Medical professionals are warning about a growing crisis as Rhode Island loses more health professionals to its neighbors. In a recent conversation on “A Lively Experiment,” Jim Hummel and his panelists discuss the worsening shortage of PCPs and dental care providers and how that is creating a dangerous problem for hundreds of children in Providence. Hummel breaks it down with Rhode Island Current reporter Nancy Lavin, political contributor Pablo Rodriguez and Aaron Guckian, who is a former candidate for lieutenant governor and the current executive director of the Rhode Island Dental Association.
You can watch the entire July 26, 2024, episode here.
JIM HUMMEL: So, before we get into a story I wanna talk about of kids with dental problems, what, in the session this year, and Pablo, you keep an eye on this, reimbursement rates for doctors has been a huge deal. What happened this year?
AARON GUCKIAN: Well, you know, I mean, patient premiums need to go to patient care, and the administrative costs, I mean, there’s, we can’t attract dentists, we can’t attract doctors because it’s not competitive. You go across in Massachusetts and Connecticut, and I think we agree on this for sure, you know, it’s 30% more. And not only is it dentists or doctors in our field with oral health, but it’s hygienists, it’s dental assistants.
I know two doctors up in the northern region, Woonsocket, they just lost two hygienists because they’re going across, and they’re going to Connecticut. And if, I think right now, we’re down 10% with hygienists after the licensure, you know, process, so bottom line is if we don’t get competitive, you know, we’re going to struggle, and what’s happening, we were talking about this, is it’s, so I know a guy with a doctor, “Can you help me fit the person in this way?” I’m becoming like the, you know, people are calling me all the time. I’m talking about very, very powerful people saying, “I can’t find a dentist.” Well, if those people are having problems, what’s gonna happen to those people that are just, you know, just hardworking, trying to get their children in to a dentist, so this is something we wanna talk about today.
JIM HUMMEL: And primary care too.
PABLO RODRIGUEZ: And primary care providers.
AARON GUCKIAN: Yes, exactly.
PABLO RODRIGUEZ: And this is not an issue of greed because, you know, I hate it when people just, you know, think that, “Oh, doctors are greedy, and they want more money.” Doctors are paying $200, $300, $400,000 for an education. Coming out of school, you know, at 30 years old with that kind of debt burden, you can’t even buy a car.
AARON GUCKIAN: No.
PABLO RODRIGUEZ: Because you can’t afford it. And that is the problem that we’ve had for many, many years. The last 10 years of my practice, I could not bring a new doctor in because they would go to Massachusetts for 20% to 30% more. So we don’t have any primary care providers accepting patients at this point, and we have the crisis of retirement.
AARON GUCKIAN: Mm.
PABLO RODRIGUEZ: I mean, we have a big amount of doctors and dentists that are going to retire in the next five years.
JIM HUMMEL: What was the buzz at the Legislature this year? They nibbled around it a little bit?
NANCY LAVIN: So what they did actually was pretty significant for certain Medicaid providers. So community health, some behavioral and at-home care providers who get reimbursed through Medicaid, the governor’s budget had originally recommended a rate increase spread out over three years to get to the full amount that was recommended. The Legislature came in and said, “No, we’re gonna do it all in one year.” So they’re getting a rate increase in one year.
However, this does not apply to primary care, doesn’t apply to dentists. There is now, you know, they’re gonna start studying more what they would need to do to increase rates, but first there need to be studies before there can be recommended rate increases for these other types of healthcare providers.
JIM HUMMEL: And the Journal had a great article a couple of months ago. I’ve been meaning to get to this, so I’m glad you’re here today, that hundreds of kids in Providence, as part of the fallout from COVID, but also a shortage of dentists, have serious oral needs, and there’s nobody to take care of them.
AARON GUCKIAN: Yeah, I mean it’s over 500 children alone in Providence. And I believe it’s one of the largest diversity, equity, inclusion, belonging issues in the country. One of the biggest reasons kids miss school is tooth infections. There’s nowhere for them to go. The Providence Health Center, you know, the federally qualified health center located in Providence, they’re at capacity. Samuels is at capacity, which is, you know, the nonprofit on the Lifespan campus at Rhode Island Hospital, and it’s terrible.
I mean, I was just telling him, you know, Mayor Rivera from Central Falls called me three, four months ago. So we have a child with boils and smells. It was late on a Friday afternoon. Dr. Fotini Dionisopoulos, who’s our president-elect, you know, got him in and was able to, you know, figure it out and get him antibiotics, but, you know, children can die, you can die from a tooth infection.
JIM HUMMEL: But you also multiply that by many, many, many other —
AARON GUCKIAN: Yeah, over 500 kids alone. There’s one school, when they go through these screenings, it’s over 80 kids that need emergent dental care with anesthesia.
Now, I’m really happy to report that Sen. DiPalma, the speaker, senate president obviously was sick, Sen. Gallo and Rep. McNamara, we all got together, and they passed this code, this Medicaid code that will help for a facility fee for our oral surgeons, pediatric dentists, to get to some of this work, but then we gotta get the ambulatory surgical center, and we gotta get the space.
So it’s something I’m really passionate about, and, you know, I’m sounding the alarm. If we don’t get this going, some child is going to die. And you can speak to it, I’m sure.
PABLO RODRIGUEZ: Mm-hmm, yeah, and we need to stop, in this country, separating body parts. Medical health, dental health, and behavioral health are part of one body. We should start looking, you know, collectively at how to manage every part of your body, not just one part at a time, because what happens when you do that is that you’re creating administrative layers, one for behavioral health, one for dental health, and one for medical health. It doesn’t make any sense, and we’re spending money that we shouldn’t be spending.
