What’s Happening in Rhode Island Public Health with Dr. Amy Nunn

Dr. Amy Nunn — CEO of the Rhode Island Public Health Institute and Open Door Health — joins Bill Bartholomew for a wide-ranging conversation on the current state of public health in Rhode Island.

Dr. Nunn shares what she’s watching most closely in healthcare policy and politics across the state, including growing concerns about Rhode Island’s primary care shortage and what it means for access, equity, and long-term system stability. The discussion explores why Rhode Island has recently ranked as one of the worst states for physicians to practice, and what structural challenges are driving that reality.

Drawing on her leadership during the COVID-19 pandemic, Dr. Nunn reflects on what she learned about operating as a nimble, community-focused practitioner in times of crisis — and how those lessons apply today. She also discusses navigating federal-level constraints on science and public health under the current political climate, and how local institutions can remain resilient and mission-driven.

A grounded, insightful look at where Rhode Island public health stands — and where it may be headed next.

Transcript

SPEAKER_01 0:00

Dr. Amy Nunn, what are you watching in Rhode Island Public Health right now?

SPEAKER_00 0:03

Well, I've got laser-like focus on what's going on at the state house this week because the Senate is taking up the health care bills, and uh definitely a lot happening with that. Um, and I'm excited that primary care um and a lot of other public health issues are being discussed uh starting this evening.

SPEAKER_01 0:27

You know, I saw a study yesterday. These things are oftentimes kind of just clickbait nonsense. Wallet Hub says that Rhode Island is the second worst state for doctors to practice, but there is some data that would support that, some things we've talked about in the past. Just your take on the the they cite this very vague statistic, the medical environment in Rhode Island as a practitioner and as an administrator, is it what what do we need to improve the medical environment in Rhode Island right now in a nutshell without you know spending eight hours on it because I know we could.

SPEAKER_00 0:58

Well, that certainly got a lot of headlines. And uh, you know, I love Rhode Island and we have a clinic here and we're really proud of everything that we do. I think the challenges are really related to the climate for reimbursement, uh, which definitely needs to be um shored up. And uh I also um one thing that I'm really proud of is that so many people have health insurance in Rhode Island. We have, I think, the third highest rates of health insurance coverage in the nation. Um following uh Massachusetts and Vermont. So it's certainly not all doom and gloom, but we've got to address our primary care shortage, and we have to do that by doing a lot of things, but I think one of the most important things that we need to do is improve our reimbursement rates. That will elevate uh so many uh that will help improve so many things in the health system. And I think until we do that, it is going to be a challenging environment to recruit um physicians.

SPEAKER_01 2:06

How do we do that? Is that a is that a legislative process exclusively? I don't really understand the, even though I've been paying a lot of attention to it, I don't really understand how this happen how this is manufactured or where it comes from.

SPEAKER_00 2:18

That's a great question. That the short answer is it's pretty complex. It is a partnership between the federal government and the statehouse, so it requires federal action as well as local action. We need to um increase the amount of money that we spend on Medicaid. Um, and we need to increase the amount that we pay physicians and healthcare practices uh at the local level, and we also need federal action to make to uh better align our reimbursement rates with our neighbors in Massachusetts and Connecticut. Our physicians make about 30% lower. Um, you can make 30 to 40 percent more by simply practicing medicine in Seacon or just over the border in um Dartmouth or in Connecticut.

SPEAKER_01 3:16

Yeah, I mean that's fundamental. And that's where sort of plugging holes is is is so important in a way, and we see that happening in a lot of different sectors, but also kind of uh opening up new ways of of looking at solving problems. And that's something that you've been doing at the Rhode Island Public, you've been doing this writ large actually through your research and in general, but through the Rhode Island Public Health Institute, of which you're the CEO and through which you've launched and and have had success with open door health. So let's talk about open door health. And uh it's positioned as the state's only LGBTQ LGBTQ plus focused clinic. And that's an important distinction. Why in this medical environment did you prioritize and identify uh very specifically? I mean, it's kind of an obvious question, but why did you come in to fill this role in this medical environment?

