I hope I’m not alone among Rhode Islanders in feeling the urge to pull out my hair when I read articles like this, from Alexander Castro on Rhode Island Current:

A public medical school could generate nearly $1.5 billion for Rhode Island’s economy within its first decade and help shore up the state’s primary care doctors.

That’s the key takeaway of a roughly nine-month feasibility study commissioned by a special legislative commission.

The 104-page report released Monday afternoon is not the final product of the commission charged with investigating how or if a public medical school could bolster the state’s primary care workforce. The final set of recommendations is not due until Jan. 2, 2026.

If you’ve ever tried to estimate the cost and reward of any project, you’ll know how many assumptions go into them.  When trying to evaluate something as complicated as turning education into economic value in the healthcare industry, the complication is exponentially greater.

That is why projects like this should only be pursued by people who put their own money at risk.  An investor has greater incentive to ensure the assumptions don’t construct a fantasy.  Almost nobody in the entire chain from the people financing the study, to those performing it, to the politicians advancing it, to the voters who ultimately approve any debt involved has significant personal investment, so it’s easy to accept a study that tells you what you want to hear.

That goes not only for financial investments, but reputational ones, as well.  The costs and benefits of such projects are so diffused and happen over such a long time it’s difficult to track back accountability.

One thing we can say is that trying to increase access to doctors from the supply side is deeply flawed in principle.  People will seek education where it makes the most sense for them, and then they will work where it makes the most sense for them.  These are two separate calculations.  If we want to attract doctors, we should make the underlying economics of being a doctor more attractive in Rhode Island than everywhere else.  Making it slightly easier to become a doctor won’t make a significant difference.

The only thresholds it might overcome will be for marginal doctors — people who wouldn’t become doctors if it weren’t cheap and easy.  That bias could do more harm than good to our healthcare system.