• Rhode Island is currently experiencing a significant shortage of primary care physicians.
• Opening a new medical school at URI is not seen as a timely or effective solution to the crisis.
• Even with more medical school graduates, there is no guarantee they will choose primary care or stay in the state.
• Better solutions include increasing pay, offering loan repayment, and reducing administrative burdens for doctors.

The doctor is not in, and there’s not one on the way either. Many Rhode Islanders are well aware that the state is facing a harrowing shortage of primary care physicians. As native Rhode Islanders and physicians invested in quality accessible primary care for our community, we are dedicated to working towards policies to support our state.

A medical school at the University of Rhode Island is not the solution to solve the primary care crisis. A medical school at URI would not provide a timely solution, would likely not achieve the target outcome of increasing the number of primary care physicians in the state, and would likely not address the underlying issue of getting doctors to stay. Instead, resources should be allocated now to supporting primary care in ways that would make sustainable change.

Lack of access to primary care is hurting patients now. A medical school at URI would not be a short- or long-term solution. In addition to the time needed to engineer an accredited medical school, it takes seven years to produce an inexperienced primary care physician. Once trained, there still must be an incentive to stay in Rhode Island. Patients do not have access to necessary care for acute and chronic conditions. The burden on our health care system, impacting ER wait times and hospital capacity, impacts everyone. We cannot afford to wait another decade for a solution.

More physicians does not equal more physicians in primary care or in Rhode Island. If the aim is to produce more physicians from URI’s medical school, this will certainly occur, but we should not delude ourselves into believing it will fix primary care. It’s not due to lack of opportunities. In 2019, the National Resident Matching Program offered a record number of primary care positions, yet the percentage filled by students graduating from MD-granting medical schools in the United States was a new low. Of 8,116 internal medical positions that were offered, just 41.5% were filled by U.S. students; most residency spots went to foreign-trained and U.S.-trained osteopathic physicians.

As medical schools across the country look to debt reduction as a means of encouraging students to enter primary care specialties, their goals have fallen far short. In 2018, The New York University School of Medicine offered full-tuition scholarships to every medical student, regardless of merit or need. In 2024, only 14% of NYU’s graduating seniors entered primary care, lower than the national average of 30%.

There must be an incentive to stay in Rhode Island (or at least not a disadvantage). Our efforts must shift to recruiting and maintaining physicians in primary care. Inequitable reimbursement from commercial insurers between Rhode Island and neighboring states (leading to significantly lower salaries than if you lived here and traveled to Attleboro to care for patients), the lack of loan repayment(average medical student debt is $250,000, forcing the choice between meaning and money), and the ongoing administrative burdens are amongst the drivers away from primary care. Rhode Island needs to get on par with surrounding states to prevent physicians from going elsewhere.

The motivations behind opening a medical school are well intended in terms of wanting to increase the number of primary care providers by enabling local talent to train close to home. Training more people in Rhode Island will not keep them here; it will invest significant resources without addressing the root of the issue. Until there are comparable salaries between Rhode Island and our neighbors, until loan repayment is improved and the administrative burdens are reduced, primary care in the state will forever be fighting an uphill battle. Both providers and patients suffer the consequences.

Dr. Kelly McGarry is the director of the General Internal Medicine Residency at Rhode Island Hospital. Dr. Maria Iannotti is a first-year resident, a Rhode Islander intent on practicing primary care in Rhode Island.

The trucking industry will have to pay its own legal bills for the unsuccessful eight-year-old lawsuit it brought to stop Rhode Island’s truck toll system, a federal judge ruled Friday, March 27.

The American Trucking Associations was seeking $21 million in attorneys fees and other costs from the state, but a decision from U.S. District Judge John McConnell Jr. says the truckers lost the case and will have to pick up the tab.

The state had previously filed a counterclaim for reimbursement of $9 million in legal bills, but an earlier recommendation from U.S. Magistrate Judge Patricia Sullivan had already thrown cold water on that possibility.

McConnell ordered American Trucking Associations to pay Rhode Island $199,281, a tiny fraction of the amount the state spent defending the network of tolls on tractor trailers.

Settling the lawyer tab may finally bring an end to a court fight that bounced back and forth through the federal judiciary since the toll system launched and the truckers brought suit in 2018.

As it stands, the state’s truck toll network has been mothballed since 2022 when a since-overturned judge’s ruling temporarily ruled it unconstitutional.

The Rhode Island Department of Transportation said it hopes to relaunch the tolls around March 2027.

The court costs fight hinged on which side could claim legal “prevailing party” status as the winner of the lawsuit.

The trucking industry claimed that it had won because the First Circuit Court of Appeals ruled an in-state trucker discount mechanism, known as caps, in the original truck toll system was unconstitutional.

But Rhode Island argued that it is the winner because the appeals court had ruled that the larger system and broad concept of truck tolls is constitutional and can relaunch with the discounts stripped out.

“The Court determines that ATA has vastly overstated the benefit, if any, that they have received from the ultimate resolution of their challenge to the RhodeWorks program,” McConnell wrote.

The truckers “failed to obtain any practical benefit from the First Circuit’s severance of the [in-state toll] caps,” he went on. “Specifically, the evidence from this dispute confirmed that the lack of daily caps will result in ATA paying a higher amount in daily tolls and that it does not receive any tangible financial benefit from their elimination.”

In her December analysis of the legal fees question, Sullivan had concluded that the Trucking Associations’ outside counsel had overbilled and overstaffed the case.

But she had recommended that the industry be reimbursed $2.7 million for its bills, while McConnell’s ruling gives it nothing.