Dear Neighbors:
This week has been a sad one for the Senate, as we lost President Dominick Ruggerio. He instilled in the Senate a culture of collaboration and civility that supported our work as a body, even as we debated and disagreed about particular issues. That is an important legacy that I hope we can sustain in his honor and memory. In this week’s letter, I share some thoughts about the State’s shortage of primary care physicians.
A. The Anchor Medical Associates Closure
The recent closure of the Anchor Medical Associates primary care practice left an estimated 25,000 Rhode Islanders (according to an ABC-TV report) without a primary care doctor. The closure aggravates a chronic shortage in Rhode Island (according to a report by WPRI) which, according to a Report by the Office of Health Insurance Commissioner (OHIC), a national shortage of primary care physicians. In his Report, Dr. Michael Fine estimates that Rhode Island is short between 133 and 266 clinicians based on a “panel size” (patient capacity) of 1500 per primary care physician. The WPRI Report states that even more may be needed, based on its assumption that the proper panel size is 1200 patients, rather than 1500. That report estimates that Rhode Island currently has primary care physicians.
B. Contributing Factors
As noted in the above OHIC report, a major factor in the national shortage of primary care physicians is their relatively low compensation relative to medical specialties. This is particularly difficult for doctors beginning their practice, who are burdened by six-figure medical school loans. From a local perspective, salary data from ZipRecruiter and Indeed.com reveal a compensation gap between Rhode Island and Massachusetts primary care physicians of between salary gap when comparing average primary care physician compensation in Rhode Island and Massachusetts of between $25,000 and $60,000.
C. Proposed Solutions
In its Report, OHIC proposes reforming the Rhode Island private insurance market by (1) increasing primary care percentage of insurers’ total medical payments and (2) reducing paperwork in such areas as prior authorization. These changes may increase insurance premiums in the short run, but as Dr. Fine indicates in his report, could reduce medical expenses in the long run. In a Boston Globe opinion piece, my colleagues Senators Lauria, DaMario and Sosnowski describe a combination of short-term measures (such as supporting primary care residencies) and longer-term ones (medical school scholarships or establishment of medical school). In their opinion piece, two hospital presidents propose a $90 million increase in overall State Medicaid funding, which they believe would be matched by $180 million in federal funds.
D. My initial thoughts
I do not serve on the Health and Human Services Committee, so I still have much to learn. From my time on the Finance Committee, I am skeptical that a $90 million increase in State Medicaid funding will generate a $180 million federal match. The current formula is 45% State/55% federal, and that could well decline when Congress considers Medicaid cuts in its reconciliation budget. As a further matter, this amount of money appears to be out of proportion to the scope of the problem. If, for example, Rhode Island decided to give every primary care physician an annual “retention bonus” of $25,000 per primary care physicican, that might require an estimated expenditure of between $20 million and $25 million, depending upon one’s calculation of correct panel size. Furthermore, there appears to be room to reform private insurance rates and preauthorization reform to address some of the disparity without relying entirely on a Medicaid increase. Over time, the longer term policies can help as well.
I will continue to learn more about this issue and support some combination of short-term and long-term support for primary care in Rhode Island that can efficiently and effectively address our State needs.