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Critical shortage of doctors prompting range of solutions

The neighbor islands and parts of rural Oahu are suffering a critical doctor shortage. Whether it's older doctors retiring sooner, or young doctors driven out of Hawaii by high costs or lured by mainland incentives, it's been an uphill battle finding a cure for a physician workforce that's way too small.

If you've noticed it's getting harder of taking longer to snag a doctor's appointment you're not alone. A physician shortage in Hawaii is worsening.

"We're not keeping up with the increase in number of needed processionals to take care of our patients," said Dr. Jerris Hedges, dean of the University of Hawaii John A. Burns School of Medicine (UH JABSOM).

The doctor workforce has fallen to just a few thousand, down 51 since last year. That's short more than 500 doctors for our population, and experts say we need to be moving in the other direction and fast because a net gain of 650 is needed in 2020.

"We've seen the retirement age get lower and lower, in part because of payment transformation, electronic health records," said Dr. Lee Buenconsejo-Lum, graduate medical education director at UH JABSOM. "If you take out the number of physicians who are 65 years of age and older, the gaps widen tremendously."

"We've had chronic underpayment for physicians in our island," Hedges said, "and we can't just suddenly say we're going to raise the payment for each doctor because the monies for those payments come thru those who purchase the health insurance, and our businesses have to remain healthy."

These and other factors are driving doctors out faster than they're coming in, especially in rural areas.

"We already have critical shortages on the neighbor islands for all specialties including primary care," Buenconsejo-Lum said.

The Big Island is the worst, more than 40 percent understaffed. Maui County and Kauai are a third under what they need. People on some neighbor islands in need of trauma care, orthopedic or other surgeries, even some childbirths -- have to fly to Oahu.

"Many have to come a week or two, three or four weeks before deliver to provide the safest environment just in case something happens," Buenconsejo-Lum said. "Trauma is a really big, really really serious challenge, also behavioral health, mental health even for children."

"We're working with our nurses and pharmacists to build teams that will take care of the patients and our needs for tomorrow," Hedges said.

Meanwhile cities and states across the mainland are taking aggressive recruiting steps that lure Hawaii doctors and med students, from tax breaks to medical school loan payoffs. We asked, is there a big fix Hawaii could offer, such as tax incentives similar or better than on the mainland?

"Certainly no income tax for doctors would be very attractive. Physicians here in Hawaii sort of are dealing with a difficult situation," Hedges said, "where you have lower reimbursement than you do on the West Coast and much of the rest of the nation, and you also have higher cost of living."

High costs are made worse when they're also paying off the degree they labored years for to become a doctor.
 
"The average is about $260,000 in debt," explained Buenconsejo-Lum. "Our residents pay on average $2,200-$2,400 a month rent like the rest of us, and contrary to popular belief residents and fellows don't actually make that much money. We've had residents say I had to take out a loan for food this month, which is really quite terrible. I think certainly more loan forgiveness would be really important, especially in higher-need specialties or higher-need locations."
 
Lawmakers set aside some money toward a loan-help matching program in exchange for a two-year commitment to working in the most-short areas.

"If that could be expanded to longer, 5 or 7 years, it could do a couple of things," Buenconsejo-Lum said. "One, it could actually pay off more, but two, someone would be much more likely to place roots in that community."

Another policy passed gives a $5,000 tax break to rural doctors for taking trainees under their wings

"These specialty areas of training lead to licensure in the state, but during that training there is important health care delivered by the trainees themselves," Hedges said.

The medical community isn't sitting back waiting for policymakers to fix it. JABSOM is recruiting more broadly from students taking nontraditional paths toward med school -- even business and engineering degrees, or working adults from emergency and rescue services. They even gave one-third of a recent class a full ride and the dean wants to do more.

"I would like to have a situation where we had a sufficient endowment for medical students where we could give every student coming to our school a full four-year scholarship," Hedges said. "That would allow us to retain these students and also minimize the number of our most talents students who also have multiple offers throughout the U.S."

In a follow-up report later this week, we're looking into one of the other big solutions many are counting on -- telemedicine -- which helps stretch the availability of every participating doctor to reach far more patients. We're looking at the pros and cons of care delivered by camera and screen instead of face to face. That's Thursday at 10 p.m. on KHON2 News.


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