HAWAII’S DOCTOR SHORTAGE

People move from the outer islands to Honolulu, or leave the state entirely when they get older and need more medical care, because of the shortage of doctors. This is an economic problem for doctors and the islands. There is always a shortage of doctors. What can be done to retain doctors in the Islands?

IDEAS TO RETAIN DOCTORS and PROPOSED LEGISLATIVE CHANGES:  

US REPRESENTATIVES AND SENATORS COULD PROPOSE TO:

• Negotiate new Medicare Reimbursement Rates to include Hawaii in the same class as California or Alaska. Right now the Medicare reimbursement is gauged by population density, so Hawaii is included with rural areas such as Guam and Louisiana, who have a much less expensive standard of living. The reimbursement rate is only 92% of the actual cost. This is the basic reason why doctors can’t stay in Hawaii.  THIS IS THE MOST IMPORTANT CHANGE THAT CAN BE MADE. 
• Institute a national licensing program for doctors and nurses. Streamline and reduce licensing tests for doctors. Have reciprocity for medical licensing with other states.  It takes 3-6 months to obtain a license in Hawaii.  Telemedicine is starting to become important due to the pandemic and could be a model for this.
• Forgive student loan debt for doctors, nurses and medical staff who serve in rural areas like Hawaii that are suffering  with doctor shortages. There is a similar program for doctors who work on Indian Reservations.
• Increase medical coverage for poor people in a basic healthcare system, so people are more likely to go to the doctor when they first get sick.

STATE OF HAWAI’I REPRESENTATIVES AND SENATORS COULD PROPOSE TO:

• Insurance companies must validate pay- for- service or your insurance model must require that the insurance companies  reimburse for service based on actual cost in the State of Hawaii for reimbursement by HMSA, Aloha Care, United etc.
• Eliminate the GET tax for medical services. Medical services, doctors, labs and drugs are a necessity.  It is against the law for doctors to pass this tax on to patients, this cost further reduces doctor’s income.  This tax affects poor people as a larger percentage of their income.
• Cap Malpractice claims at $1 million: From a ER doctor who explains it perfectly: “Without malpractice caps all our hard earned assets are at risk with each malpractice suit. We are covered for one million per case. If the award is over one million it comes out of our personal assets. The longer you practice the more likely you will be sued. One every ten years, statistically. So we want to retire so our assets, needed to retire, are not at risk. Hawaii has several suits with a $3-5 million award.  The caps need to align with the malpractice insurance caps. This is a huge and worrisome disconnect.”
• Streamline and reduce the licensing test for doctors. Have reciprocity for medical licensing with other states.  It takes 3-6 months to obtain a license in Hawaii. This is a disencentive and makes it more difficult.
• Help aspiring primary care physicians to work in Hawaii  to increase the general care to people.  Too many people use Urgent Care as their primary care entry to the system.
• The Hawaii State legislature could create an annuity fund to pay a stipend to each doctor. The goal would be to help pay Hawaii doctors the same as their peers on the mainland.
• Increase medical coverage for poor people in a basic healthcare system, so people are more likely to go to the doctor when they first get sick.

HAWAI’I COUNTY COUNCILS AND LOCAL LEADERS COULD PROPOSE TO:

• Eliminate the GET tax for medical services. Medical services, doctors, labs and drugs are a necessity.  It is against the law for doctors to pass this tax on to patients, this cost further reduces doctor’s income.  This tax affects poor people as a larger percentage of their income.
• The County Council and Local Chambers of Commerce could fund an annuity to pay partial scholarships for medical students that would require then to stay for 4 years on Hawaii island for loan forgiveness.

“The report by the Hawaii Physician Workforce Assessment Project found

• More than 150 doctors left the state in 2019, another 91 physicians retired,  while 123 decreased their work hours, with the highest shortages happening in primary care.
• The decrease represents about 8% of Hawaii’s physician workforce.
• Hawaii needs to add as many as 820 doctors to a pool of 3,484 physicians actively providing care to satisfy the need for services, the report said.
• The physician population in Hawaii is aging. Not enough new doctors are being recruited, with about half of active physicians aged at least 55, while nearly 1 in 4 are age 65 or older, the report said.
• The shortages mean people throughout the state are waiting longer for health care and at times facing life-threatening consequences, said Dr. Kelley Withy, lead investigator for the report.

Annual Report on Findings from the Hawai‘i Physician Workforce Assessment Project for the 2020 Legislative Session from the  Executive Summary:  “There are currently 3,484 active physicians providing patient care to patients in Hawaiʻi for a total of 2,974 Full Time Equivalents (FTEs) of direct care to patients. The national demand model applied to the State of Hawaiʻi indicates a need for 3,483 total FTEs or a shortage of 509.  However, when island geography and unmet specialty specific needs by county are examined,the estimated unmet need for physicians (accounting for geographic distance and air travel)increases to 820 FTEs (up from 797 last year). Primary care is the largest shortage statewide (300 FTEs needed), and on all islands, with Infectious Disease (72%), Pathology (58%),  Pulmonology (56%), Colorectal Surgery (52%), Hematology/Oncology (47%), Thoracic Surgery (45%), and Allergy & Immunology (43%) being the largest subspecialty shortages statewide by percent of estimated unmet need.” From the Annual Report on Findings from the Hawai‘i Physician Workforce Assessment Project for the 2020 Legislative Session https://www.hawaii.edu/govrel/docs/reports/2020/act18-sslh2009_2020_physician-workforce_annual-report.pdf https://www.hawaii.edu/govrel/docs/reports/2020/act18-sslh2009_2020_physician-workforce_annual-report.pdf

Doctors leave Hawaii for a variety of reasons, including the high cost of living and lower average pay, limited job prospects for spouses and dissatisfaction with the medical community, see more:   https://www.usnews.com/news/best-states/hawaii/articles/2019-12-26/hawaii-experiencing-shortage-as-more-doctors-leave-state   

“So, from the Big Island, we’re very much in a state of crisis there. We have a 44% shortage of physicians on the Big Island. About 230 doctors is the number of physicians that we’re short of and of the remaining practicing physicians 32%, or basically a third of the remaining doctors, are 65 years old or older.”  From Dr. Scott Grosskreutz<https://www.linkedin.com/in/scott-grosskreutz-a87b0913b/> is a radiologist with Hawaii Radiologic Associates   and is a member of the Hawaii Physician Shortage Crisis Task Force. He joins us in this edition of “What They’re Watching” to discuss doctor shortages on the Big Island.

This report was compiled from research and conversations and multiple doctors.

Questions or Comments?   Debbie Hecht hecht.deb@gmail.com