When Abigail Dillon, MD, was deciding where she was going to practice after completing her residency in family medicine, she had a few options. She grew up in Philadelphia and went to medical school there and she loved the region, but half of her family is in New England.
She spent her academic career here too. She earned her undergraduate degree at Boston College and then, in a gap year between college and medical school, worked for the Brown University School of Public Health, where she collaborated with her uncle, who is now retired; and after medical school she trained in the Brown Family Medicine Residency Program. (Medical residency is a period of supervised, hands-on training in a specific specialty that physicians complete after graduating from medical school.)
But even in deciding to stay in New England, Dillon had to choose between Rhode Island, which she had fallen in love with, and Massachusetts, where doctors earn about 30 percent more money.
“It came down to the fact that I had my son here, and I felt like during residency, we found a great community,” she says of herself and her husband. She’s now a family medicine specialist at Brown Health Medical Group Primary Care and assistant professor of family medicine at Brown.
Keeping doctors in Rhode Island, especially primary care physicians, is a persistent problem, says Kelly McGarry, MD, professor of medicine at The Warren Alpert Medical School and program director of the General Internal Medicine Residency Program at Rhode Island Hospital.
Some factors behind it are national, like lower pay rates for primary care; and others local, like lower reimbursement rates to Rhode Island practitioners compared to other New England states. “Why would they stay when leaving might get their loans paid sooner?” McGarry says.
But they do stay, and Brown is working on pushing for reforms that would make the state more attractive for new primary care doctors, which include family medicine, pediatrics, adult medicine, geriatrics, and internal medicine specialists. They want to recruit more local students to go to school here, too.
For graduates of Brown residency programs, it comes down to community, family, and wanting to make a difference in a patient population that they’ve learned to know and love. “When we have people stay, it’s largely because they value the culture,” McGarry says.
THE PRIMARY CARE GAP
A lack of primary care physicians is a nationwide problem. While these doctors have traditionally been the first stop when someone had a medical problem, more than 100 million Americans don’t have easy access to primary care, according to a National Association of Community Health Centers report. The same group also found that the number of Americans who can’t access primary care because there aren’t enough local physicians doubled from 2014 to 2023.
It’s a worsening problem too: The Association of American Medical Colleges projects a shortage of between 20,200 and 40,400 primary care physicians by 2036. According to HealthSource RI, 15 percent of Rhode Islanders are unable to get a primary care appointment at a convenient time. That’s up from 11.2 percent in 2022. The Rhode Island Office of the Health Insurance Commissioner also found that the situation is worse for low-income households and for Hispanic adults, with one-third reporting not having a usual source of care.
Despite this persistent problem, there isn’t an easy fix. Nationally, primary care doctors make less than physicians in other specialties. According to the federal Health Resources and Services Administration, in 2024 a doctor practicing orthopedics earned $564,000 a year, and a plastic surgeon earned $544,000. In comparison, a family medicine doctor made $281,000. That’s not an insignificant difference when the average medical student graduates with more than $200,000 in student loan debt.
Rhode Island doctors make less than their out-of-state counterparts too. According to the Rhode Island Foundation, private employer-sponsored health plan reimbursements are much lower here: an average of $188 per outpatient service in Rhode Island, compared to $202 in Massachusetts and $266 in Connecticut. Medicare and Medicaid reimbursement rates are also lower in Rhode Island, and have been stagnant, even as health care costs have risen. As a result, Rhode Island had the lowest average physician salary in the United States.
For doctors who enjoy living in Rhode Island, there’s nothing but a short commute stopping them from earning 30 percent more just over a state line. “It’s a huge difference in being able to support your staff and support yourself,” McGarry says of these pay disparities.
But for those who do stay, “what draws them more is the community and the people and their colleagues,” she adds, plus ease of living in the state. As a native Rhode Islander and Brown alumna, McGarry can’t imagine living or working anywhere else, even if she knows there are challenges for others making the same choice.
THE DRAW OF THE OCEAN STATE
Brown’s internal medicine residency program graduates 10 residents a year. Of those, anywhere from zero to four stay in the state to practice medicine each year, McGarry says.
In academic year 2022–2023, of 106 graduates from primary care residencies in Rhode Island, only 15 planned to provide primary care in Rhode Island.
Jenna Georgiou, MD, knew from when she was 8 years old, growing up in a small town at the Jersey Shore, that she wanted to become a doctor. She realized early in her medical training that she wanted to work in family medicine. In one class, she practiced taking blood pressure on an actor, who was playing the role of a patient as part of their training. Afterward, the actor broke character and said that she made him feel safe.
At that moment, “I knew that this is what I wanted to do with the rest of my life,” Georgiou says. She knew that seeing not just patients but families, and being a constant in their lives, where they could share their vulnerabilities with her because of trust built over time, was her ideal way of practicing medicine.
That’s what she does now, as a family medicine doctor at Brown Health Medical Group Primary Care – Hillside in Pawtucket. She’s also a clinical assistant professor of family medicine at Brown, where she tries to help her students figure out if the pace of family medicine work is right for them. “Do you want to see someone once in the emergency room on the very worst day of their lives? Or do you want a continuity of care with entire families?” she asks them.
For her, the answer was the latter. One group of her patients, for example, is four generations of the same family living in a multi-generational home in Pawtucket. “I’m a big part of their lives,” she says.