SPEAKER_00 4:08

Thanks. We just turned six this week, uh last week rather. Um so it's our sixth birthday, and we're excited about everything that we've achieved. The short answer is there was an unmet need for an LGBTQ-focused clinic. We were one of 13 states in the country that did not have an LGBTQ clinic, and so many of the patients that we were taking care of for infectious diseases at Brown Health, and which was then lifespan, um, were telling us how much they needed a primary care provider. And we heard from hundreds and hundreds of patients that they needed a primary care home. And we decided we were up for the challenge, not really knowing how much work it would be to start a clinic from scratch. Um, but here we are six years later with over 5,000, almost 6,000 patients, and so proud of uh the fact that we've been able to respond to community health needs.

SPEAKER_01 5:22

You launched right before COVID, which is wild in a lot of ways, but you were right there right before we started to pay a lot of attention to a gap in brick and mortar healthcare services on the whole, especially walkability for vulnerable populations. So, in a way, you were ahead of the curve in the trend in terms of noticing a need for this, but you were also opening your operations during a time where, I mean, how much more chaotic could chaotic of a medical environment could you get? So, what was it like your during your first year? What are your big takeaways from COVID that still apply today? Now, wow, five, six years later? Six years later. Wow.

SPEAKER_00 6:04

Well, I think it's kind of like having children. It builds character. Definitely. It was a challenge. And I look back on it and it feels kind of like a sci-fi movie. You know, I remember coming into the clinic at the very beginning because the clinic we had to close three weeks after we opened, you know, under, you know, executive orders. And uh I remember coming in to the clinic because we were afraid that we might get looted just because we weren't coming in. And so I would come and work um remotely and the highways were empty and everyone was at home. And um, you know, we opened and closed twice along, you know, alongside the the executive orders in response to the executive orders. Um, we didn't have any patients at the beginning, so I was panicked that we might have financial problems, but thanks to the generosity of our donors and our community, we were able to stay open. And I feel just so proud of the fact that we were able to do that. And then, you know, once the economy reopened, we reopened and everything, you know, started was uh was fine. It was certainly rocky because every time there was a COVID surge, you know, we would have to pull staff out of normal clinical activities and have them run testing and then subsequently vaccines. But everything um everything turned out okay. It wasn't a linear process, um, but we're still here, you know. And I think the other um the other crisis that we responded to in 2022 was the the monkeypox uh crisis, you know, now the term used to describe it is called inpox. And um I think you know we we are pretty good. One thing I've learned is we're pretty good at responding to emergencies because we're nimble and small and we can hustle when we need to for our patients. And so, you know, we've learned how to do that. And um I think we've also had to do that in response to a lot of the challenges uh that have happened with public health during the Trump administration. And uh we've gotten to be pretty good at responding to emergencies.

SPEAKER_01 8:28

Right. Well, it's an emergency right now in Rhode Island in healthcare, it's an emergency right now globally in terms of the picture that we're seeing. But you mentioned a word that I thought was so important, nimble. And that came from, I mean, that's a that's a COVID, that's a byproduct of COVID um existing and operating and and frankly, in your case, providing uh essential services during COVID. Nimble seems to be the opposite of what a lot of the healthcare system has become right now. So as people search for primary care providers, as that becomes maybe a top of mind issue for a lot of people, but just in general, what can uh healthcare uh administrators, policy shapers, anybody glean from open door health as not only a model for the specific demographic that you've described, but just in general as a best practice for being nimble and being able to, as you say, hustle for your patients. I feel like there's a lot of people who they wouldn't even describe their relationship with their primary care physician as anything intimate, never mind someone who would be there to hustle for them.

SPEAKER_00 12:00

Well, I think it's what this time in history requires. Public health is under assault, medicine is facing a lot of crises, and um, you know, my background and training are in international health, and you know, we have been trained to respond to what people need. You can't just give them what you want to give them, you have to meet the moment. And so we take great pride in doing that and responding to what people need. The the moment that we're not responding to community health needs is the moment that I should step down because I think uh that's our goal is to respond to what the community needs. I think it's really important.

SPEAKER_01 12:42

How challenging is this environment right now in the Trump administration where it's not only from a dollar standpoint, it's not only from an aspirational standpoint, perhaps, but it's also a psychological thing. I mean, let's be honest, there's an assault on knowledge, of which medicine is one of our core tenets that we've established as what has made us great as a species, and it's under assault. What does that do to a practitioner on a day-to-day basis as you navigate this environment?

