Doctor’s departure emblematic of challenges in rural health care for patients and providers

Dr. Laura Barber at the Chelsea Health Center in Chelsea, Vt., on Thursday, Nov. 16, 2023. Barber, who has worked at the center for eight years, was notified by Gifford Health Care that she is being let go effective December 15, which she said is because she is unable to meet her quota for the number of patients she sees each day. Barber said that expecting rural clinics to perform at the same level as those in more populated areas is unrealistic. “Gifford just doesn’t care,” she said. Barber worries about what will happen to her patients when she leaves. “They’re my people, they’re my family, and I can’t do anything for them.” (Valley News / Report For America - Alex Driehaus) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Dr. Laura Barber at the Chelsea Health Center in Chelsea, Vt., on Thursday, Nov. 16, 2023. Barber, who has worked at the center for eight years, was notified by Gifford Health Care that she is being let go effective December 15, which she said is because she is unable to meet her quota for the number of patients she sees each day. Barber said that expecting rural clinics to perform at the same level as those in more populated areas is unrealistic. “Gifford just doesn’t care,” she said. Barber worries about what will happen to her patients when she leaves. “They’re my people, they’re my family, and I can’t do anything for them.” (Valley News / Report For America - Alex Driehaus) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. valley news / report for america — Alex Driehaus

Will Gilman, 67, at his home in Chelsea, Vt., on Thursday, Nov. 16, 2023. Gilman, who is quadriplegic, said that having a doctor who knows him and his medical history is invaluable, especially one like Dr. Laura Barber, who would occasionally make house calls on her way home from work. Gilman is concerned about the future of the Chelsea Health Center and is planning to work with his neighbors to circulate a petition in the hopes of keeping Dr. Barber. “I’m always fighting losing battles,” he said. (Valley News / Report For America - Alex Driehaus) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Will Gilman, 67, at his home in Chelsea, Vt., on Thursday, Nov. 16, 2023. Gilman, who is quadriplegic, said that having a doctor who knows him and his medical history is invaluable, especially one like Dr. Laura Barber, who would occasionally make house calls on her way home from work. Gilman is concerned about the future of the Chelsea Health Center and is planning to work with his neighbors to circulate a petition in the hopes of keeping Dr. Barber. “I’m always fighting losing battles,” he said. (Valley News / Report For America - Alex Driehaus) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Valley News / Report For America — Alex Driehaus

By NORA DOYLE-BURR

Valley News Staff Writer

Published: 11-22-2023 12:33 AM

Modified: 11-22-2023 7:41 PM


CHELSEA — The sole physician at the Chelsea Health Center is departing next month, and both the doctor and her patients said they are concerned about what that might mean for the quality of health care in the community.

Will Gilman, the 67-year-old owner of Will’s Store in Chelsea, said he tries to avoid going to the doctor as much as possible, but as a quadriplegic there are times when it’s unavoidable.

“Doctors are part of my life,” Gilman said in a phone interview this week. “I’m not just an everyday kind of patient. It’s been important to me to have a doctor who has a history of being here long enough to understand my personal situation.”

Gilman said his condition makes him prone to developing urinary tract infections, which can become dangerous if not treated quickly. Dr. Laura Barber, a 67-year-old Royalton resident who has worked at the Chelsea Health Center since 2015, has written Gilman a prescription for antibiotics so if he feels an infection coming on, he can start taking medication immediately.

When Barber leaves next month, Gilman said he’s concerned that her replacement won’t understand his treatment needs as well.

“It’s not as life-changing as that for the whole town,” he said. But “for me personally, not having a doctor who’s been here seven or eight years — she knows who I am — it’s a big deal.”

Article continues after...

Yesterday's Most Read Articles

Barber said her employer, Randolph-based Gifford Health Care, fired her effective Dec. 15, giving her a 90-day notice in September.

“A lot of patients I had built a relationship with over eight years tended not to trust the medical establishment,” Barber said in a phone interview. “I really am very worried about what’s going to happen to the people. It is the medical resource for the majority of the population of the area.”

Barber’s departure illustrates some of the challenges facing health care delivery in rural areas. Over years with one provider, patients have developed a personal relationship with her, which they say helps improve the quality of the care they receive. Now she said she’s being asked to leave after failing to meet a relatively new benchmark for the number of patients Gifford’s providers are required to see each hour. While patients say they like that she doesn’t rush them out the door, Gifford says it faces financial challenges that require its providers to be more efficient, both to boost the bottom line and to ensure that patients have access to care.

Meanwhile, Gifford officials said they are looking for a permanent replacement for Barber. Until the permanent post is filled, Gifford will staff the health center with a per diem provider who knows the community. The health center also employs a part-time physician assistant, who is expected to remain on staff.

Patients received a letter in the mail this week from Dr. Joshua White, Gifford’s chief medical officer, alerting them to the end of Barber’s tenure there and directing those who have appointments scheduled with her after Dec. 15 to call to reschedule. It also informs them that Gifford has primary care clinics available in Randolph, Berlin, Vt., Bethel, Chelsea and Rochester, Vt.

