Mark Lichtenstein, M.D., lives in northeast Vermont, the most rural part of the state, where he trades his stethoscope for gardening tools when not taking care of patients in the local community health center.
America's smallest states -- especially those with large swaths of rural landscape -- face special challenges when it comes to providing access to health care services for their populations. Ditto for membership organizations such as the Vermont AFP, which relies on a small pool of family physicians to fill board positions and volunteer for various committee assignments.
Just ask Vermont AFP President Robert Penney, M.D., of Burlington.
"There are not a lot of people to do the work," Penney told AAFP News Now. "We have a 12-person board of directors and limited financial resources."
In addition, he said, most of the chapter's board members reside in Chittenden County, which holds about one-quarter of the state's entire population. "We're trying to get more representation from the rest of the state," said Penney. "Burlington (the state's largest city, with a population of about 42,600) is up in the northwest corner in Chittenden County, and that tends to be where a lot of the medical activities are centered."
- The Vermont AFP is a small chapter in a largely rural state.
- Chapter leadership works hard to ensure that the board's makeup represents the state's geographic diversity.
- The Vermont AFP demonstrates strong support for issues that concern the health and well-being of children and adolescents.
That area includes the University of Vermont College of Medicine, as well Fletcher Allen Health Care Center, which serves as the state's academic medical center.
Vermont is best described as a long, narrow state with a total land area of just 9,216 square miles, or about .0026 percent of the total land area that comprises the United States. According to the latest U.S. Census Bureau estimates, about 626,430 people call Vermont home.
The state also is home to eight federally qualified health centers (FQHCs) that treat, through an additional 40-some satellite sites, upwards of 120,000 people, or one in every five residents.
Vermont AFP Board member Mark Lichtenstein, M.D., of Greensboro, population 700, is one of two board members who work in an FQHC. "I came here in 1979 right from residency in Buffalo, and I haven't left," he said. "There are a lot of us who practice in rural Vermont, but not very many take the time to be on the board."
According to Lichtenstein, his community health center was the first in the state and is considered the most rural. "It's easy to go months without seeing another doctor other than your partners," said Lichtenstein, who paused and then added, "I could say years."
It seems that the Vermont AFP's high visibility in the Vermont statehouse keeps members tuned in and ultimately may have contributed to the chapter winning two membership awards at the AAFP's 2012 Annual Leadership Forum held in April in Kansas City, Mo.
According to Vermont AFP Executive Director Stephanie Winters, the chapter won first place among small chapters for retention of active members and came in second among small chapters for the highest percentage increase in active members.
Winters said an immunization bill generated a lot of chapter communication with members, as did health care reform efforts at the state level.
"There are a lot of health care issues going on the state, and when members see that their specialty has a voice, they see the value of belonging to their AAFP chapter," said Winters.
Lichtenstein, who figured he's in his sixth or seventh year on the Vermont AFP Board of Directors, said his work with the chapter helps him interface with colleagues and find solutions to some of the most frustrating problems he faces as a rural doc -- for example, how to handle the care of nursing home patients or connect a patient with the subspecialist care he or she needs.
"Our needs are very different from those of the 'city people,' and so we try to make sure that when someone rural leaves the board we find someone else in the same category to fill that spot," said Lichtenstein.
Advocacy also is a focus of the Vermont AFP, and, at 36, Andrea Regan, M.D., of Hinesburg, is the youngest member of the board. However, she has already seen a personal payoff for her involvement because, for the first time, she will represent the chapter as an alternate delegate at the 2012 Congress of Delegates, Oct. 15-17 in Philadelphia.
Regan also is a member of the Vermont Department of Health's Immunization Advisory Committee, a multidisciplinary team that meets quarterly and includes pediatricians and other community health care professionals.
As part of her work with that group, Regan testified twice during Vermont's 2011-12 legislative session regarding S. 199, a bill that contained a clause calling for the elimination of Vermont's "philosophical exemption" clause from the state law requiring that all children enrolled in school and child care facilities receive immunizations specified by the department of health.
"It's funny, I'm a native Vermonter, and I had never been to the statehouse before," said Regan who described her initial experience in providing testimony as "terrifying." But those trips to the state capital in Montpelier served as a primer on the legislative process and more.
"I learned so much about immunizations, in part from my research, but also from prominent members of our community, including infectious disease specialists who also were speaking in support of the legislation," said Regan.
Hannah Rabin, M.D., checks on one of her pediatric patients at Richmond Family Medicine, a clinic she and three family physician colleagues built and opened in 2011.
She also noted that in Vermont, the loudest protests against childhood immunizations come from highly educated people. "We have a lot of independent, critical thinkers who don't always follow what government agencies want … parents who recognize that because of high immunization rates, the risk for their child, individually, to catch an illness is quite low."
Ultimately, the immunization bill passed, but it preserved the philosophical exemption.
In addition to the bill on which Regan testified, the Vermont AFP supported other legislation that affected children's health issues during the 2011-2012 Vermont legislative session.
- H. 151, which would impose an excise tax on sugar-sweetened beverages, was referred to the Ways and Means Committee.
- H. 109, which proposed raising tax rates on cigarette and tobacco products, was rolled into tax bill H. 436 and passed. It raised the tax on a pack of cigarettes by 38 cents.
- H. 46 and H. 604, which called for measures to protect young athletes who suffer concussions while participating in athletic activities, were rolled into H. 559 and passed.
The Vermont AFP also focuses on the health of the state's younger patients. In fact, according to Allyson Bolduc, M.D., of South Burlington, Vt., the chapter's president-elect, the Vermont AFP has worked hard on the state's lead screening program in past legislative sessions. "Our focus, really, has been to be at the table when these issues related to the health of the children in our state are discussed so that we can try to have an impact on the outcomes," she said.
Chapter executive director: Stephanie Winters
Number of chapter members: 369
Date chapter was chartered: April 10, 1951
2012 annual meeting date/location: Nov. 10, Capitol Plaza, Montpelier
In addition, for several years, the chapter has been the beneficiary of a $30,000 continuing grant funded through the Vermont Department of Health and aimed at developing and implementing strategies to ensure access to the department's child and adolescent health screening recommendations.
In addition to other projects, that pot of money provided a small stipend to chapter member Hannah Rabin, M.D., of Richmond, who served a stint on the state's Joint School Health Committee.
"We wanted to make sure that we were working closely with the schools because that's the best way to reach kids in Vermont," said Rabin. "We partnered with the school nurses to help kids get good preventive care and to set up good protocols within schools to help deal with children who have chronic illnesses, such as diabetes or epilepsy," she said.
"We also were overseeing the rewriting of the school nurse handbook and trying to figure out how to help schools get electronic health records for their school nurses," said Rabin, who has since resigned her committee position to tend to a new practice she started with three other FPs in October 2011.
That practice, Richmond Family Medicine, opened in a town where only the most elderly of residents remembered having a town doctor. The practice is thriving, said Rabin. And yes, a good portion of her patient panel is children.
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