It doesn’t take a clinical degree to diagnose why Rhode Island has difficulty retaining health care providers who completed their education in the Ocean State.
Rhode Island notoriously lags its neighboring states by about 20% in reimbursement rates across medical services. And with degree programs that easily surpass $100,000 in tuition for doctors and mid-level clinical professionals, many simply can’t afford to practice in the Ocean State and pay off their student loans, said Joseph Trunzo, association director of the School of Health and Behavioral Sciences at Bryant University.
“When you pair that kind of debt with working in a state where the reimbursement rates are inherently lower than the neighboring states, it is very hard to keep people in the state,” Trunzo said, “and to retain those students when they can live in the same place, drive a couple miles over the border and make 20% more.”
It’s not a decision graduates make with luxury in mind, he said.
“This isn’t the difference between having a beach house and not having a beach house,” Trunzo said. “This is the difference between being able to feed and support your family and not being able to feed and support your family.”
Trunzo spoke on the second of two panels at Providence Business News’ spring 2026 Health Care Summit, which took place on April 2 at the Providence Marriott Downtown.
The panel also featured Meghan Grady, executive director of Meals on Wheels of RI Inc.; Linda Hurley, CEO and president at CODAC Inc.; and Dr. Christopher Ottiano, interim chief medical officer and medical director at Neighborhood Health Plan of Rhode Island.
Ottiano said the panelists may have looked like they were from “unrelated silos,” but amid health care system turbulence that requires – and oftentimes complicates – a team-based approach, “it’s actually a little bit of a family reunion up here.”
“The short- and long-term approach, from the Neighborhood perspective, is short and long-term collaboration with our network of providers,” Ottiano said.
Meals on Wheels’ Food as Medicine initiative exemplifies the “important bridge between health care and community-based organizations,” Grady said, “and how powerful those partnerships can be.”
The concept, which is not unique to Meals on Wheels, uses nutrition and education to prevent, manage and treat chronic illness. Grady said that this approach is particularly important when about 60% of Rhode Islanders have a chronic illness.
Since 2022, Meals on Wheels of Rhode Island has delivered more than 55,000 meals tailored to an individual’s medical needs, Grady said, and an additional 4,000 medically tailored grocery bags in the same period.
Observers estimate that nationwide, medically tailored meals could save $34 billion on health care costs, and around $2,500 annually per patient in Rhode Island.
But much-needed collaboration is hard to achieve in a health care system faced with staffing shortages, panelists noted, including a dire shortage of primary care providers.
“We have folks who come to us for care, and we ask who their primary care doc is,” Hurley said. “It’s the last doc they saw in the [emergency room]. And we know that that is not an effective use of dollars, on a professional side or on the person who needs care’s side.”
Like Trunzo, Hurley points to low reimbursement rates as a major barrier to attracting and retaining primary care providers.
“That is the real issue. … It is primarily about the rates,” Hurley said. “It’s about the dollars. It’s about being able to reimburse people to have a full and healthy family life.”
Amid this primary care shortage, some panelists advocated for a team-based approach to help relieve providers of heavy patient loads and paperwork. But the clinicians who would fill these gaps face their own obstacles.
The federal government recently reclassified numerous clinical degrees as not “professional,” which cuts students off from some previously available funding sources.
It’s one of many jolts to hit the state under policies instituted by President Donald Trump’s administration. More than 10,000 Rhode Islanders recently lost coverage through HealthSource RI, the state’s health insurance marketplace, and more will follow if anticipated cuts to Medicaid and Medicare go into effect in the fall.
“I would like to see more creative programs where you don’t have to force the students to take on debt,” Trunzo said, noting that loan repayment programs aren’t enough of an incentive.
If the state can create more scholarship programs, students “feel, hopefully, a debt of gratitude to the state for supporting their education,” Trunzo said, “and hopefully they stay.”
Currently, just about 30% of Bryant’s physician assistant graduates remain in Rhode Island.
But it’s a tough sell, Hurley said, noting that many of CODAC’s clinicians are reimbursed about 39% less than Massachusetts clinicians for the same services.
“Very clearly, we cannot compensate those who are providing those services at the rate Massachusetts does,” she said. “People get up to 100% more – we’ve heard up to 200% more – for working in an entity in the southern part of Massachusetts, where they drive 16 minutes from Providence ... And that is a real issue.”