She’s also fallen in love with living in Providence. She and her husband, an artist and entrepreneur, only have one car because they walk or bike everywhere. While that kind of lifestyle influenced their decision to stay in Rhode Island, it was mostly Rhode Islanders—whom she describes as hard-working, salt-of-the-earth people who remind her of the Italian American population from her hometown—who made her stay. “They’re just really good people and very open with their lives,” she says.
Dillon, who works with Georgiou at the Pawtucket practice, also wanted to be the kind of doctor who would be there for someone through the duration of whatever health problem they may have. You’re someone’s doctor instead of just another clinician.
“As a specialist, you don’t really get to say, ‘I’m that person’s go-to person,’” Dillon says. “I really wanted a holistic approach to care taking ... and ideally taking care of the whole family.”
She did consider practicing in Massachusetts, where her husband works, but even if the pay would have been higher, she knew how much she was needed in the state.
“I really just wanted to stay in Rhode Island and be one little drop in the ocean of keeping more providers here,” she says.
Daniel Walden, MD, is originally from Georgia, but it wasn’t a stretch to come here. Like Dillon, he has family in Rhode Island, and his parents were about to move to the state when he was deciding where to rank programs in the National Resident Matching Program, the main system used in the US to place medical school graduates into residency training programs. He put Brown first.
“It was nice to relocate at the same time they were,” he says. “It’s the first time in my adult life I’ve really lived in close proximity to my family.”
He also knew he wanted to be a doctor from a young age, despite a diversion into natural sciences. But after working in the field, and traveling where he learned about other cultures and seeing the human side of his work, he realized he “really did want to be there for people when they needed it,” he says.
Walden chose to become a general internist because he wanted to develop longstanding patient relationships.
“I like to see the big picture for people,” he says, adding that he enjoys working with diverse patient populations.
He will begin practice this fall at Medical Associates of Rhode Island in Bristol and East Providence. Being at a small independent practice means that he is working with people across a range of disciplines, and has flexibility in his schedule. He’ll be able to learn the financial aspects of being a doctor too. “I really want to know the business side of medicine,” he says. “I want to be able to develop my practice and my group.”
Walden was part of Brown’s medical resident unionization effort and the bargaining team working for their first contract. “It’s in everyone’s best interest to attract good doctors and good students to come to Brown residencies,” he says. They sought pay increases to keep up with the cost of living and benefits like 401K matching.
He also sees why other residents leave Rhode Island after they graduate. Money isn’t everything, but it is a big something. Most people from his residency program now practice in Boston, he says.
“There’s just no reason for people to stay in the state unless they have another tie, like family like I do or they grew up here,” Walden says. “There needs to be some real action from our political leaders to incentivize primary care so we can all improve access to primary care going forward.”
HELPING TO CLOSE THE GAP
Rhode Island has an estimated 700 primary care physicians for the state population of 1.1 million people, according to a study by researchers at Brown. That’s about one provider for every 1,700 people. The study also found that if every physician saw 1,200 people a year, about 343,000 people would still be without a provider, and that Rhode Island needs 300 additional physicians to close the gap.
Fixing the pay disparity between Rhode Island primary care physicians and those in Massachusetts and Connecticut would be a major step in keeping residents practicing in the state, says McGarry, adding that hospital leaders are campaigning to increase Medicaid reimbursement rates to help level the playing field.
In 2025, the state Office of the Health Insurance Commissioner released a rule requiring commercial insurance companies to increase funding for primary care services to 10 percent by 2028. It would increase primary care funding by $40 million over four years, but OHIC has found that it hasn’t happened yet.
Also last year, Rhode Island Gov. Dan McKee and the Executive Office of Health and Human Services awarded $6.7 million in grants to primary care physicians in the state. The Rhode Island General Assembly passed legislation to ease some administrative burdens primary care physicians face, and also directed EOHHS to increase reimbursement rates to 100 percent of the Medicare fee schedule for fiscal year 2026. OHIC was required to conduct a rate review for primary care services by Sept. 1 as well.
According to OHIC’s 2026 report, these changes are “designed to rebalance the health care system by redirecting necessary resources to an area in critical need of support.”
McGarry sees another path forward by recruiting from a talent base that’s already local: Rhode Island students who are interested in science and medicine. Rather than convincing residents who are from somewhere else that they should stay, this would encourage future doctors to stick with their roots when they’re ready to practice.
Those efforts include Brown’s Pathways to Medicine program, where high school students are paired with medical students, residents, and attending physicians who serve as mentors. Through the program, high school students can review medical case studies, participate in health care simulations and interactive workshops, and see things like the anatomy lab. The program introduces them to what medical school is like by putting them in that environment, with guidance on what their next academic steps should be if they want to go into health care fields.
The Medical School operates nine such “pathways” programs for middle school students all the way through undergraduates. Recognizing that the path to medical school is often not obvious and also requires rigorous preparation, the programs offer mentoring, skill building, and assistance in preparing a medical school application.
McGarry says she’s met with high school students in the program, and seen how just exposing them to this world can open their eyes to possibilities.
“If they start to see early on that this is a cool career and interesting job, and they actually see what a generalist or internist gets to do, they might consider it as a future career,” she says.