Dear Editor,
On Sept. 15, Dartmouth Health announced it would lay off 124 workers and eliminate 303 open positions, most of them at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and its clinics. The same day, UVM Health said it would cut nearly 200 positions. Vermont Public reported both announcements, along with the system’s loss of $63.5 million in the first half of 2026, as reported in June by the Valley News.
Coverage of cuts like these tends to focus on patients, and it should. But there is a second group worth thinking about this winter: the nurses, physicians, technicians, and administrators who are still there.
When a system trims open positions, the work those positions would have done does not disappear. It gets absorbed. The nurse covers one more shift. The physician carries a heavier panel. The manager who had to deliver the layoff news goes home and does not sleep. In a small community, that manager may then run into a laid-off colleague in the grocery store on Saturday.
That is a recipe for burnout, and burnout in health care is not new. What makes rural burnout harder is what happens when someone tries to get help.
Physicians have a specific fear here. A 2017 study in Mayo Clinic Proceedings surveyed 5,829 physicians and found that nearly 40% would be reluctant to seek formal care for a mental health condition because of concerns about their medical license. In my clinical work, nurses and other licensed staff describe similar worries. Add a small town, where the therapist’s waiting room might be next to your patient’s, and many simply do not go.
There is also a scheduling problem that rarely gets named. A clinician working rotating shifts, covering for an empty position, often cannot promise to be anywhere at the same hour every week. The standard model of therapy, 50 minutes once a week, assumes exactly that.
A Cerevity white paper, “Why Standard Therapy Fails: The Case for Longer Therapy Sessions,” lays out what it calls the “dose-and-depth model.” The idea is simple. Instead of starting with the weekly hour, start with four questions: how much total therapy the person needs, how much uninterrupted time the material requires, how the sessions should be spaced, and whether the format fits the person’s actual life. For someone on a chaotic schedule, a few longer sessions spaced around their rotation can be easier to keep, and kept appointments are the ones that help.
None of this replaces what hospitals owe their staff. But there are things health workers in southern Vermont and the Upper Valley can do now.
Notice the signs early. Short sleep, a shorter temper, dreading the drive in, and feeling numb about patients you used to care about are all worth taking seriously before they become a crisis.
Ask what your employer’s program actually records and who sees it. Many people avoid help because they assume the worst. Some of those assumptions are wrong, and some are not. Knowing which is which is worth a phone call.
Look outside your own building. Telehealth means a nurse in Ludlow or a physician in Windsor can see a licensed therapist who has never treated a colleague and will never sit next to them at a town meeting.
Ask for a schedule that fits. It is reasonable to ask a therapist about longer or less frequent sessions if weekly hours are impossible with your shifts.
Talk to one person. Not the whole unit. One.
The people who held our hospitals together through the last several years are now being asked to do more with less, again. Their work deserves notice. So does their health.
Sincerely,
Martha Fernandez, LCSW
Lakewood, Calif.
Martha Fernandez is a licensed clinical social worker and co-founder of Cerevity, a private-pay concierge network of independent licensed clinicians built for high achievers. She is the author of “Wired to Burn: A Therapist’s Guide for High Achievers Running on Fumes.” Learn more at www.cerevity.com.