How to Fix Hawaii's Doctor Shortage

Hawaii has hundreds fewer physicians than it needs, particularly in primary care. Here's what's being done to fix the growing shortage.


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Where Have All the Doctors Gone?

The Anatomy of a Doctor Shortage

If you want someone to blame for Hawaii’s doctor shortage, find a baby boomer, a baby, and the nearest Mainland transplant.

A population that’s growing (baby, transplant) and aging (baby boomer) is one of the main drivers behind the projected 1,400-doctor shortfall that Hawaii is facing for the year 2020, according to a study by the UH medical school’s Hawaii Physician Workforce Assessment Project.

Hawaii’s population is expected to grow by 28 percent, from 1.21 million to 1.55 million, between 2000 and 2030. During the same period, the number of residents age 65 and older is expected to double. And older people simply see the doctor more often than younger people do, with those 75 and older using three times the physician services as people 65 and younger.

Meanwhile, Hawaii’s doctors are aging, too. Forty-one percent of the physicians who were practicing at the start of the decade are expected to retire before this decade’s over. And they aren’t being replaced fast enough by young doctors to prevent a net loss of 50 doctors a year, the study says.

Hawaii isn’t alone. The state’s doctor shortage is part of a nationwide doctor shortage driven by the same forces of falling physician supply and rising demand. The Association of American Medical Colleges projects a national shortage of 91,500 doctors by 2020.

Exacerbating the problem was the federal cap put on graduate medical training in the 1990s, when the nation was widely perceived to be experiencing a doctor glut. Since the cap was lifted in 2009, medical school class sizes have been growing and new medical schools have been opening. Yet, as it takes 11 to 15 years to train a doctor, the promise of expanded medical education is no quick fix.

The Affordable Care Act, President Obama’s health care law, which will extend health insurance to some 35 million currently uninsured Americans starting next year, is frequently accused of causing, or at least worsening, the doctor shortage. The blame is misplaced, says Dr. Kelley Withy, the lead researcher with the Hawaii Physician Workforce Assessment Project.

In Withy’s model of the growing gap between physician supply and demand in Hawaii, the Affordable Care Act causes an initial blip in demand that is quickly offset by measures the new law takes to improve outcomes, increase efficiency and expand the number of primary care providers.

Still, Withy says, many doctors worry about how the new law will affect their practices. “We hear penalties. We hear new requirements. Those are all scary when you’re working 12 hours a day, seeing patients like crazy,” she says. “But I don’t think Obamacare’s worsening anything except our fear and confusion of the unknown.”

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