Op-Ed: The Doctor Isn’t In – But They Could Be!

It’s a classic Rhode Island “good news versus bad news” scenario: the good news is that thousands of patients outlived their primary care physicians, who retired! The bad news? You can’t find a doctor. Many are bounced around practices that they’ve been loyal to for years.  Hold times on the phone regularly exceed 30 minutes, and often by the time you get an appointment, you feel fine or can’t remember why you called! Urgent care center wait times go into hours and even at hospitals, hours can become days. It’s a point of constant conversation and frustration as practices have struggled to replace a whole generation of primary care providers.

Talking to ourselves – since there’s rarely a doctor nearby – we offer our thoughts on what a medical school at University of Rhode Island could do on many levels, which might also help provide the impetus to get medical reimbursements at levels comparable to Massachusetts and Connecticut, keeping our own specialists here rather than opening surgical centers just across the borders. In some cases, doctors earn almost 30 percent more by performing procedures just outside the state –  and Rhode Island has a “critical shortage of primary care physicians” with few solutions in sight.

Mention this concept and there are some immediate negative thoughts: “too expensive, will not attract top-notch students unless top-notch faculty, and will not attract top doctors as faculty unless they are associated with a teaching hospital.” Similar sounding thoughts arose when Roger Williams started its law school in 1993, and, by all measures, it’s a success today.

But here’s how it becomes a win-win for Rhode Island. Graduates would follow the established protocols by the US Armed Forces whereby students get a subsidized or no-cost medical education, and when they graduate with their MD, they have an obligation to provide medical service in Rhode Island for seven to 10 years, not counting medical school, internship, or residency. Tuition is doubled for students who don’t accept the obligation, and this number would be limited to 30-40 percent. Medical school acceptance rates are very low, so we know that there is still a large highly capable market.

Medical school classes changed during COVID and show no signs of going back to the old in-person protocols for the first two years. Everything is filmed and available 24/7, except for labs. URI already has excellent lab space and other medical infrastructure in place to support the nursing school, and naming rights, combined with “line item” support from the state should provide enough money to prime the pump.

Both Lifespan and Care New England’s academic hospitals serve as teaching hospitals for Brown medical students, and the two hospital systems both serve as primary university collaborators for research. Since they all require state support, an arrangement to include URI medical students into the equation should be workable.

Former RI Department of Health Chief Dr. Michael Fine weighed in, pointing out that, “We need to triple or quadruple the number of primary care residency slots, which we can do without spending one more penny of public funding, by regulating hospitals differently. Residency training is all funded by Medicare to hospitals and there is no federal oversight of how hospitals spend that money, so they spend it on specialty training because specialists make hospitals money. The State regulation of hospitals could easily change that.”

Rhode Island could use its size and uniqueness to be a national research lab with each resident’s health information being part of a single electronic medical record system. “Such a process would let us track health outcomes in the population over time, which no one else in the nation can do,” Fine adds.

Contrary to politician’s dreams of a biotech wonderland, Fine notes that “our obsession with biotech is a colossal waste of money. Biotech creates products that make healthcare more expensive but rarely improve public health. It creates jobs, though, and profits for investors.”

“We already know how to prevent or effectively treat most heart disease, diabetes, and stroke, and prevent lots more cancer and infections than we do,” Fine continues. “We just lack a coherent way to get all this evidence-based prevention to the population who needs it. If we invested in doing that, we’d turn ourselves into that national research laboratory, lower the cost of health care significantly, and improve our measured public health.”

RI is not going to get rid of biotech and pharma, and probably won’t create another Harvard Medical School, but we could create generational change for our residents and create a win-win scenario with a medical school at URI.