[seanpecor]

Motherandchild, I think it would really benefit you to do a total cost/benefit analysis of a potential Vermont relocation. There are so many factors to consider.

Moving to Virginia in 2004 and now planning a return to Vermont in 2008, here are some of my own observations, some of which I had not anticipated.

In Vermont, health insurance cost me more to acquire as a small business owner than it does in Virginia. However, in Vermont, I had no prescription co-pays, aside from a small $250 deductible. For me, the advantage is clearly in Vermont's favor because I take Advair, Allegra (Allergies) and Concerta (A.D.D.) and down here I shell out about $150/month for my co-pays. Other health coverages in Vermont are also (by state law) more comprehensive and therefore, if the CTO position offered full health coverage then that _must_ be considered, particularly if you're moving from a state that allows HMOs to design very pro-HMO health insurance plans.

Auto insurance will also likely be lower in Vermont if you're moving from a metro area.

Your general spending habits may also decline when living in Vermont. That's my own observation anyway, based on living in/near a variety of metros. Down here in the Roanoke, VA area, people tend to allow for a much higher car payment relative to their salaries. There are Benzes, BMWs, Denalis, Land Rovers every where you look.

Moderator cut - hyperlinking/copyright

But it's always a value judgement, no? If you think that such a reduction in salary will prevent you from enjoying basic material/retirement planning necessities then don't make the jump. We're going to be paying more taxes when we move to Vermont, and - everything else being equal - our living expenses may be somewhat higher than were we to stay in Virginia. But that's quite alright with us. Is 1 out of 5 acres in Virginia conserved? No. Does Virginia recycle virtually everything? Absolutely not. Are billboards illegal in Virginia? Nope. Is there a strong liberal arts educated community in Virginia, smart enough to take part in town hall meetings and political discourse? Nope. It's those intangibles that must also be considered when making such tough decisions.

Sean

[68vette]

Originally Posted by seanpecor

With all due respect, I disagree with 68vette on the characterization of Burlington's Fletcher Allen and of smaller Vermont hospitals. Small hospitals do not equal bad hospitals. Porter Medical Center in Middlebury is a top notch facility. Porter is smaller simply because it services a smaller population base. It does not lack facilities or resources to handle major medical emergencies. They've got CT and MRI technologies and top shelf specialists. As I said before, my son had a horrific arm injury and he was in surgery within an hour after arriving at Porter, and after a 4 hour surgery the outcome was 100% satisfactory. With the wrong specialist, his arm might have healed asymmetrically or stopped growing.

In Middlebury, you can live in the country _and_ be less than 10 minutes from Porter Medical Center. I grew up in Burlington in the "new" north end and I was easily 15 minutes from Fletcher Allen; longer during rush hours. Furthermore, Fletcher Allen was - in my opinion - when I lived in Burlington - severely understaffed and unable to handle high loads of incoming E.R. patients in a timely manner. I once sat in Fletcher Allen's waiting area for 5 hours with a concussion and multiple lacerations on my face. And to add insult to injury, the attending E.R. doctor at Fletcher Allen sewed my lip back together slightly askew creating an extra flap in my lip that I have to this day. Compare that experience to my experience down here in Boones Mill, VA. After being kicked by a horse, and arriving within 15 minutes at my county's rural hospital, I waited less than 15 minutes to be seen, and within an hour I had x-rays that were reviewed by the attending E.R. folks. Literally 65 minutes after arriving, I had been treated and released.

Fletcher Allen is a great institution. I'm simply saying that Porter is also a wonderful institution, sized appropriately according to the population it serves.

And I don't know. If the choice is between dying of a heart attack at 80 on my own piece of heaven in the wondrous rural Champlain Valley, or plodding along until 85 or 90 in a concrete jungle.... You can just spread my 80 year odd ashes in the back 40, thank you very much.

