The Health Care System needs changing (no surprise) [Last 4th quarter moon of 2021]

I started to write to the editor of Seven Days regarding an article on the loss of physician practices. (find the article here: )

My response was two-pronged: highlighting our broken healthcare system AND pointing out that Nurse Practitioners are providing high-quality care to patients and are too often left out of the conversation. My letter was too long for the 250-word cap. While trying to whittle down my 750-word response, possibly doing some good editing, I was also changing my voice, deleting my thoughts, words, personality. It occurred to me that this was the opportunity to honor my intention to begin writing, to carve out the time, develop a writing practice, in short, MAKE IT HAPPEN. It was my recent New Moon intention… and today, the last quarter brings that intention home… so here I am… closing out the year, and moon cycle, with my response to this article.

To the #SevenDays editor,

I want to thank you as well as implore you to gather more information as it pertains to the delivery of healthcare in response to the recent article “The Doctor Is Out: Why Independent Physicians Are Disappearing From Vermont”.

I have been an RN for over 30 years, a Nurse Practitioner for nearly 17 years, first as a family practice/primary care provider, and the last seven of those years in Mental Health & Psychiatric care. I have seen the insidious end to patient choice and satisfaction of care and the disintegration of provider job satisfaction over the course of those years. There is much more to say on the matter of health care reimbursement and providers being paid for their services.

Much of my career has been working with tribal health organizations- historically a single payor system, like Medicaid and the military VA/Active duty systems. I enjoyed working in this system as care was administered equally, with no deductibles or co-pays. I worked the office day without ‘production’ reports from Administration. This was for Indian Health Beneficiaries, but if you had insurance, the care was not so equal.

I have now been in my VT private practice for 15 months after nearly three years with a local FQHC. The pandemic-induced uncertainty provided an avenue for me to move towards a career-long goal. I am happy to say, personal satisfaction in my work and the interactions with my clients have increased tremendously, though not without the frustrations and regular doubt that are referenced in your article: whether my practice can last.

In short, the insurance companies have a misplaced power over what they will pay providers… entities deciding on the fee to be paid don’t actually provide any healthcare service, every entity has its own formula deciding on the amount of payment, with patients having varying deductible amounts. It is difficult to understand how this system grew and flourished- imagine how the ‘pay what you want’ model at the grocery, plumber, or lawyer’s might go…

It is important to me to provide care to all, not just those who can afford to pay out of pocket. It is equally important to work in balance with my personal and family life. Very difficult when I cannot be sure what a week of seeing patients will bring into the office accounts.

I feel fortunate to have had a degree of success in my first year of private practice, the pandemic has made mental health a priority and I am glad to have been of service. I spend more time with my patients, I hear their stories, support them through their difficulties, celebrate their successes. They in turn express feeling heard, they appreciate the time spent and the access to me directly and, I think, the fact their provider is not burning out gets across.

and now for the BUT:

I am working more than I want to with a school-age child. I am frustrated with the inconsistency in payment, I dread January when patients’ deductibles reset and they won’t be able to pay for their services and so may choose to forego care, which can increase the severity of illness when they return to care.

I was an admirer of Dr. Rogers who is mentioned in your article. I thought of him as the last holdout from the consolidation of practices into bigger corporate entities. He delivered more personalized care, the ‘country doc’ that many appreciated. I wondered if a Family Nurse Practitioner was considered to succeed him?

so now, the implore part:

There are many nurse practitioners (NPs) delivering high-quality care who could fill the gaps, as we always have in areas where doctors would not and do not go.

NPs could fill the need for high-quality primary care easily. They are dissuaded from private practice with pitches from FQHCs and large hospital practices that they “take care of everything”- perhaps provide a sense of security, but dictate a style of practice that NPs, as well as doctors, do not often enjoy. All the while promising “life-work balance”, a catch-phrase they know is important but fail to meet for many. Never minding the disparate wages for similar reimbursements for patient visits from the insurance companies.

My experiences in rural Alaska created a personal opportunity to realize my care was valued, appreciated, and absolutely necessary in places that physicians would not or could not be persuaded to go. It also taught me a tremendous appreciation for my physician colleagues with whom I collaborated, albeit remotely, who shared their expertise when a case was beyond my skillset.

There is much more to explore in this healthcare story, the system is terribly broken. Our local FQHC managed to add an administrative position or two during the pandemic with the help of subsidies, while employees decreased their hours, and patient visits were down… without changes in costs to patients with out-of-reach deductibles remaining.

There are still some Providers like myself who will continue providing an alternative care setting for patients, for as long as we can manage to do so…

Ann Marie Dryden MSN, APRN

Published by FYRAnnM

Health Care Provider, Teacher, Dreamer! at Finding Your Roots Health and Wellness

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