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Commentaries are opinion pieces contributed by readers and newsmakers. VTDigger strives to publish a variety of views from a broad range of Vermonters. Commentaries give voice to community members and do not represent VTDigger’s views. To submit a commentary, follow the instructions here.
This commentary is by Julie Wasserman, MPH, of Burlington. She is an independent health policy advocate who worked for Vermont state government for more than 25 years.
The Trump administration recently awarded Vermont a $195 million Rural Health Transformation grant whose stated purpose is to strengthen health care access, quality and outcomes in rural communities. One of the most critical elements to achieving this goal is an adequate supply of primary care physicians, yet Gov. Phil Scott’s spending plan does not address Vermont’s current shortage.
Primary care is the foundation of a highly functional, cost-effective health care system. Strengthening and expanding primary care is crucial to Vermont’s health care reform efforts.
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by Olivia Gieger
December 30, 2025, 5:21 pmDecember 30, 2025, 5:21 pm
Research shows that ready access to primary care is associated with fewer emergency department visits, fewer hospitalizations, higher quality, better outcomes, happier patients and lower costs. Vermont desperately needs all of these.
Lower health care costs would also bring urgently needed property tax relief. Statewide health insurance costs borne by school districts increased by 12% and 16% in the last two budget cycles. Health benefits could soon make up 20% of district spending, according to Sue Ceglowski, the Vermont School Boards Association executive director.
The most recent data on Vermont physicians comes from the Vermont Department of Health’s 2022 Physician Census. It found that Vermont had fewer primary care physicians in 2022 (569) than in 2000 (585), and primary care physicians comprise just 18% of all Vermont physicians. The number of specialty care physicians nearly tripled during the same period (895 in 2000 versus 2,543 in 2022). Almost one-third (32%) of Vermont’s primary care physicians were over the age of 60 four years ago, and in five Vermont rural counties, it was more than 45%.
Vermont needs to attract and retain primary care physicians, especially in rural areas. Why is the Scott administration not using part of the $195 million award to address this critical shortage?
Instead, the state will spend $17.5 million on grant consultants and contractors to gather and study data for hospital and regional transformation and provide project management support ($15 million), and another $2.5 million to develop and implement a Statewide Health Care Delivery Strategic Plan, due in 2028.
The state’s planned use of the grant includes noteworthy initiatives such as the promotion of integrated team-based care, facility upgrades, expansion of urgent care for mental health and substance use, funds to house health care workers, training programs to increase the number of licensed nursing assistants, and tuition and financial assistance for nurses, dental hygienists, and radiology and medical technicians. The grant also aims to help fund a rural Family Medicine Residency Program. Yet direct fortification of Vermont’s primary care physician workforce is absent.
The Vermont Steering Committee for Comprehensive Primary Health Care was created last year by the Legislature (Act 68) to inform the work of state government on “access to, delivery of, and payment for primary care services.” One of its top mandates is to “provide recommendations for recruiting and retaining high-quality primary care providers”.
While Vermont’s $195 million award provides funding for the first year of the Trump administration’s five-year One Big Beautiful Bill Act (OBBBA) grant opportunity, subsequent annual awards may prove elusive.
A recent article in the New England Journal of Medicine warns that Rural Health Transformation grants represent “a vehicle for advancing the Trump administration’s priorities” while serving to stifle anger over OBBBA’s “sweeping changes to health programs, including cuts of nearly $1 trillion in federal health care funding.”
Future awards may be jeopardized “if states don’t meet new criteria that the administration may impose in subsequent funding years,” according to the same article. This implies year-one funding may be the lure for future coercive and onerous demands by the Trump administration.
Vermont needs to embrace its health care reform priorities and not let the enticement of future federal awards — with unattractive strings attached — compromise or blind us.
Given the potential threat to Rural Health Transformation funding in future years, coupled with Vermont’s pressing need for primary care physicians, Gov. Phil Scott’s administration needs to use a portion of its current $195 million award to develop and implement a comprehensive plan to recruit and retain primary care physicians.
As a leading national health expert, Lisa Rosenbaum, MD, recently wrote in the New England Journal of Medicine, the great mystery of primary care isn’t how to make it better, but why we haven’t done so.
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