Brown University Health emergency medicine physician Dr. Emily Shearer isn’t starry-eyed about the state’s healthcare crisis. Threats to Medicaid coverage, a primary care scarcity, and jam-packed ERs are putting immense strain on the system with no end in sight.
Nevertheless, Shearer believes Rhode Island is more than capable of meeting these challenges. She spoke with Ocean State Media political reporter Ian Donnis about how to solve the myriad problems facing healthcare in Rhode Island.
Interview highlights
On her top concerns with Rhode Island’s healthcare system
Dr. Emily Shearer: There are things that I'm concerned about that are true not only in Rhode Island, but also in the rest of the United States. One of those issues is how crowded emergency departments have become in this country…
I think that Rhode Island has a really robust healthcare system, and certainly compared to other states, we can see that in the data that we do really well compared to other states. Obviously, in the Emergency Department, we see and treat people with a broad variety of medical emergencies, so anything from a broken arm, a broken leg, to severe chest pain that the person is very concerned that they may be having a heart attack. We also see a subset of people who have other types of medical conditions who come to the ER because the ER is really the only door open to them.
On the impact of Rhode Islanders visiting emergency rooms in lieu of primary care
Shearer: I definitely think that behind every person coming to the ER, there's a story, and sometimes that story is, "I don't have access to a primary care doctor," or, "I can't get in to see my primary care doctor." And that is an issue nationwide in addition to Rhode Island, and I think it's definitely an ongoing issue that needs to be addressed. I know that the state and several of our healthcare organizations, including Brown University Health, have worked on addressing the primary care shortage here. I know Brown University Health, for instance, has made some headway in hiring some new primary care doctors. I think that's a really promising step forward. I think we'll need to continue to monitor it, for sure.
On the potential impact of Rhode Islanders losing access to Medicaid because of federal policy changes
Shearer: I am very concerned about the impact of those cuts. Everybody deserves to have health insurance. Something that we know is that when people lose insurance, they lose access to their primary care; they lose access to preventative services. And something that I'm very concerned about, both as an ER doctor and a public health researcher, is seeing people who have lost those preventative services come into our ERs sicker. So for instance, I'm thinking about someone who has diabetes who needs insulin to control that diabetes. When they lose their health insurance, they're no longer able to afford their insulin, and so when I see them in the emergency department, they show up later and sicker, potentially in a diabetic crisis that could be life-threatening to them. I know my ER colleagues and myself are bracing for that to potentially be the case in the years moving forward.
On concerns about the healthcare payer mix
Shearer: It is absolutely true that, here in Rhode Island, we have a larger proportion of our population on Medicaid than other states. So here in Rhode Island, about a third of our population is on Medicaid compared to about a quarter nationally. And compared to private or commercial insurance, people who have government insurance – whether it be Medicaid or Medicare – do bring less dollars to the hospital that's taking care of them than those with commercial insurance.
One thing that is also true about the state of Rhode Island is, in addition to us having a higher proportion of patients on Medicare or Medicaid, we also have very low commercial rates that our hospitals charge commercial insurance companies here. That actually is, in part, due to some regulations that Rhode Island enacted in 2010 called the Affordability Standards. I do think that that is part of the reimbursement picture that's going on here in Rhode Island.
On the difficulty of finding a primary care doctor in Rhode Island
Shearer: It's absolutely a problem, and it's one that's actually a little bit difficult to quantify with the data. If you look at summary statistics of how many primary care doctors there are per 1,000 people in Rhode Island, for example, Rhode Island seems to look quite well nationally. However, we know that those numbers don't always tell the full story.
Some primary care doctors do not work full-time because they're burnt out. They have a lot of administrative burdens that make them feel like they can't work full-time. There are some doctors – primary care doctors – in Rhode Island and elsewhere who are moving towards concierge models, where they don't accept Medicaid or other types of insurance. And so even if they are in the state, they're not available to every type of patient. Unfortunately, it is something that I hear frequently from patients in the ER.
One thing I always ask patients when I see and treat them in the emergency department is if they have good access to follow-up for primary care because we always want someone to be able to follow up from an emergency department visit with a primary care doctor. It concerns me when people say that they don't have that.
On whether the state is doing enough to convince people who study medicine to stay in Rhode Island
Shearer: I was very happy to see that in the latest budget, the state included funding for a new medical school. One thing that I think is missing from that picture is if we look at the studies, we know that medical trainees tend to stay in the area, not where they necessarily went for medical school, but where they went to residency or for their specialty training. So I do worry that building a medical school without increasing the number of primary care residency spots in this state may not be sufficient to keep people here.
