First some good news! The Rhode Island General Assembly passed two bills and created one study commission that helps us start getting better access to primary care in Rhode Island.
Bill 2024-S 2716A establishes a primary care training sites program, which has been funded with $2.7 million in the 2025 state budget bill. Bill 2024-S2717A added $500,000 to the state Wavemaker program to help defray the costs of student loan repayment for primary care physicians, nurse-practitioners, and physician assistants who practice primary care in Rhode Island.
Then, the Rhode Island State Senate created a 21-member commission to study and analyze the state’s health care workforce as it pertains to educating and retaining primary care physicians, including the potential of establishing a medical school at the University of Rhode Island.
Kudos to Senators Pam Lauria and Sue Sosnowski for leading this charge, for their courage and wisdom (and for being such decent and thoughtful human beings.)
All good. Why? Because every dollar we spend on primary care is likely to generate twelve dollars in downstream savings. And the more primary care clinicians we have, the better our general health becomes – we’ll have longer life expectancies, less infant mortality, less cancer mortality, less heart disease mortality, and so forth. Why is that? Because primary care clinicians and practices are the places that remind you to do what works to prevent heart disease, diabetes, stroke and cancer – the places that bug you to have a mammogram or a colonoscopy or to check your blood pressure, and if people don’t have and use a primary care practice regularly, they are much less likely to do the things that prevent disease. And give you a place to go besides a hospital emergency department when you get sick, understanding that hospitals do a great job with life-threatening illnesses, but lead to unnecessary cost and procedures for people who have routine illnesses, if and when they chose to be treated in an emergency department instead of by their primary care doctor or practice.
We don’t know how many Rhode Islanders have and use primary care regularly. While about ninety percent of our kids have primary care, only about half of adults, nationally, have and use primary care, and there is no reason to suspect the numbers are any better here, given the difficulty that many people experience finding a primary care doctor, nurse practitioner or PA. There are about 800,000 Rhode Islanders over 18. That means that about 400,000 people likely don’t have primary care – and that we may be short as many as 400 primary care clinicians today, assuming each one can take care of 1000 people. (The shortage is probably larger than that, because most Rhode Island clinicians take care of closer to two thousand people and are doing the work of two or three people, which is why so many of our doctors, PAs and NPs are burning out.)
The good news is that the $3.2 million we are investing now will likely lead to close to $40 million in savings down the line. The bad news is that Rhode Island spends about $4 billion on health care, so that $40 million is just a drop in the bucket. If we invested more, we’d save more. How much could we save? Something like $2 billion a year. But we’d have to invest more – a hundred million a year or more, to get that kind of savings.
A $3.2 million investment sounds like a safe, cautious, conservative investment in primary care. And $100 million sounds a little crazy.
But that means we are leaving something like $2 billion dollars on the table. Is $100 million investment worth it, if we all get longer lives, less disease, and a healthier workforce? And get a$ 2 billion return on that investment? You tell me.
Some people think we’d be crazy to spend $100 million on primary care.
I think we’d be crazy not to.
Hear and meet Michael Fine when he reads from his new book The Jewish Prince of Denmark and Other Stories on Tuesday, July 16, at 530 pm at the Little Compton Library and Tuesday, August 13, at 5 pm at the Newport Public Library.
Michael Fine, MD, is a writer, community organizer, and family physician. He is the chief health strategist for the City of Central Falls, RI, and a former Director of the Rhode Island Department of Health, 2011–2015. He is currently the Board Vice Chair and Co-Founder of the Scituate Health Alliance, and is the recipient of the Barbara Starfield Award, the John Cunningham Award, and the June Rockwell Levy Public Service Award. He is the author of several books, medical, novels and short stories, including On Medicine and Colonialism, Rhode Island Stories, and The Bull and Other Stories, You can learn more about Michael at www.michaelfinemd.com
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