January 29, 2026
January 23, 2026
Beyond the Bedside (Part III) … The internal pressures shaping BMH
In the first two installments of our series on Brattleboro Memorial Hospital (BMH), we focused on the financial pressures facing our hospital and the external forces that disproportionately affect small, independent, rural healthcare providers. We explored the rising cost of delivering care while reimbursement from Medicaid and Medicare has remained stagnant — or declined.
Some may wonder why BMH relies so heavily on Medicaid and Medicare. The answer is straightforward: about 65 percent of our southeastern Vermont community depends on these two government programs for health coverage. In that sense, BMH and the community it serves are deeply interconnected. When reimbursement falls short, the impact is felt not only by the hospital’s balance sheet, but also behind the scenes as we work to preserve access to high-quality, local healthcare for everyone who needs it.
Workforce challenges further complicate this picture. Recruiting and retaining healthcare professionals has been an ongoing issue in rural America since the late 1990s. Today, according to the American Hospital Association, only 10 percent of physicians in the U.S. practice in rural areas. Half of those physicians are age 50 or older, and looming retirements are expected to result in a nearly 23 percent decline in the rural physician workforce by 2030. For BMH specifically, more than 50 percent of our active practicing physicians are 50 or older.
The COVID-19 pandemic intensified these challenges, prompting thousands of highly trained healthcare professionals nationwide to leave the field altogether. This is not to suggest that BMH is understaffed. Rather, it highlights the reality that our staff has had to adapt, improvise, and at times step outside their comfort zones to ensure patients continue to receive responsive, high-quality care — often with fewer resources than would be ideal.
At the same time, we face steep barriers when hiring. We cannot compete with the salaries and signing bonuses offered by larger urban systems, simply because we do not have the patient volumes required to generate that level of revenue. Rising housing costs in and around Brattleboro, coupled with limited professional opportunities for spouses and partners, make recruitment even more challenging.
These pressures inevitably ripple through the organization. For some employees, it means taking on additional roles or shifts. For others, it involves cross-training so they can support colleagues outside their primary specialties. This flexibility helps ensure patient needs are met — but it also adds strain to an already demanding work environment.
BMH is a hospital that never truly sleeps. As a community hospital, we are open 24 hours a day, seven days a week, 365 days a year. Patient volume and medical needs are unpredictable, requiring constant readiness from both clinical and non-clinical staff. Teams must manage emergencies alongside admissions and discharges, balance scheduled and unscheduled surgeries, and coordinate specialist availability — all in real time.
Sustaining this level of complexity is no small task. It depends on seamless coordination and rapid, reliable communication across departments and disciplines. While some might view these conditions as a recipe for burnout, the staff at BMH has demonstrated remarkable resilience.
Even amid profound change and growing uncertainty, our employees continue to show up for this community in meaningful ways — often under pressures that are largely invisible to the public. Their dedication, adaptability, and commitment are a powerful reminder that behind every challenge facing modern healthcare, there are people working tirelessly to ensure care remains close to home.
January 22, 2026
Brattleboro Memorial Hospital Provides Update on Nursing Union Negotiations
Brattleboro Memorial Hospital (BMH) is providing an update on ongoing collective bargaining negotiations with the Brattleboro Federation of Nurses (BFN). These conversations are taking place during an exceptionally challenging financial period for the hospital, driven by significant and unforeseen changes in financial conditions.
On December 3, 2025, BMH submitted a revised fiscal year 2026 budget to the Green Mountain Care Board (GMCB) showing a projected loss of approximately $14.5 million. Following the original submission in August, the GMCB directed BMH to conduct a deeper review of its budget. As a result, several inaccuracies were corrected, including some of which resulted from aspirational assumptions no longer realistic under current financial conditions. BMH has been operating at a loss since 2017, and the challenges ahead continue to compound this long‑standing negative financial trend.
BMH recognizes the importance of its nursing workforce and values the critical role nurses play in delivering high-quality patient care. The hospital remains committed to bargaining in good faith and working collaboratively with BFN to reach an agreement that supports employees while ensuring the organization’s long-term financial stability.
Negotiations include discussions about wages, employee retirement benefits, medical benefits coverage offerings, and shift/specialty differentials—premium payments provided to employees for working specific shifts, performing specialized duties, or working under particularly challenging conditions. BMH’s current offerings in these areas are more generous than prevailing industry standards and the proposed adjustments are intended to align more closely with similar organizations and the regional market. These changes reflect the hospital’s financial reality and its responsibility to maintain a balanced, sustainable budget while continuing to provide essential healthcare services to the community.
In recognition of the impact of these proposals, BMH has also indicated a willingness to reopen negotiations on specific economic issues during the term of the agreement with BFN.
“We are at a point where hard financial decisions must be made,” Acting Co-CEO Dr. Tony Blofson said. “The truth is, we cannot continue operating at status quo—it’s simply not sustainable. Our shared goal is to ensure the long-term health of BMH, the jobs of all of us here, and to preserve the care our community depends on.”
Negotiations are ongoing, and BMH will continue to provide updates as appropriate.
Follow this link to read the January 22, 2026, Brattleboro Reformer article entitled “BMH Outlines Financial Improvement Projects” by Chris Mays.
January 21, 2026
January 20, 2026
January 2, 2026
Beyond the Bedside (Part II): The External Pressures Impacting Brattleboro Memorial Hospital
By Acting Co-CEOs Dr. Tony Blofson and Dr. Elizabeth McLarney
We hope you had a chance to read Part 1 in our series about the mounting external pressures that have generated a tidal wave of financial distress at Brattleboro Memorial Hospital and rural hospitals across the U.S.
