For years, there has been a shortage of physicians on Hawaii Island. But what kinds of doctors do we need? And how many?
On July 11, 2016, Hawaii County convened a stakeholder meeting to create a community consensus around these two questions. Attendees were advocates and professionals from throughout East Hawaii. The attendees also realistically weighed our community’s ability to support specialists.
We understand that our rural population cannot support every specialist that we would like to have locally, but access to that care is needed. At the meeting, there was a presentation of data and statistics about the physician shortage we face in the county and state. The consensus we arrived at in this meeting will enable us to focus our efforts as a community.
The districts in East Hawaii showed varying needs. Puna’s increasing population is accelerating the need for urgent and primary care. Ka‘u’s remote location presents access challenges for all medical services. Increased access to rheumatology is needed in all of East Hawaii. Many people in our community receive medical care by either waiting for a specialist to fly here or going to Oahu themselves.
Behavioral health was cited as a priority in all areas. Limited access to specialists and reduced availability of public behavioral health services has created strains in other areas of the health care system. Emergency Medical Services must respond to an ever-increasing number of mental health calls, stretching the capacity of one of our most critical services.
The University of Hawaii “2015 Report on Findings from the Hawaii Physician Workforce Assessment Project” states that Hawaii Island is short 170 full-time physicians. According to the report, the number of full-time physicians we need for the island are: cardiology (eight), psychiatry (nine), primary care (24) and oncology/hematology (six). Previous recruitment efforts, while successful, did not leverage the resources of the entire community.
Meeting attendees created a local needs ranking based on their professional experience. Ranked from first to fifth, they are cardiology, psychiatry, family practitioners (primary care), oncology/hematology and child psychiatry. We now have a clear agreement on who and what to prioritize when spending our limited resources of time, energy and money.
Through a facilitated discussion, the group agreed on three activities that will improve our community’s ability to recruit new physicians.
First, we need to create a “welcome wagon.” Local families and businesses must welcome and mentor new doctors. Cultural differences, insurance reimbursement rates and community resources can all be difficult to navigate alone. The happiness of a physician’s family is just as important. New families need to buy a home, spouses need to find jobs, children need to go to school and participate in youth sports, and the family needs to feel integrated within the community. If we fail to “welcome” new physicians, experience has shown we will lose them.
Second, the entire community must actively advocate for the Hawaii Island Family Medicine Residency program at Hilo Medical Center. It attracts hundreds of physician applicants annually and seeks to place home-grown doctors in our community. The welcome wagon activities also would help to keep these medical residents in East Hawaii.
Third, everyone agreed that islandwide federal Healthcare Provider Shortage Area designation would help recruitment. With that designation, incoming physicians might be able to qualify for student loan forgiveness and other placement incentives.
Last November, Community First convened a Recruitment and Retention Task Force to address the physician shortage. Members of the Regional Health Improvement Collaborative — Hilo Medical Center, the East Hawaii Independent Physician’s Association, private businesses and the HMC Foundation — pledged to raise funding for placement of two new doctors in our community. The July meeting grew out of the need to identify what our most urgent medical needs are.
In a second program, HMC and EHI partnered to recruit needed specialists for our community. HMC can provide some financial support for the incoming physician and established EHI physicians will provide mentorship to the new practice.
One of the most significant indicators of successful recruitment and retention of physicians is local, family ties. We need your help. If you know of a physician who is trying to relocate to East Hawaii, please contact Community First. The only way we will solve this physician shortage is together.
Tony Kent, MBA, community engagement coordinator for Community First, was born and raised in Hilo and is the father of a young family.
This column was prepared by Community First, a 501(c)(3) nonprofit organization led by KTA’s Barry Taniguchi and supported by a volunteer board of local community leaders. Community First was established in 2014 to help the community respond to the health care cost crisis and support initiatives that change health care from just treating disease to caring for health. To learn more about Community First, visit CommunityFirstHawaii.org.