SPEAKER_00 13:14

Well, I think I have to I feel like every day I have to be prepared for everything. So, and sometimes that means being prepared for things you hadn't even imagined. And so a lot of times my day doesn't look like uh I thought it would. Um, you know, my day at 8 a.m. or 6 a.m. looks one way, and I end up spending my day on totally different things. I think one thing we're making a concerted effort to do is to help inform the public about what they need to know that's important about their health and well-being. And being on the show is an example of that. Um there have there's a whole lot of misinformation and disinformation out there that needs to be corrected. And so we're trying to spend a lot of time working with the media to help people understand what they need to do to live their um healthiest lives. And sometimes that means just getting on the news and saying, yes, you should still get vaccinated. Please vaccinate your children. No, you should not be eating beef tallow in lieu of olive oil, um, and you know, disputing a lot of things that have absolutely uh no scientific grounding. Um, there is a lot of misinformation coming out, and we want to be part of helping the public understand what they need to know to get access to health care and what they need to know uh to be healthy.

SPEAKER_01 14:45

Yeah. I remember our podcast the day after it was announced that Tylenol was something that should be avoided for pregnant women to uh avoid creating an environment for autism and pushing back on that junk science at best.

SPEAKER_00 15:02

And well, and and I had to spend a whole weekend reading all the science for that. Um and uh and I feel like that's our job. That's that's what we want to be doing is doing applied work that helps people understand how they can be healthy, not just you know, um following the trend of just business as usual. This is an unusual time in history, and I think it requires an extraordinary response, and and we want to help lead that response and put science back in the in the uh public health dialogue.

SPEAKER_01 15:41

Yeah, though no doubt it's important. I read a study that showed that there was a decrease in Tylenol usage among pregnant women after this announcement or proclamation from really Bobby Kennedy, and that shows the impact that this stuff has. So who knows how much further it could go if not for defenders of science, frankly. I mean, let's be honest. It's easy to uh try to be sort of objective about it. And but the objective position is to say they're pushing back against science. Um, what's next for for open open door health? What's next for Rhode Island Public Health Institute? Any uh you know, anything anything on the schedule?

SPEAKER_00 16:20

Yes, there's so many things that we're excited about. We're excited to expand our initiatives related to health and wellness, healthy eating and active living. Those are big priorities for us. We have a new physician with us that is now offering what we call lifestyle medicine. Um, and that basically refers to helping people live their healthiest lives by uh making changes in their um dietary behaviors, the physical activity, and incorporating that into their health and wellness visits when they come to see us. So we want to expand that service, and that's being led by Dr. Satna Chowdhury, who's our new medical director. And one of the other things I'm really excited about is just responding to the primary care crisis. There are 300,000 Rhode Islanders who do not have a primary care physician, and we um hope that we can expand our services and help fill that gap. And um, we are working on a new building, which will be located across the street from the public safety complex in Providence, and we hope to be able to serve up to 20 to 25,000 people in our new facility. And um, we're in the process of um designing that building and working with the city for zoning approvals.

SPEAKER_01 17:53

Amazing. Dr. Amy Nunn, always a great uh opportunity to speak with you, and thanks for your work in this community.

SPEAKER_00 18:00

Thank you so much for having me.

SPEAKER_01 18:04

You know, it's a rare thing that we follow up with the guests so quickly, but mere moments after we signed off, we had some major news we had to share. Dr. Nunn, the floor is yours.

SPEAKER_00 18:14

So on April 11th, um Open Door Health is going to be partnering with Dancing for a Cause and Studio One to have a fundraiser called Dancing with the Doctors. And we are working with eight other physicians who will be having performances on April 11th at Twin River Casino. And uh both Dr. Chan and I will be dancing along with some of our board members and other colleagues and physicians across the state. And people can come out and see us and support. It's a fun event. It's kind of like dancing with the stars, if you've seen that. Um, we're all taking dance lessons and it's a it's a contest, and uh we're just so excited to open up this event to the community so people can come celebrate our sixth birthday.

SPEAKER_01 19:11

Well, there it is. Anywhere people can get information online.

SPEAKER_00 19:18

You can email info at dancingwithhedoctors.com or you can email Molly Kittler, Molly.kittler at riphi.org. And we also have some information up on our website.

SPEAKER_01 19:35

All right, thanks again.