If so, you have a better understanding of how the soaring costs of hospital overhead combined with shrinking payments from government health insurance programs like Medicaid and Medicare have been devastating for rural hospitals—especially those like BMH that have worked hard to remain independent and part of the community we serve. Unfortunately, our challenges don’t end there.
While workforce shortages have affected every hospital in the country, falling numbers of available clinicians, nurses, medical technologists, and emergency medicine specialists have hit small rural hospitals the hardest.
That’s because BMH and hospitals like BMH are forced to compete in a shrinking labor market with larger hospitals and health systems that are better positioned to offer higher salaries, and generous signing bonuses. We are fortunate that BMH has a great team, but the competition for talent is ongoing and intense.
The downstream effect on existing staff and patients is felt in a variety of ways. When open positions remain unfilled, patients experience delays and longer wait times for primary, emergency, and specialty care. Existing staff members are under pressure to take on heavier workloads, making the risk of burn-out-driven turnover very real.
This plays out on a daily basis as surging numbers of people with substance use and mental health disorders turn to BMH’s emergency room as a first point of care. The added workload on staff is very real and often heartbreaking as mental health patients typically wait for hours and sometimes days for placement in an appropriate psychiatric facility.
The difficulties we face in recruiting and retaining healthcare workers often means rural hospitals are forced to hire contract labor to fill the gap. These healthcare professionals, known commonly as “travelers,” are incredibly expensive. Depending on their specialty, we pay double what we pay our own staff. And with contracts that typically run 13 weeks, they represent a short-lived solution to a long-term problem.
Healthcare worker burnout is not restricted to a hospital’s clinical operations. It’s also a huge and ever-growing challenge for employees on the administrative side of a hospital. Few people realize how expensive and time-consuming it is to interpret and fulfill the growing mountain of regulatory and reporting requirements imposed on hospitals.
By law, BMH must comply with hundreds of state and federal requirements while also meeting a host of oversight guidelines and accreditation standards. We are not implying that rules are unimportant. We are simply pointing out that the expanding scope and complexity of regulations associated with things like patient and staff safety, quality reporting, billing, staffing ratios, emergency preparedness, licensing, accreditation, and protecting patient information is enormous and increases expenses.
This is further complicated by the fact that the electronic medical record platforms across the regulatory landscape of U.S. healthcare are fragmented. They follow different formatting and compliance standards. The result? We have no choice but to enter the same information multiple times in order to meet the disparate documentation requirements of Medicaid, Medicare, commercial insurers, and regulatory bodies.
Brattleboro has supported BMH for more than 120 years. That support is the reason we are able to meet these pressures head-on and continue delivering high-quality care to the people who depend on us. We are proud to be part of this community, and we know we can get through these challenges by working together.
December 18, 2025
Beyond the Bedside: The External Pressures Shaping Brattleboro Memorial Hospital
By Acting Co-CEOs Dr. Tony Blofson and Dr. Elizabeth McLarney
When news about Brattleboro Memorial Hospital’s recent budget woes and leadership changes became public last October, we were deeply moved by the unhesitating and heartfelt messages of support we received from our community.
BMH is so much more than a collection of buildings. It’s home to a network of skilled healthcare professionals who have the best interests of the community at heart. That’s clearly obvious to so many people.
But what’s less obvious is the ways in which steadily mounting financial and other pressures from outside the organization have grown over the past decade. That’s why we’d like to share a bit about these pressures and explain some of the complexities they add to running a rural community hospital like BMH.
Imagine owning a business that begins the year in a financial deficit. Unfortunately, this is the annual reality for BMH and all Vermont hospitals due to the state provider tax. The tax is calculated at 6 percent of revenues, which means the amount can vary year to year. In fiscal year 2025, BMH paid over $6 million in provider tax, underscoring the significant financial burden this places on healthcare institutions.
As a business owner you might respond by raising your prices. But hospitals like BMH that care for a large percentage of people who receive Medicaid and Medicare are required to accept reimbursement rates that often do not cover the full cost of services. Add to this recent federal legislation that cuts Medicaid funding by $1 trillion over the next ten years, and you understand the scope of the challenges we face.
BMH has been and always will be committed to meeting and exceeding modern standards of care. But the perfect storm has arrived for hospitals in rural America in the form of dwindling financial resources coupled with soaring costs not just for leading edge medical technology, but for basic equipment, medications, staffing, insurance, and compliance with regulatory requirements.
In the U.S. between 2017 and 2024, sixty-two rural hospitals closed while only 10 opened. And rural hospitals that can produce positive margins and remain open tend to be those that have more beds, higher occupancy, and are affiliated with a health system. Like other industries in our country, healthcare appears to be moving toward survival of the biggest. But is bigger always better?
It’s not if you have to drive 50 minutes to deliver a baby or reach an emergency room. What do you do if you’re unable to drive, or you lack an internet connection that will allow you to reach a provider online?
These are just some of the reasons why BMH has remained fiercely independent for more than 120 years. We’ve followed this course because it gives us the ability to remain deeply rooted in the needs of the community. Independence has allowed us to remain responsive and personal—but it comes at a cost.
We lack the economies of scale that help give large health systems an advantage—shared resources, centralized purchasing, and broader networks of specialists. These things mean BMH is more vulnerable to economic downturns, rising prices, and unexpected crises like the Covid-19 pandemic.
But they don’t mean we can’t come up with innovative ways to survive and even thrive in the 21st century. For example, we are a founding member of the New England Collaborative Health Network giving smaller hospitals, like BMH, stronger purchasing power. BMH’s strongest asset is our community, and with your help and understanding we will make it through these difficult times.
In Part 2 of this mini-series, we will talk about how staffing shortages, regulatory requirements, and the rising demand for mental health services have added to the complexity of BMH’s challenges.
