A New Model for Primary Care

This article was published in our 2015 Annual Report.

Dr. Milt Fowler and physician assistant Leslie Osterman

Dr. Milt Fowler and physician assistant Leslie Osterman

For Dr. Milt Fowler and physician assistant Leslie Osterman, teamwork is the key to continuity of care.

Dr. Milt Fowler had just completed his residency when he arrived at Gifford in 1976.

He and his wife were eager to leave the city and wanted to be part of a small community.

He’s still practicing at Gifford forty years later, and now he faces another major life transition: easing into retirement.

“I’m having a hard time cutting back. I’ve known some of my patients for 35 or 40 years,” he said. “There’s a deep richness and joy in practicing primary care in a small community. Once you’ve shut the door on the chaos and paperwork and sit to connect with a patient, the office is like a sacred space.”

Providers at Gifford often say that an ongoing patient relationship is the most satisfying part of their work. For family physicians, the bonds can grow especially strong: it is not unusual for long-time primary care physicians to have treated several generations in a single family.

“I see my role as being a positive influence, someone a patient can come to for help—not just with medicine, but with other issues as well,” said Dr. Ken Borie, who has been practicing family medicine at Gifford since 1980. “Family doctors can build trust in ways a specialist can’t. That’s what’s valuable about being a primary care physician—it’s one of the intangibles that you can’t put a price on.”

Across the country a shortage of primary care physicians is forcing rural community hospitals like Gifford to look for alternatives to this traditional model. As a generation of long-time physicians starts to retire, fewer new providers choose a career in primary care.

Many factors have contributed to this shortage: primary care pays less than other fields and many medical students, burdened with student debt, specialize in other areas. Those who do practice primary care are in demand, and are much more mobile than the providers who settled in Randolph years ago. Rural communities are especially hard hit, since salaries are much higher in urban areas.

To respond to this primary care recruitment challenge, Gifford has implemented a team model, often pairing a physician with a physician assistant or nurse practitioner. These healthcare professionals have been specially trained to diagnose and treat a variety of conditions, prescribe medication, order and interpret tests, counsel, and manage patient care.

Fowler works closely with Physician Assistant-Certified, Leslie Osterman. The arrangement shortens a patient’s waiting time for appointments, but also helps to make sure that patients have quality time with a provider during visits.

“There are not enough MD/DO’s to care for everybody—we have to find new models,” said Fowler. “Leslie and I work really well together. She’s taken over much of the acute care and the preventive and health maintenance visits like annual physicals and cancer screenings. I tend to manage care for patients with more complicated needs.”

Osterman previously worked as a respiratory therapist but found she wanted to be more involved in patient care. She saw that the physician assistants she worked with could focus on preventative medicine, and shared knowledge and decision-making as a team. She returned to school, received a Masters of Physician Assistant studies from Franklin Pierce University (she completed three of her nine rotations at Gifford), and came to practice at Gifford in 2015.

“Milt introduces me to his long-time patients and they see us working together. If their next appointment is with me, I won’t be some random person they haven’t seen before,” said Osterman. “Continuity of care is really important to people.”

The new team model increases patient access to primary care professionals while preserving a quality provider/patient relationship. Like the long-term providers they work with, physician assistants and nurse practitioners say they specifically chose their roles because they wanted to build ongoing connections with patients.

“I trained as a physician assistant because I had seen that many doctors weren’t able to spend extra time with patients discussing concerns or preventive care,” said Osterman. “Sometimes patients need extra time for education or explanations, and I wanted to help fill this need.”

A Message from the Medical Staff President

The following was featured in our 2012 Annual Report.

Marcus Coxon

Marcus Coxon

Our effectiveness as a medical home has grown this year with the expansion of health care teams and our collaboration with the Vermont Blueprint for Health. But at the heart of these teams are Gifford’s long-established primary care practices. In each of our health team locations, we have providers and support staff whose relationships with the community run deep.

Take Starr Strong, for example. For 19 years, Starr has committed herself to the people of Chelsea – first under the mentorship of Dr. Brewster Martin and now as a mentor in her own right.

