Socioeconomic barriers and workforce shortages are preventing many Rhode Islanders from accessing health care, creating obstacles that particularly affect communities of color.
Panelists at the Providence Business News Fall 2022 Health Care Summit on Oct. 27 discussed the crisis that is being felt nationwide and in Rhode Island, where there is a “resource shortage” of about 20%, according to Corey McCarty, senior vice president and general manager of Commonwealth Care Alliance Rhode Island.
Some of the worst shortages can be seen in the primary care sector, which lacks funding to attract new workers, and in the nursing sector, where many staffing gaps are filled by travel nurses. In addition, a shortage at clinical sites is creating barriers for medical students because there are fewer people to help with training, said Dr. Thomas Meehan, program director of the physician assistant studies program at Johnson & Wales University.
Despite the many vacant positions, numerous challenges prevent many workers from entering the field, including access to child care and a lack of competitive salaries. This is especially true for people in communities of color, for whom higher education and high-paying jobs often remain inaccessible.
“As you see in [certified nursing assistant] programs, it is mostly Black and [Latino] people,” said Melissa Husband, chief of staff at Neighborhood Health Plan of Rhode Island. “We are the core folks that are on the ground every day in the homes of the populations that are hardest hit and hardest to serve. And you’re not seeing that progression when it comes to the Black and brown community being able to get those higher-paying jobs.”
A lack of trust is another barrier distancing many Black and brown communities from health care, Husband said. This is a challenge that must be addressed by increasing representation and investing in programs that prioritize communities’ needs.
“Health equity are just words until you genuinely bake it into who you are,” Husband said.
Some of the strategies implemented by health care providers to attract and retain workers include grants, tuition reimbursement programs and partnerships with other local entities such as academic institutions.
But these are only part of the equation, McCarty said.
“It really needs to be a little bit different as we start to think about some of the root causes of the challenge,” said McCarty, who emphasized shortages in the mental health field and Medicare’s current restrictions limiting access to behavioral health clinicians.
Economic hardships are also plaguing the country and rippling into health care, with high inflation and price increasing affecting access to insurance and eligibility. “This is going to be one of the toughest years we’ve seen in a while,” McCarty said.
While the pandemic has exacerbated many problems in the field, it has also reshaped health care’s approach to virtual care, which has in turn expanded access to care in many cases.
In the Medicare Advantage population, over half of seniors continue to have at least one virtual appointment, said Dr. Sri Adusumalli, senior medical director for Enterprise Virtual Care for CVS Health Corp. Data shows that over 75% of patients expect virtual care to be an option. As virtual care has become more common, its adoption by both patients and staff is growing, Adusumalli said.
“Historically, virtual care had been episodic and perhaps limited to on-demand, urgent care,” Adusumalli said. “But it’s really evolved to encompass the whole spectrum of care.”
While McCarty said telemedicine is “never going to replace” traditional care, this widespread acceptance created a new access point to care that never would have existed before, eliminating many barriers such as transportation.