Sean

Sean, I never said that the smaller hospitals were bad hospitals. My point is that they do a good job at what they do, but they are limited in their resources. I'll give you a good example. Just a few days ago a young pt came from one of the smaller hospitals in state. The pt was thought to have a clot in the brain. A clot busting drug was used and the pt was transfered to Fletcher Allen. A short while after arrival the pt decompromised and soon expired. The pt didn't have a clot, it was an aneurysm and the clot busting drug is what caused this pt to expire. This wasn't the fault of the small hospital. They used the tools they had like a cat scan to try and diagnose the problem. At Fletcher Allen or Dartmouth there are other tools to use like interventional radiology or neurosurgery to prevent this from happening. This small hospital did everything they could have done to save this patients life. A sad ending for this young person, but a reality of living in a rural state. I also have worked in a rural hospital when I first moved to Vermont. It was a fine hospital and they cared about the community they served. It's not a hidden fact. If they get a patient that is outside of their scope of practice then that patient is going to a Tertiary care facility where they can be better managed.

Also, Fletcher Allen is a very different hospital from when you were hear last. In the last few years it has doubled in size and the new ER has tripled in size. The nurses have a union so there are set nurse to pt ratios and the other improvements go on from there. Last year I twisted my ankle playing soccer and went to the ER. It was 30 min from coming in to going out the door including physician exam, x-rays and treatment.

[OhBeeHave]

I sent in a video of me yelling at my wife as we were trying to push our car up the icy driveway in the middle of the night, but they haven't aired it yet

It took us 2.5 hours to drive 10 miles within Chester on 2/17. Our hill had a grade and it iced over in the rain. Hubby winched the truck up the grade (about 1/4 mile) and it took 2 hours. AAACK We feared another car sliding down at us and called the VSP for assistance. They couldn't make it through -- I am not surprised, as I am amazed we made it as far as we did. The did get the town dump truck/sander through to help. Thank heaven!

Before we left I told him we needed chains. I've been reading and learning. But did he listen? No.

This episode should be shown to all newbies entering VT. When it gets cruddy, STAY HOME! We had the misfortune of having gone out before the rain started and didn't know better. We do now.

[MRVphotog]

Sounds like your road is going to be fun if we have a bad mud season.

I live on a dirt road with a steep grade and once in a awhile rain on a snowpacked dirt road will make it scary icy but for most Vermonters, rain simply means wet easy to drive roads.

A 4wd pickup was my answer and have never in 11 years been unable to navigate the road. A few icy or mud episodes did make it tricky tho. The sign at the bottom as you get on the road from Rt 100 does say "this road not recommended for winter travel" which does keep the tourists away.

[turnyourback]

i can definitely attest to the fact that my experience in the fletcher allen ER was nothing short of wonderful. i came in with strep throat (being from new jersey and not having a GP in the area), and was out in about an hour/an hour and a half. i was seen right away. it was a great hospital experience!

[OhBeeHave]

Originally Posted by MRVphotog

Sounds like your road is going to be fun if we have a bad mud season.

I live on a dirt road with a steep grade and once in a awhile rain on a snowpacked dirt road will make it scary icy but for most Vermonters, rain simply means wet easy to drive roads.

A 4wd pickup was my answer and have never in 11 years been unable to navigate the road. A few icy or mud episodes did make it tricky tho. The sign at the bottom as you get on the road from Rt 100 does say "this road not recommended for winter travel" which does keep the tourists away.

We were driving a 4WD Ford F350 crew cab dually (long bed) This is one HUGE truck. It was in 4WD Low prior to going up the grade. EEK. Scary, scary ice. This was our 4th winter up there and the first time we've ever experienced anything like this.

Yup, ought to be a fun mud season. I've booked my tickets to visit my folks in FL to coincide with part of it!

[MassVt]

....in terms of healthcare, bigger is usually better.

For general internal medicine/surgery, the smaller hospitals are fine; however, if you're in need of treatment from a neurosurgeon/cardiologist/pulmonologist/interventional radiologist, etc, then you should seek care in a larger medical center. I've worked at the Fletcher Allen (when it was called The Medical Center Hospital of Vermont), and I've worked at a major teaching hospital in Boston for 15 years, and there IS a difference.

[68vette]

That was the point I was making. Would you go to a doctor who has done six surguries in the past two months or one who has done six in past week? Small hospitals do a fine job, but when it comes down to your life go with who is going to protect it best.