With humility and compassion, family physician Dr. Ken Borie has cared for the people of Randolph for 32 years. The humanity he brings to medicine is an example for all, including the many medical students who he guides through the family medicine portion of their clinical studies.

And Dr. Lou DiNicola, a local pediatrician for 36 years, has been among the foremost leaders in this state when it comes to children, advocating at every turn for their health, safety, and welfare.

Those of us enjoying long-standing relationships with Gifford and with our central Vermont community consider ourselves fortunate to know and work with these practitioners and their support teams. Such stability, and depth, builds our medical homes into more effective tools for helping our patients.

~ Marcus Coxon
Medical Staff President & family physician

Fighting Disease Through “Compassion” – Dr. Ken Borie

Dr. Ken BorieOriginally from Pennsylvania, Dr. Ken Borie has been a family physician in Randolph since 1980. Married with two grown sons and a teenage daughter, Dr. Borie lives a few doors down the street from Gifford, walking to work – even on his day off. His wife, Mary, is a registered nurse in Gifford’s Birthing Center.

In his free time, Dr. Borie is an oil and watercolor portrait painter and enjoys gardening, reading, jogging, whale and bird watching, and golfing. He studies history and medical history, teaches Civil War medicine to schoolchildren, and often has Dartmouth Medical School students with him as he shares his passion for family medicine and his compassion for patients.

Below is his story as told in his own words, as featured in our 2012 Annual Report.

“My journey to Randolph began when I was just 8 years old. I grew up in a neighborhood surrounded by doctors. I saw them as mentors and role models, and knew – even then – that is what I wanted to do with my life.

After acceptance to medical school, I spent my first year in awe of the anatomy of the human body. The summer after my freshman year, I hiked the Long Trail end to end and then went to Waterville, Maine for a six-week medical externship. That summer showed me the beauty of Vermont and where I wanted to practice. It also showed me my future specialty: family medicine, as I worked with an amazing family doctor who “did it all”.

Dr. Ken Borie

The two sides of Dr. Borie – top, an early ’90s portrait shows the dedicated physician hard at work and bottom, Dr. Borie in 1989 sharing a smile.

I came to Randolph in July of 1980, right out of my family medicine residency. Peter  Frankenburg was my real estate broker and sold me the house I live in today. One of his selling pitches included “…and the Fourth of July parade goes right past the house.” Dr. Ron Gadway and Dr. Ed Armstrong initially hired me at Medical Associates, but very soon I was able to open my own practice as Phil Levesque, the CEO at Gifford at the time, was looking for a family doctor in Randolph. I worked as an independent and solo practitioner in Randolph until Gifford officially hired me in 1994.

Thirty-two years of practice later, I can tell you first-hand that being a physician is a blessing. I feel honored to have patients put their trust and faith in me. There is no greater honor than to have a young woman ask me to take care of her newborn baby or after caring for an elderly woman for 25 years, sitting with her and her family as she dies in Gifford’s Garden Room.

I’m not alone in this work. Exceptional physicians, like Drs. Milt Fowler, Mark and Elizabeth Jewett, Lou DiNicola, Terry Cantlin, Mark Seymour, Bill Minsinger, and Dennis Henzig, along with many others on Gifford’s staff, have worked at my side for decades. Together we have helped keep the people of central Vermont healthy.

We’ve incorporated many strategies to achieve that goal, but there is a saying on a statue at Gifford that says it best. The statue is of two birds and is crafted by the talented Jim Sardonis. It reads: “Science has provided many tools for fighting disease, but the oldest tool, compassion, is still the most important.” These words help guide me through each day.”

~ Ken Borie, D.O.
Gifford family physician

Dr. Ken Borie

Above left: an undated portrait of Dr. Borie. Above right: Dr. Borie chats with Joe and Lois Mulderig of Randolph. Joe and Lois, ages 88 and 85 respectively, have been married for 65 years and have been patients of Dr. Borie’s since moving to Vermont about 20 years ago.