The uncertainty of Rhode Island’s healthcare system continues as leading physicians see a crisis looming, with Congress debating Medicaid’s future, Rhode Island’s legislature grappling with a stubborn budget deficit, and the improbability that the state will be able to close the Medicaid payment gap with neighboring states.
Add to that, says Dr. Shannon Small, an assistant professor of surgery at Yale School of Medicine, surgeons in this country are ageing with fewer younger physicians to take their place, promising a “surgeon shortage” in the United States within 10 to 15 years.
“According to the American College of Surgeons,” says Small, “more surgeons are set to retire in the next 10 years than we are replacing them. So, there will be, unfortunately, as it stands right now, a shortage of surgeonsl … which is a problem.”
Dr. Michael Fine, former director of the Rhode Island Department of Health, says “primary care in Rhode Island is in imminent danger.” Small says that residencies are going unfilled in areas of family medicine, internal medicine, and pediatrics … “we’re not training enough doctors.”
And State Senator Victoria Gu, D-Westerly, paints a bleak picture as the legislature heads into the final weeks of the session, still trying to close a budget deficit that she estimates is around $100 million. Governor McKee at his state of the state address earlier this said then, the state was facing a $250 million budget deficit.
While the legislature last year was able to increase the Medicaid payments to doctors, it wasn’t enough to close the gap, and prospects are that there will be no increases this year, as the legislature is facing significant shortfalls in school aid, to RIPTA, and more.
Meanwhile, Rhode Island’s only medical school is at Brown University, where Fine has said inthe past that few Rhode Island students are admitted. He is on a commission that was charged by the legislature with determining the feasibility of developing a medical school at the University of Rhode Island.
Fine says the commission will reconvene on Friday and expects to present its recommendations to the legislature in September.
Gu also points to another challenge, a perceived federal cap on the number of federally funded residencies. Fine is concerned, that there “may be a holdup in needed federal funds to get a badly needed family medicine residency started at Thundermist in Woonsocket.”
According to Open Health Policy “The supply of new entrants is constrained primarily by the Centers for Medicare and Medicaid Services (CMS), a federal agency that provides the bulk of the funding for hospital residencies.”
Open Health Policy says “CMS funding for residencies was capped beginning in 1997 at 1996 levels, and has only been raised once since then” in 2021, “slowly increasing residencies in specific underserved situations such as rural areas,” initially by 200 new residencies nationwide, climbing to 1,000 a year over a five-year period.
Those numbers fall woefully short, according to the Open Health Policy, as the country’s population increased from 2000 to 2020 by 18 percent. Raising the cap on the number of federally funded residents also means growing the CMS deficit.
Rhode Island is among the states with the most residents and fellows per 100,000 residents, according to the Association of American Medical Colleges (AAMC). The top three, the AAMC says, are New York at 95.4, Massachusetts at 86.4, and Rhode Island at 80.9.