WILLIAMSVILLE — I met my husband in 1984, when he was the new, young, doctor in town and had been in practice about five weeks.
At the time, he was one of just two family physicians at Grace Cottage Hospital who covered the emergency room after a full day in the clinic. Grace Cottage is Vermont's smallest hospital, with only 19 beds - but it still has a 24-hour ER.
When we met, my first impression was, “This man looks tired.” I quickly learned it's because when he was on call, he didn't sleep. So when he asked me to marry him, I said yes - when there was a third doctor in town.
We've been married over 25 years now, and happily, there are more doctors in the call schedule, but the doctor's still tired. For all that he loves medicine and his busy practice, he's no longer the young man who can function without sleep for days on end. Nor does he want to.
But recruiting new, primary care, doctors is difficult.
There just aren't enough medical students choosing family practice, because it requires the longest hours for the least pay.
And for a doctor just starting out, money matters: $200,000 of medical school tuition on top of undergraduate loans and living expenses means most new physicians begin their professional lives in serious debt.
The majority of those who do chose family practice take jobs in urban and suburban areas, where hospitals can afford emergency room personnel. This means a primary care physician's on-call duties generally do not require getting out of bed to give hands-on care as the doctors at Grace Cottage do every night.
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Rural medicine remains a lonely frontier. Neither advances in medicine nor communications technology can change geography or climate: rural doctors must act on their own when they care for the sick and injured in the middle of a stormy night.
Some nights are quiet, and the doctor gets to sleep; other nights, the phone rips through dreams and reels the doctor in to care for someone who's had an accident or taken ill.
For those of us who live in rural Vermont, it's a blessing to have a doctor nearby, and a comfort to be treated by a doctor we know.
But those doctors are aging. Of the seven primary-care doctors at Grace Cottage, two are in their mid-40s; three are in their late-50s, and two are 60 or older.
This is part of a statewide trend. According to the Primary Care Workforce Report published in November 2010, one in five of Vermont's primary care docs is over 60, and more than a quarter of them have been in practice for 20 years or more. Many of these physicians will be retiring just when Vermont's universal health care initiatives launch.
The shortage of primary care doctors is not unique to Vermont; current projections indicate a significant, national shortage of physicians. Ironically, just as people receive coverage, there will be a universal shortage of doctors for them to see.
There are some initiatives Vermont could implement to recruit and retain a new generation of family docs. These include increasing training capacity, increasing debt reduction, and decreasing the administrative burdens of providing care.
My husband still loves the face-to-face, hands-on part of his job. But after nearly 30 years of broken sleep, he's ready to pass his beeper on to younger colleagues - if only they could be found.