Some friends and colleagues from Brown University Health are arguing that Rhode Island doesn’t need a new medical school at URI – and that such a new medical school won’t help address Rhode Island’s primary care physician supply crisis.
One part of that is true. If you dropped a medical school from outer space into Rhode Island, that by itself won’t change the number of primary care physicians in Rhode Island.
But my colleagues from Brown University Health, which just noodled around with the idea of killing off the Birthing Center of Newport Hospital, are missing the point, which is sometimes what folks who run virtual monopolies sometimes do, as they hold up the rest of us for more and more money.
It will take a massive effort, with all hands-on-deck, to address the Rhode Island primary care shortage.
To fix Rhode Island’s primary care physician supply crisis, we need to do a thousand important things at once: we need this new medical school, but we need to make sure it is for Rhode Island, not for people from Wall Street, California and New Jersey. So at least half of the spots need to be reserved for Rhode Islanders who will commit to practicing primary care here. Then we need many new primary care residencies – perhaps three or four, including one at Newport Hospital. We need to fix the payment amount and process for primary care, so primary care practices can attract physicians who might otherwise go to work in Boston or Connecticut or New York. We need to fix the workload of primary care physicians, so their work is doable in an eight-hour day. We need to fund pathway programs, so students in our communities see a pathway for themselves becoming primary care physicians. We need scholarships with obligations to practice here and money for loan repayment and interim support, so we can attract graduating residents and residents earlier in their training, and even third-and fourth-year medical students, because we need to turn on the supply spigot, and fast.
All that said, look at what a great opportunity a new public primary care medical school presents for Rhode Island:
We now train about 106 primary care residents per year (from the three primary care specialties and from all states). About 30 choose to practice primary care (many internal medicine and pediatrics residents — primary care specialties – end up in specialty practice) and only about 15 of these stay to practice in Rhode Island
Brown’s medical school accepts less than 15 to 20 Rhode Islanders a year who went to high school here. Only 20 percent of all medical students choose primary care, so it is likely that there are 3 to 5 Rhode Islanders a year who go to medical school here and choose to practice primary care — but we don’t know if they choose to practice in Rhode Island. Many go elsewhere for residency and are most likely to stay to practice close to their residencies.
So it is likely, based on the percentage of residents who train here and stay to practice, that no more than one or two Rhode Islanders a year go to medical school here, choose primary care, do residency here, and choose to practice primary care here.
But I’ve estimated we will lose 55-110 of our practicing primary care clinicians a year to retirement.
It turns out it costs about $100,000 to employ a recruiter and recruit each new primary care physician to Rhode Island.
The net cost to the state of tuition reduction for our URI medical students is likely to be about $35K a year. That means that offering tuition reduction in exchange for an obligation to practice primary care in Rhode Island likely costs the state about $140 k for each new Rhode Island primary care clinician’s tuition.
But some experts believe each primary care physician likely saves someone about $1million a year by preventing disease, preventing unneeded ER visits and the better management of chronic disease.
About 30 percent of Rhode Islanders are on Medicaid, and if that $1 million savings estimate is true, each primary care physician likely saves the state about $300 K a year, about half of which , or $150K, is federal money (because of how Medicaid is funded) and goes back to the federal government – but half, about $150K, stays in Rhode Island.
So the return on a $140K investment will be over 100 percent ($150K returned for $140K spent) in the first year, and then the state runs a new profit of $150K a year for four more years, if that tuition break carries a 5-year obligation to practice primary care here.
And that’s just money. Think of our civic life and civic pride, when our kids go to our medical school and do residency here, and then practice in their own communities, and with their own families.
See why we need a medical school that admits Rhode Islanders and obligates them to practice primary care here for five years, in exchange for a lower price tuition? We spend $140K and get back $610K. Better ROI than crypto by far. And we protect Rhode Island bodies – and strengthen Rhode Island communities — about twelve different ways.
We’d be crazy not to build this medical school. Starting yesterday.
You can find Michael Fine’s commentaries and short stories on
https://michaelfinemd.substack.com/and on http://www.michaelfinemd.com