“Your care is Gifford’s top priority, and we understand that these changes are inconvenient and sometimes difficult,” White wrote. “We will make every effort to assist you in making this as easy and as seamless as possible.”

No clear replacement

Bonnie Kennedy, a 79-year-old Chelsea resident who along with her 81-year-old husband is a patient of Barber’s, said Barber “never rushes you out” and is a “very caring, understanding person.”

Kennedy, who owns HEB Manufacturing in Chelsea, said it’s now unclear where she’ll be able to find a new doctor. The other primary care locations Gifford, a federally qualified health center, suggested are at least half an hour away.

“No disrespect to the nurse practitioners (and) physician assistants … there are times you want to see a doctor,” she said.

Dan Bennett, Gifford’s CEO, in a phone interview this week declined to discuss Barber’s departure specifically, citing restrictions about discussing personnel issues.

Bennett said that in general Gifford implemented a financial improvement plan in August 2022 for its primary care practices. As part of that, Gifford’s primary care providers now are asked to see two patients per hour, which he noted is still a lower rate than some practices require.

Ensuring that providers meet that metric should improve Gifford’s finances by boosting revenue while also increasing access for patients, Bennett said. He noted that the difference between a provider seeing 1.5 patients an hour and two patients an hour is 765 patient visits per year.

“We need to set these minimums so that we can meet our responsibility to our community to provide that access,” he said. “And to have practices that are financially viable.”

Bennett said he wasn’t certain what level of provider Gifford will hire to replace Barber. The organization is “looking for the right fit,” he said.

Barber said that Gifford has asked that providers see 16 patients per day, which she said is equivalent to two patients per hour, but does not account for the time it takes to review a chart before the visit, see the patient, document the visit, enter prescriptions and order tests and consults.

“Seeing the 16 patients a day they want leaves no time at all for all the ancillary tasks,” she wrote in a Wednesday email. One day this week she had 38 prescription refill requests, which require that she check them in both the new and old record systems, since information from the old system hasn’t carried over into the new one.

“I have been seeing 11 or 12 patients most days, though sometimes patients cancel at the last minute or don’t show up for their appointments,” she said.

Barber acknowledged that the Chelsea clinic is less busy than Gifford’s clinics in larger towns. Chelsea has roughly 1,200 residents, while Randolph has about 4,500 and Berlin nearly 3,000.

Barber pushed back on Gifford’s assertion that people lack access. She said the clinic doesn’t have a waiting list and that people with acute needs can be seen within a day or two, while patients without an urgent problem who are seeking to establish care may be seen within a few weeks.

In addition, some people in the Chelsea area don’t have access to reliable transportation, which sometimes means that they miss appointments.

“That’s a vacant spot that I can’t do anything about,” she said.

Barber, who has been in practice since 1985 and worked for a private group practice in Texas before coming to Gifford in 2015, said she would be willing to work at another Gifford clinic but was told by administrators that there’s no place at Gifford for her.

“For whatever reason, they seem to particularly want me out,” she said. “I very much would like to stay there.”

Care board policy

Bob Frenier, a Chelsea resident and former Republican state representative, said in an email that he lays the blame for Barber’s forced departure at the feet of the Green Mountain Care Board, which is responsible for regulating hospital budgets in the state, “and the Democrats who created it.”

“Their policy of limiting competition among medical care providers (“certificates of need”), limiting the number of insurance companies and the variety of their policy offerings, along with GMCB control of hospital budgets guarantees the rationing of care that resulted in Dr. Barber’s dismissal,” wrote Frenier, who sits on the board of the Chelsea Health Center but said he spoke for himself not the board. “Nobody is smart enough to control health care supply and demand like that without rationing such care.”

Susan Barrett, executive director of the care board, said in an email that the board has approved Gifford’s budget as requested for the past two years.

Bennett, for his part, said he stands by the decision to require that providers see at least two patients an hour. The hospital, which has historically subsidized other parts of the organization, such as primary care, can no longer bring in revenue sufficient to do that.

“Every component of the organization has to be able to be financially sustainable,” Bennett said. “That’s the overarching issue that we’re dealing with. We’re incredibly heavily regulated here in the state. (We) can’t just increase our hospital rates to subsidize these other programs. We also need to be trying to improve affordability for people in the community.”

Frenier, like his fellow Chelsea residents, said he was sorry to see Barber go.

“Dr. Barber is the first doctor we’ve had in a long time who stayed beyond a few years,” he said. “A lot of people depend on her; I hate to lose her.”

For his part, Chase Ackerman, the director of First Branch Ambulance, said he didn’t think Barber’s departure would make a difference for the ambulance service, which serves Chelsea, Tunbridge and Washington, Vt.

Ackerman said he is “trying to get people to relax a little bit. You would think the president was stepping down. Somebody’s going to be there to take care of them if they need them.”

“If you have an emergency you still go to the emergency room,” he said. “They’re not going to lose access. People who saw Dr. Barber will have access to this new provider.”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.