Response to commentary
There was a lovely commentary about the physician shortage credited to doctors Lynda Dolan and Kevin Kurohara published Jan. 27 in the Tribune-Herald. I’d like to take a moment to review some of the points raised.
I love Dr. Dolan; she is 12 ways to awesome. In addition to her private practice, she also is a long-term care hospitalist, a medical director at hospice (Hawaii Care Choices) and VP of the Independent Physicians Association.
I love Dr. Kurohara; he has been here since Pele planted her foot down. In addition to his private practice, he also is a long-term care hospitalist, president of the IPA, committee member at HMSA and sells Amway.
But the last time I checked, doctoring is a job. No physician should need a side gig to support his/her private practice.
The article states “many of these 50 physicians work as sole-proprietors, small business owners,” but fails to mention the number of practices that closed in the past three years because of financial struggles.
Hilo’s most recent casualty, Dr. Henry Lee Loy, even issued a closure letter to his patients, stating “the medical environment for private independent practice is no longer sustainable.” He is not the only one — doctors have left private practice, stopped taking insurance or left the island altogether.
They suggest our small solo practices are significantly better than larger systems that “typically carry high fixed overhead costs.” I’m curious as to why we think it is a larger clinic or hospital that is the cause of the additional costs.
I didn’t see a source cited, but I can definitively state HMSA reported a net income of $56 million for the second quarter of 2018. It should also be noted that in the United States, primary care accounts for 8 percent of medical spending. Exactly where are we looking for the savings in 8 percent of costs?
Dr. Kurohara states HMSA’s payment transformation allows him to provide “highly personalized care.”
I disagree. Doctors are paid to provide “cook book” medicine in order to meet “quality” metrics such as mammograms, diabetic eye exams, blood pressure goals or vaccines without any ability to vary the plans based on a specific patient’s treatment goals or needs.
Let’s be clear: I’m a fan of quality medical care, but I don’t think these metrics accurately measure quality.
After lauding our small practices and diminishing larger groups, Drs. Dolan and Kurohara go on to report that the “East Hawaii IPA is working hard to form a medical group” (did you forget you said big groups cost too much?) “designed to attract, recruit and retain new providers.”
Having been the youngest member of the East Hawaii IPA primary care physicians for eight years, I have a particular interest in how they intend to solve this dilemma. I certainly know they declined to listen to my opinion on what graduating residents want in a working environment.
After the closure of Dr. Kurohara and friends’ East Hawaii Medical Clinic, which was the previous attempt at attracting new physicians, I’m curious as to what they think will be different this time around.
Michelle Mitchell, M.D.
President, Hawaii Family Health Inc.