ and that such decisions require careful consideration of residency-based training differences.

On prevention versus acute care, Powers said both functions are necessary and primary care must balance preventive work with capacity to manage complex illness. He closed by noting the importance of culture, professional satisfaction and connection to community as reasons many physicians choose to remain in Vermont. He and the committee agreed the bill and related initiatives are part of a broader strategy to strengthen primary care access in the state.