It’s getting a lot harder to find a primary care doctor in Rhode Island. With providers booked as far as a year in advance, patients are left with few options. Behind the problem is what Providence Journal reporter Amy Russo calls a “perfect storm” of issues, including pay, burnout, and the loads of paperwork required by insurance companies. Morning host Luis Hernandez talked with Russo about some takeaways from her reporting.
This interview has been edited for length and clarity.
TRANSCRIPT:
Luis Hernandez: Well, I guess first, I mean, how did you find this story? Because one of the interesting things about this is, I’m new to Rhode Island, I’m having a hard time finding a primary care doctor. But I hear this from a lot of people. But I’m wondering, how did you find this story?
Amy Russo: So what happened was, I was supposed to have a physical this month, and it was canceled because my primary care physician left her practice. And I called up to reschedule it. And I was told, “Well, we’re not going to schedule people now until 2024.” And my mind was blown by that. So I tweeted it, just thinking, you know, this is a really weird experience for me, I’m gonna write about it. And a bunch of people tweeted back and had pretty much the same exact or similar experience. It was just so many people. And it was really clear that this was a story.
Hernandez: So this is actually a common problem then, right now in the state.
Russo: Yeah, it might be that people’s physicians leave their practice. And then you’re kind of back to square one with finding some established care. Or it might be that you just can’t get your annual physical scheduled that easily. But it’s usually a problem, from what I’ve heard, for people who are trying to establish new care at an office, not for people who have already been seeing the same doctor for years and might have an easier time getting in.
Hernandez: I found it interesting, in your story, the reasons why this is happening, but point out the big ones.
Russo: Yeah, so one of the big ones is that we don’t have as high of a Medicare reimbursement rate as other New England states. So we’re lower – compared to some states only a little lower, or it could be a lot lower. So that’s a big issue. In general, I’m hearing that being a primary care provider in Rhode Island just doesn’t pay as much as it might in other New England states. And it’s really a big combo of things. There’s a lot of paperwork for these primary care providers’ nonstop appointments. The job just doesn’t look that attractive, when you compare it to specializing in something where you’re making more, there’s less paperwork, you’re less overburdened. So it’s this perfect storm of reasons that’s causing people to want to leave and causing students to look at it and say, “I don’t want to do that.”
Hernandez: I’d heard this term before, and you came up in your story, about “concierge services.” But I’d never really looked into it. What is that?
Russo: So it was my first time hearing about this, too. But apparently, it became sort of popular around 10 years ago. And basically, your office might tell you at the beginning of the year, hey, if you pay, you know, $1000 or $3,000 right up front at the start of the year, we will give you way more personal care. That might mean having the doctor’s cell phone number, that might mean more time with your doctor, you can get all your questions in, and that doctor’s probably seeing fewer patients, they’re not interacting with insurance, it’s the patient’s responsibility to do that. And it’s, from what I was told when I did my story, probably the way that physicians would have imagined medicine being when they were studying in school, and it’s a lot more of an ideal world. But for the patient it’s pretty pricey. If you think like a $3,000 upfront payment, not everybody has that in their bank account.
Hernandez: And you said it too, insurance – and it’s dealing with insurance and all that paperwork. That’s one of the headaches, right?
Russo: Absolutely. One physician told me about how he was, you know, constantly trying to get some pre-authorization for something simple his patient needed. And he was just describing it as one of these routine headaches, that there are, you know, these blocks that are put up by the insurance company. And I’m sure you and I might have even dealt with them in the past, when going to a doctor and needing to have something done and having to wait for that clearance, whether you get it or not. So it’s one of several headaches.
Hernandez: The other thing too, and I didn’t know this, but like CVS is offering like some very basic health care services, right?
Russo: Yeah. So CVS MinuteClinic launched, I want to say, about 20 years ago. And basically, I mean, I think of it as sort of an urgent care, but they have primary care providers there who can meet with you on a walk-in basis, or it might be a nurse practitioner, depending on the state. And they can do a lot of things. They can treat minor illnesses, minor injuries, they can give your shots. They can diagnose skin conditions, do a physical, so it’s a little more involved than perhaps you know, oh, my knee hurts and I’m going to urgent care. You can almost kind of do that as your annual visit if you can’t get into a doctor’s office, but I’m sure any doctor would say like you need to have established care somewhere, so it’s not a fix-all. But the way it was described to me by CVS was, a tool that can fill gaps that exist right now.
Hernandez: How bad is the shortage right now, of primary care doctors?
Russo: So I don’t have Rhode Island numbers. But we do have sort of a national estimate. The Association of American Medical Colleges is predicting a primary care provider shortage between about 18,000 and nearly 50,000 providers within the next decade or so. So I’ve seen estimates kind of that range that apply to the national level. And it does sound pretty serious.
Hernandez: So I mean, what are they doing in, you know, in medical schools? How do you – I mean, I wonder what they’re, what they’re saying about the fact that, you have people who are, as you said, thinking, why do I want to get into this? It does not sound good, it doesn’t pay that well, I could go do something else. How are they handling that?
Russo: So Bryant University, for example, is trying to expand the size of each cohort. So it can have a bigger number of students training to be physician assistants, which kind of might be what the future looks like, in the sense that, you know, it’s sometimes hard to see your primary care provider. You might be seeing a physician assistant. So schools are kind of looking to get more students to study in that area, but it’s hard also because there aren’t always enough clinical placements for them to go into. So there’s still an issue there with cultivating enough people who can take these jobs.
Click here to read Amy Russo’s reporting on the issue.
