Hawaii’s shortage of doctors has been great for years, but worsened in 2020 – and the shortage of doctors on the Big Island just got worse.
A 2020 Hawaii Physician Workforce Assessment – completed by Dr. Kelley Withy, professor at the University of Hawaii’s John A. Burns School of Medicine and researcher on the Medical Workforce – found that Hawaii County has 287 doctors and 53% fewer doctors than comparable mainland communities.
That is the greatest shortcoming in the state.
Maui County has a 43% shortage, Kauai a 33% shortage, and Oahu a 20% shortage. 29% more doctors are needed nationwide.
The Big Island had a 44% medical shortage last year.
Ideally, Withy said, Hawaii County should have 539 doctors, but instead there are 270.
“We got a lot worse in a rush,” said Dr. Scott Grosskreutz, a Hilo radiologist who helped organize the Hawaii Physician Shortage Crisis Task Force.
The task force was formed two years ago to address the worsening medical shortage in Hawaii. Since then, members of all islands have joined.
“In Hawaii, where the cost of providing services is high, many practices find it difficult to remain viable,” he said
It is estimated that there are 2,812 full-time equivalent physicians in Hawaii, compared to the 3,529 physicians needed nationwide.
However, the assessment found that there is actually a shortage of more than 1,000 doctors across the country when the needs of specific islands and specific medical specialties are considered.
Grosskreutz said the goal of the crisis task force is to make Hawaii a workable place for younger health care providers.
However, it is difficult to recruit younger doctors, which means that the state has an older cohort of providers.
However, many of these doctors will have to retire soon, and there are few doctors who can replace them, Grosskreutz said.
“We’re trying to recruit more doctors to come here, we’re trying to train more doctors locally, and we’re desperate to keep the doctors we have,” Withy said.
Almost half of Hawaiian doctors – 46% – are 55 years or older, and 21% of doctors are 65 years old. One is 90 years old.
Last year at least 110 retirees, 139 moved and 120 cut working hours.
Eight died.
“The number of deaths has increased in the past two years,” Withy said. “If it were just this year, I would think it was COVID. It’s a clear indicator that our doctors are aging and working until they die. “
Grosskreutz, president of the Hawaii Radiological Society, repeated these views.
“Many local doctors have postponed retirement until their (late) 60s and 70s while accepting the risk of the COVID pandemic,” he said. “A third of our remaining doctors on the Big Island are over 65 years of age. These senior doctors just can’t go on much longer and need to be replaced by the recruitment of younger providers.”
According to Grosskreutz, the doctor shortage on the Big Island will soon approach 300 doctors, and a doctor shortage of 60% to 70% is forecast for the near future.
Not an easy solution
However, difficulties in recruiting and retaining vendors willing to live and practice in Hawaii are only part of a complex and intertwined puzzle.
Reimbursement rates from insurance companies and Medicare and Medicaid, as well as high overheads and the general state excise tax on medical services are among the factors that make it difficult to attract and retain healthcare providers.
Dr. Matthew Dykema, a resident general practitioner, moved to Hawaii in 2012.
He worked at the Bay Clinic for four years before joining the established Joyful Living practice in 2016. In 2017 he took over the operation from a retired doctor.
“As for the (doctor) shortage, it just means that I have a lot of patients trying to take care of myself,” said Dykema. “Even if I want to win another provider, it is financially difficult to do that and… there is no one. It’s hard to motivate people to move here when it’s not even financially viable. “
Dykema, who is the only provider in their practice, said there is a list of people who want to be patients, but the practice can only gradually take in new patients as old patients leave or die.
But Dykema may be better off than some
He received a grant from the National Health Service Corps, which paid for his medical education in exchange for four years of work in an underserved area. Dykema said his work with the Bay Clinic was part of that four-year commitment.
“I’m in a good position as I have no medical school credits and have been prudent throughout my studies,” he said. “… If I had a lot of debt from medical school, there was no way I could practice medicine here. Not in private practice. … It’s just a real challenge to make ends meet when you have overheads and reimbursements (insurance) are low. “
The effects on health
Withy said the shortage of doctors could lead to a higher risk of untreated chronic disease and early mortality.
For example, there are no cardiac surgeons, neonatologists, endocrinologists, or colorectal surgeons on the Big Island.
“Let’s say you had a premature baby,” Withy said. “I would say the risk on the Big Island is greater than in Kapiolani (Medical Center for Women and Children), where you have seen neonatologists. And if you have a heart attack and you need an operation right away, you wouldn’t get it. “
Likewise, according to Grosskreutz, the lack of access to health care providers could lead to higher mortality rates for other reasons.
“For example, it has been shown that having a personal doctor or health care provider doubles the chances of a woman being screened for breast cancer with a mammogram, and we’re missing more than half the doctors we need on the Big Island,” he said.
According to Withy, those working to address the medical shortage will lose government funding “because lawmakers do not consider anything that requires general funding, even if it does, such as loan repayment.”
The state is facing a budget deficit of at least $ 1.4 billion due to the pandemic.
Withy said that since 2012 there has been a loan repayment program that is funded by a federal grant that requires a dollar-for-dollar match. For the past three years, the legislature has been the game’s main source of funding but can no longer afford it, she said.
Since its inception, there have been 52 loan repayees. Withy said the current contracts will continue but new ones will not be placed.
However, before former Mayor Harry Kim stepped down, Lisa Rantz, president of the Hawaii Rural Health Association and executive director of the Hilo Medical Center Foundation, said the foundation’s county gave the foundation $ 100,000 to repay loans for doctors in Hawaii County.
What’s next?
Withy said a lot must be done to address the state’s medical shortage.
“If we could triple the size of the medical school and residences, that would be a long-term solution,” she said. “… The Big Island used to have the worst basic care shortages, then they started the family medicine (program), and now they are not the worst basic care shortages.”
Withy said, increasing doctor salaries and reducing the administrative burden are the quickest ways to get doctors to come – and stay – here.
In the last legislative term, a bill was introduced to exempt doctors and basic service APRNs from general consumption tax, which was cut due to the COVID-19 pandemic.
Grosskreutz said the law passed the Senate but was not voted on during the emergency meeting called last spring.
The task force will ask Big Island lawmakers and Mayor Mitch Roth to support the introduction of a more targeted law in the upcoming session that will help recruit more healthcare providers in the neighboring islands to meet the growing numbers of Medicare and Medicaid To care for patients.
According to Grosskreutz, Hawaii is only one of two states that tax health services and the only state that taxes Medicare services.
“We believe that taxing patients on their health care when they are sick or injured is socially unjust, especially during a global pandemic,” he said. “Often these patients are unable to work and have difficulty caring for their families.”
Teamwork is key in addressing the medical shortage, Rantz said.
The Hilo Medical Center Foundation serves as the Area Health Education Center on the Big Island helping navigate the pipeline of healthcare workers.
“We have enormous bottlenecks, Maui has enormous bottlenecks. Molokai does, but if you can’t get a doctor to move there full time, or if he can’t afford a full-time doctor, then maybe one of our doctors could (could skim), ”Rantz said.
“So we have resources. We just have to map them better, ”she said. “If we work together, we can do that.”
For her part, Rantz said she was not surprised by the growing shortage of doctors on the Big Island.
“I expect that number will increase, and I fear for our church. I think we need to band together and let our government – whether this is our county council, our mayors, our state and federal lawmakers – know that they need to address this. You have to help.
“Because it is not good for the health of our community not to have access to care.”
Email Stephanie Salmons at [email protected].