PART Two

PROVIDENCE – Talking about data with Neil Sarkar, president and CEO of the Rhode Island Quality Institute, who is the keeper of data for the state’s health information exchange, is much like participating in a therapy session with a skilled practitioner of the science of data. Sarkar is also the founding director of the Brown Center for Biomedical Information.

Sarkar is in the midst of transforming CurrentCare, the state’s health information exchanage, from an opt-in to an opt-out system, which, as he reminded ConvergenceRI, means that he has a full plate. About 50 percent of Rhode Islanders are participants in CurrentCare.

As he told ConvergenceRI at the beginning of the interview that took place on Tuesday, Oct. 17, at the Quality Institute offices, “I know what I know, and I know what I don’t know,” adding: “Three-quarters of success in life is about state of mind.”

The interview with Sarkar is PART Two in a three-part series, “It’s all about the data, the data, the data…” It was initially envisioned to be part of the ConvergenceRI edition on Oct. 23 that included PART One, a look at the lack of affordable housing data from the 2023 Housing Fact Book produced by HousingWorks RI, featuring an interview with Brenda Clement, the executive director of HousingWorks RI, and, PART Three, which was an interview with Nancy Wolanski, lthe Director of the Nonprofit Resource Center, and Cortney Nicolato, the president and CEO of United Way of Rhode Island, illuminating the fact that there is a dire lack of data when it comes to understanding the critical role that the nonprofit sector plays in the Rhode Island economy.

The interview with Sarkar was to have created, in ConvergenceRI’s viewpoint, the triptych of the story of data in Rhode Island, linking together health data with housing data and employment data. But, ConvergenceRI simply ran out of time in editing the story for publication. So it goes.

The inclusion of the interview with Sarkar in this week’s edition of ConvergenceRI has its own bit of serendipity, linking it with stories about new developments in the neuroscience research around toxic stress and interviews with both Attorney General Peter Neronha and Deputy Attorney General Adi Goldstein, talking about their efforts to address the current health care crisis in Rhode Island.

The legal team at the Attorney General’s office is now grappling with how to solve the lack of access to primary care providers in the state – which in large part can be linked to the failure by the state to increase the Medicaid rates for providers.

In turn, from Sarkar’s perspective, the biggest problems facing the health care industry in Rhode Island are the massive cases of burnout by those in the caring profession.

As ConvergenceRI shared stories about the ongoing conversations with Rhode Islanders about health care, Sarkar kept the focus of the conversation finely tuned on the responsibilities before him.

SARKAR: Richard, I wish I could solve all the world’s problems. But I am 100 perent focused on what we do at RIQI. Our scope is  ensuring that health data are avaikabke to all who need it – and who hopefully can benefit from it.

At a population level, [we want to] help identify where there are opportunities for better types of intervention and earlier intervention.

Right now, looking at providers, I have a very strong view on the challenges that providers are facing. They are burning out, and it is not all their fault. It’s because we are barraging them with data and tasks.

People may have forgotten, but there was a pandemic that we had to work ourselves through. And people are tired. We now expect the world somehow to magically be back to how it used to be, but our schedule hasn’t been reinvented.

Bad reimbursements

Earlier in the interview, Convergence talked about the problems in health care related to the inadequacies of reimbursements for providers.

ConvergenceRI: The workforce is underpaid, because there has never been an increase in Medicaid rates for providers.
SARKAR: Yes

ConvergenceRI: And, until you have that increase, and even then, the workers are burning out, and many don’t want to be in the caring profession anymore.  
SARKAR: You’ve nailed the issue, right on the head. That is the fundamental problem we have in the community right now.

In our health care community, the rate of burnout is very, very high and can be directly tied to lack of workforce, and the [payment] rates that we have are not there. Why would anybody subject themselves to the tortures of practicing medicine in any form right now?

ConvergenceRI: You said: “the tortures of practicing medicine.” Did I hear you correctly?

SARKAR: It’s difficult. It’s really hard. There’s no doubt about that. And, burnout is a real issue in our community – and the community broadly, across the country.

So, if you know that you are going to be burnt out, but you can get paid more by driving half-an-hour north, why wouldn’t you? You have debt to pay off.

This is the struggle. In my role as a faculty member at the Alpert Medical School, we look at these graduates. It is a financial decision; it’s not that they don’t want to take care of patients at a primary care level. It's a financial decision.

But, even if they do stay, they are going to leave our state, because why wouldn’t you?  It’s the smart thing to do.

ConvergenceRI: Why wouldn’t you take a salary that is $20,000 to $30,000 to $40,000 a year higher?
SARKAR: And yes, and know that even in that environment, it is still not going to be ideal; you are still going to be tired and burnt out. But, at least you are going to get paid a little more.

That’s the struggle that we are up against as a community right now. And, I would argue that Rhode Island really does lag in its payments.

Anecdotally, many of us are here, myself included, because we love this state. I have adopted it as my home. I can’t honestly imagine living anywhere else. And, I don’t think I will.

But, I am not in the majority of people who come from outside. I’m here because I like it here.

More to come
There is much more to come in the interview with Neil Sarkar, but for the moment, it is important to capture his insights into the way that burnout is harming the caring profession. The rest is commentary.