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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Source: Hawaii Physician Workforce Assessment Project

Dr. Christine McCoy, a physician on the Big Island, was on duty in the emergency room of Hilo Medical Center when a man came in with his arms wrapped in gauze. As McCoy removed the gauze, she found several large, bleeding skin cancers, which the man had left untreated until he could no longer ignore them.

Like a lot of people on the Big Island, where waiting lists to get into a primary care practice may be 500 people long, the man did not have a doctor he could see for regular check-ups. If he had, he certainly would have been put into treatment well before the cancers had gotten so bad, McCoy says.

“People walk into the emergency room here with just crazy things that you would never see anywhere else, because they would be taken care of long before,” McCoy says.

By the same token, Big Island emergency rooms are often filled with people worried about coughs, sore throats and other minor ailments that a primary care doctor would ordinarily deal with—if one were available.

“People here basically use emergency rooms and urgent care centers as their source of primary care,” says McCoy. “That’s a problem because the ER and urgent care aren’t going to worry about the mammograms, tetanus shots and cancer screenings, and they don’t do the ongoing management of chronic diseases.”

Hawaii is in the middle of a doctor shortage, and this is where you see it most clearly: on the Neighbor Islands, in the practices of primary care physicians who aren’t accepting new patients, in the patients who aren’t getting timely care or preventative care or the follow-up care they need, and in the inefficient allocation of health care dollars (emergency rooms are an expensive place to treat coughs and sore throats).

According to the latest findings from the UH medical school’s Hawaii Physician Workforce Assessment Project, which has been producing annual estimates of the state’s doctor shortage since 2010, Hawaii currently has 742 fewer physicians than it needs. The shortage affects all islands and cuts across nearly every specialty, but primary care (which includes family practice, internal medicine and pediatrics) is disproportionately hurting.

With a projected rise in demand for health care, coupled with a net loss of 50 doctors a year (see “Where Have All the Doctors Gone?”), the current shortfall could grow to become a hole in the physician workforce that’s 1,400 doctors wide by 2020, the UH researchers say.

If nothing is done to address the problem, it could soon become as hard to find a doctor in Honolulu as it now is in Hilo, Kona and Līhu‘e. In their 2011 report to the state Legislature, the researchers painted a dire picture of one possible future:

“Newcomers, the indigent and the elderly will feel it first. As the shortage deepens, we’ll all experience the effects. Harried [primary care providers] will spend precious little time with each patient, focusing primarily on immediate acute problems. Preventive care, health screening, early diagnosis and even physician job satisfaction will be triaged to the sideline. Our emergency departments will be overflowing, our hospitals will be running at above 100 percent occupancy and the costs will be staggering.”

But the outlook isn’t all doom and gloom. The report also spells out a series of potential solutions, including the movement toward a new “team-based” model of medical care, which aims to reduce the demand for doctors. Most of the solutions, however, deal with the supply side of the equation. “The recruitment, training and retention of physicians is key,” says Dr. Kelley Withy, the Hawaii Physician Workforce Assessment Project’s lead researcher. “We gotta get ’em, teach ’em and keep ’em.”

What follows is a roundup of some of the main initiatives that have been proposed to address the doctor shortage, and where they stand today.

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,June

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