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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Patient-centered Medical Homes (PCMH)

What they are: A model for health care that puts a doctor in charge of a team of health providers who work together to coordinate a patient’s care. One of the emphases is on open and easy communication between patients and health care providers. Withy calls it “the Cheers model” of medical care—“Where everybody knows your name.”

How they help: Eases demand for doctors by spreading routine primary and preventive care among non-physician team members, such as nurse practitioners, physicians’ assistants and health psychologists.

Details: Although the model is still evolving, PCMHs have become popular with many health care policy experts, who see them as the best way to move expenditures toward prevention and basic care. In theory, they allow a smaller physician workforce to care for a larger population, and result in better outcomes.

In the past few years, Hawaii’s largest health insurer, Hawaii Medical Service Association (HMSA), has wholeheartedly embraced the medical home philosophy, and the UH medical school has added a lecture on the benefits of PCMHs to its first-year curriculum. But the medical home concept isn’t entirely new. Kaiser Permanente, Hawaii’s second-largest health insurer, has been using the PCMH model for the past 50 years or so.
 

Payment Reform

What it does: Increases compensation for primary care practitioners, who are both the most in demand and the worst paid of all the doctors.

How it helps: There’s no incentive like a financial incentive.

Details: Loaded with medical school debt, many young doctors forgo primary care for the higher-paying specialties, such as dermatology, urology and plastic surgery. According to state Sen. Josh Green, who is both a doctor and the medical director of the Hawaii Independent Physicians Association, new federal guidelines that have raised reimbursements for primary care physicians attached to Patient Centered Medical Homes are starting to make a difference. “When pay for primary care reaches 70 percent of the median income for specialties, you tip the scales and people start going into primary care,” Green says. “We’re starting to see that, and it’s a game changer.”
 

Neighbor Island Residency Training

What it is: A new three-year family medicine residency training program on the Big Island.

How it helps: Puts young primary care doctors to work on the Big Island, one of the areas where the need for doctors is greatest.

Details: After graduating from medical school, doctors undergo three years or more of on-the-job training as hospital residents. Since doctors tend to settle down in the communities in which they train, it’s reasonable to expect some of the Hilo residents will stay on the island after their residency is complete. The first four Hilo residents will begin training in July 2014. The program will then grow until it has a total of 12 residents at any one time. Similar programs could eventually be set up on Maui and Kauai.

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