Wednesday, June 30th, 2010 | Posted by Greg Wiles |  Print This Article

Hawaii 9-1-1: Doctor Shortage Worse Than Recently Reported

Hawaiirheumatologist.com

BY GREG WILES - New figures from the University of Hawaii researchers show the state’s doctor shortage is worse than recently reported, with the state needing more physicians now and in the future.

An updated report on the doctor deficit shows the state is short by 644 physicians compared to what it should have if it were meeting national averages.

Instead the state has roughly three-quarters of the numbers of doctors it should have.

“This is a big problem that we have,” said Dr. Kelley Withy, a research at UH’s John A. Burns School of Medicine.

“This is a crisis on the Big Island and it’s getting to be a crisis elsewhere.”

Withy yesterday released new figures from the study she and Dr. David Sakamoto are overseeing. The survey found the state had the equivalent of 2,862 full-time physicians, or less than the 3,324 it should have given the state’s population.

Hawaii’s doctor shortage has long been talked about in the medical community and at the legislature, but until Withy and Sakamoto released findings earlier this year, there had been mostly anecdotal evidence.

The findings back up reports that some residents are unable to see physicians when they want. It shows there are not enough specialists for cardiac care, cancer radiology and neurological surgery.

Only about a quarter of the 40 physician categories that researchers reviewed had a sufficient number of doctors.

The report update compares to less precise numbers researchers released earlier this year showing Hawaii has a shortage of more than 500 doctors. The report was unveiled at the Hawaii Physician Workforce Summit, a gathering of 130 of the state’s top physicians, policy makers, hospital administrators and insurers.

Source: Hawaii Physician Workforce Assessment

Attendees were told of the current shortage and that the deficit may more than double over the next decade.  That’s because the average age of Hawaii physician is 51, or three years more than the average across the country. About four out of every 10 doctors here will reach 65, or retirement age, in the next decade.

That translates into 1,335 of the state’s physicians possibly retiring by 2020. If that occurs, Hawaii’s doctor deficit will balloon to 1,600.

The report represents a rallying point of sorts for those who want more action on solving the problem. But even then, questions remain on how much and how quickly the problem can be resolved.

Some lawmakers have attempted to tackle parts of the problem over the years.

For example, summit participants agreed tort reform could help attract doctors here as premiums would be reduced. Lower malpractice insurance rates would mean there would be more money for doctors’ salaries, which many in the medical community say are far too low.

But efforts to change Hawaii’s tort laws have had little success at the Hawaii State Legislature. There has been heated debate over whether capping of damages is the correct action and whether plaintiff rights will be compromised.

There also is the issue of where the money will come from to fund shortage solutions given the state’s recent budget woes. That could be seen in a recent fight to get funding to help establish a residency training program in Hilo, home to some of the state’s worst physician scarcity.

That ended yesterday when Gov. Linda Lingle agreed to appropriate $140,000 to help start what could form the foundation of residency programs on all islands for the medical school.

The medical school also has faced $6 million of budget cuts in the past two years. Dr. Jerris Hedges, dean of the school, has added two spots to incoming class sizes despite the cuts.

That brought to 64 the number of students who enter the program each year. Hedges would like to get that number to 75, but will need $10 million to do so.

Yet he believes it’s necessary, especially if the shortage results in tourists questioning whether they should vacation here because they’ve heard there’s problems with access to healthcare.

“We need to be ahead of that,” Hedges said, noting it may be difficult to ask for a general fund appropriation, but that perhaps a small tax going toward the training could be instituted.

Other initiatives being considered also will take new funding.

Sen. Josh Green, a Big Island emergency room doctor, plans to introduce a measure next legislative session for the creation of a Hawaii Health Corps, a program under which doctors, physician assistants and nurse practitioners could have their hefty school loans repaid by the state.

The plan calls for repayment of 20 percent of healthcare training costs per year to a maximum of $35,000 annually. To take part in the program the healthcare provider must commit to five years of service in Hawaii.

Green, a Democrat, said the state will prioritize who gets loan repaid based on need for their specialty type and whether they fit a regional need.  The program also would take advantage of matching federal dollars.

“We need to make a splash,” said Green, explaining his idea would be to make Hawaii a Mecca for doctor recruits.

There’s one large hitch to the plan – it would cost upwards of $10 million annually. But Green contends the program will be worth more than that to the state in the improved health of its residents.

There are a myriad of other ideas to solve the problem, some as simple as making sure there are welcoming wagons and community mentors for new medical students and doctors. Others are much more complex, such as more widespread adoption of the patient-centered medical home programs.

Summit participants yesterday came up with 10 ideas in all to pursue and vowed to follow up on them in coming months.

The heads of both legislative health committees attended yesterday’s session along with at least three other lawmakers and former Hawaii County Mayor Harry Kim.

Sen. Roz Baker, D-Maui, said lawmakers may not take up the large issues next session, which have previously proven contentious, such as tort reform.

“You’ve got to look at the pieces you can work on,” said Baker. As such, smaller bits of issues, such as lawmakers looking for ways to have physician groups tie up with Federally Qualified Health Centers to come under federal tort reform.

She also believes the community has to be more involved, down to making sure they watch their own health.

Baker and Sen. David Ige, D-Pearl City, head of the Senate Health Committee, said legislators have been finding ways to help fight the shortage in recent sessions, such as passing legislation for the Hilo residency program and establishing a category for advance practice registered nurses, or nurse practitioners, who can help take the pressure off of doctors.

“That’s going to help with our primary care shortage,” Ige said.

For now, the impact of doctor shortages are most acutely felt on the Neighbor Islands where people have a difficult time scheduling appointments with specialists or have to fly to Oahu.

“Oahu needs to be concerned about what’s happening on the Neighbor Islands,” Baker said. “We’re having to ship people over here.”

So too is it becoming apparent to some Oahu residents who’ve had a tough time getting a doctor’s appointment, Hedges said.

“I think people appreciate that the need is significant enough now,” Hedges said.

Shortage Estimates

Source: Hawaii Physician Workforce Assessment

The summit was sponsored by the John A. Burns School of Medicine, the Hawaii/Pacific Basin Area Health Education Center, the Hawaii Independent Physician Association and the Hawaii Medical Service Association.

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ADDITIONAL BACKGROUND

Attendees at the Hawaii Physician Workforce Summit learned yesterday that the doctor shortage Hawaii faces is worse than was previously thought. The 130 participants came up with 10 potential solutions they will be working on in coming months.

• Change the system. Move to a team care/medical home approach that gives patients better and more efficient care.
• Electronic Medical Records. Take steps to expand these systems for improved care-coordination.
• Non-Physician Clinicians. Expand use of non-physicians such as nurse practitioners to help take pressure off of doctors’ time demands.
• Administrative simplification. Adoption of uniform billing procedures, forms to cut down on paperwork time.
• Rural payment differential. More pay, more support for doctors in rural areas.
• Community integration. Creation of a statewide recruitment network that includes welcome wagons and spousal job interviews.
• Increase targeted training. More medical school and residency training slots to address specific specialty and rural shortages.
• Pipeline programs. Increase the pool of future providers through internships, mentoring and programs such as high school health academies.

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Author: Greg Wiles

Greg Wiles is a long-time business journalist who currently works for Hawaii Reporter. His previous experience includes the Honolulu Advertiser and Bloomberg News.

Greg Wiles has written 69 articles for us.