State legislators might consider a host of potential prescriptions to ease Rhode Island's worsening shortage of primary care doctors when they convene in January, from beefing up loan forgiveness programs to overhauling Medicaid reimbursement rates to lowering barriers for foreign doctors to practice in Rhode Island. The lack of physicians is top of mind for two of the most powerful politicians in the House. Both House Speaker K. Joseph Shekarchi, D-Warwick, and House Majority Leader Christopher R. Blazejewski, D-Providence, revealed recently that neither of them has a primary care provider. Still, Shekarchi is expressing leeriness about enacting legislative solutions that might add to Rhode Island's dire financial situation. Estimates show that the state may face a $300 million deficit in fiscal 2026. Because of that, Shekarchi says he isn't ready to throw his support behind increasing Medicaid reimbursement rates or using financial incentives to attract and retain more doctors, moves that could widen the state's shortfall. Dr. Michael Fine, a family physician and former R.I. Department of Health director, has previously estimated that as many as 200,000 to 400,000 state residents don't have a primary care doctor. Observers point to many causes for the shortage, ranging from lower earnings in primary care compared with other specialties, lower insurance reimbursement rates in Rhode Island and an increase in administrative work that lowers the number of patients each doctor can take on. A Senate panel is investigating the feasibility of establishing a medical school at the University of Rhode Island, but the group isn't scheduled to submit its findings until January 2026. In the meantime, Shekarchi says he is willing to back legislation that doesn't have a big price tag attached, such as making it easier for foreign doctors to come to Rhode Island to practice medicine. Massachusetts recently overhauled its system by waiving the requirements that foreign-trained doctors complete a U.S. residency. Fine, chief health strategist for the city of Central Falls, says state officials must act quickly, citing a recent report that found a 25% decrease in primary care physicians between 2012and 2022. Top-of-the-list of recommendations in a 2023 report by the R.I. Office of the Health Insurance Commissioner were increasing reimbursement rates for primary care to align with neighboring states, followed by "significant reductions in the administrative burdens placed on primary care practices." Fine said that while raising pay is "the quickest short-term push," that may not solve the problem over the longer term. Instead, Fine says, taking steps such as creating new residencies for primary care physicians and nurse practitioners would be a start, followed by new scholarship programs with the caveat that recipients agree to practice in Rhode Island. "We need to focus on our own students and give them the tools they need to get there. Just pushing up the [reimbursement] rates doesn't [fully address the shortage]," he said. "Don't just throw money at it." Another option is requesting a waiver from the federal government to move from a model of fee for service to a monthly per person - commonly known as capitation - whereby physicians are paid a fixed amount regardless of how often they see the patient. Stacy Paterno, Rhode Island Medical Society executive vice president, says the legislature should work on streamlining burdensome administrative processes and strengthen training programs and recruitment efforts. "These challenges present an opportunity to reimagine and reinforce primary care as the foundation of a sustainable, patient-centered health care system," Paterno said. n