Current Status of the Developing Crisis

Since the initiation of this project, there have been several alarming developments in the primary care environment in Rhode Island that serve as important reminders of the developing and worsening crisis. In less than one year, at least 29,500 Rhode Islanders have lost access to primary care where they used to receive it due to the closure or shrinkage of practices.

There have been calls for rapid resolution to issues that are drivers of this instability but limited impactful action to date. The lack of stability in the sector is unsurprising and deeply concerning. RIMS highlights and centers the current challenges to serve as a call to action to move quickly to action to address system instability.

In March 2025, Anchor Medical announced that they would close, leaving 25,000 primary care patients to find new providers. This spurred significant coverage of the issue, and increased calls for resolution from the provider community and state leaders.

Hospital-based practices are also facing challenges. In the fall of 2024, a group of primary care providers left South County Hospital, impacting an unknown number of patients. Several providers and other health care advocates penned an open letter to the community expressing concerns about leadership at the hospital.

The health centers are also struggling, In July 2024, Providence Community Health Center, the state’s largest health center, closed its Olneyville location, limiting access to care across the lifespan for almost 5,000 of the state’s most vulnerable patients. They laid off an additional 70 employees in May 2025, and continued to call on state leaders to take swift action to avoid more cuts.

The state’s second largest health center, Thundermist Health Center, laid off 15% of its workforce and cut salaries for many remaining employees in the fall of 2024. Thundermist subsequently sought $8M in loans to remain operational. The health centers have initiated the Save our Health Centers campaign to draw attention to their challenges.

Given all the challenges in the sector, it is unsurprising to hear that providers are struggling. In the fall of 2024, the Rhode Island Chapter of the American Academy of Pediatrics released survey data of Rhode Island’s pediatric providers, including 161 primary care providers. The results of the survey, especially the qualitative data, underscore the urgency of the challenges providers face. Given these challenges, it is unsurprising that medical students and residents at Brown Health unionized in early 2025, the first unionization of physicians and physicians in training in Rhode Island.

There continue to be plans and proposals for improvements, but there are high levels of disagreement on approach and limited immediate impact. Blue Cross Blue Shield of RI did take action to reduce prior authorization requirements and improve primary care reimbursement amounts and methods in response to the worsening crisis and in compliance with new regulations promulgated by the Office of the Health Insurance Commissioner in March 2025.

Overview

Primary care access has received significant local media attention over the last few years as more patients have trouble finding care when their primary care provider retires or leaves the practice. Primary care providers, those who train primary care providers, health care industry leaders, and community advocates have worked hard to evaluate the current situation, elevate provider and patient concerns, and develop actionable plans. 

As evidenced by the reference tables throughout this document, those additional references included in Appendix A, and feedback obtained directly from providers during the development of this compendium, the challenges impacting primary care providers are broad ranging. 

Workforce challenges are central to lack of access to primary care in Rhode Island. Issues related to primary care salaries, especially for physicians with high debt burdens, are consistently centered in these discussions. Challenges retaining primary care providers after residency or even after practicing in Rhode Island for a period are well documented. There is growing concern that primary care-trained providers who remain in Rhode Island are leaving or reducing their primary care hours, opting to either work part-time clinical schedules, work in “boutique” or “concierge” practices, or practice outside of primary care in specialty clinics such as wound care clinics. 

Provider burnout and system waste are driven by excessive administrative requirements, including those related to prior authorizations and pharmacy benefit managers, Value-based care arrangements, including accountable care organizations and the accountable entity program have had mixed impact on primary care providers and their patients.  

Providers offered the following feedback on their overall perspectives on providing primary care in Rhode Island: 

“I find my job really rewarding. I picked primary care so I could develop longstanding relationships with my patients.”

“I wouldn’t want to be anything other than a family medicine doc!”

“I am lucky to work at (organization name) where we have a lot of resources for our patients. Providing care as a team makes all the difference for me. And my patients.”