JABSOM building

Compared to mainlanders, Hawaiʻi residents are half as likely to be able to find physicians they need, such as surgeons and infectious disease specialists, based on an updated John A. Burns School of Medicine (JABSOM) report on the doctor shortage presented to the 2015 Hawaiʻi State Legislature. Plus, 300 more physicians in primary care— those working in family medicine, internal medicine, emergency medicine, obstetrics and gynecology and pediatrics—are needed so that patients can get the care they require.

The shortage of physicians in infectious disease is at 65 percent, with only 13 infectious disease specialists statewide where the population demand is for 24. These are doctors that patients would need to see for antibiotic resistant wounds, HIV/AIDS or other diseases difficult to treat or diagnose.

The shortage of general surgeons is at more than 51 percent, with only 55 surgeons seeing patients when the estimated demand calls for 112.

The worsening doctor shortage is being monitored by the legislature because lawmakers know it’s already difficult for people on the neighbor islands or in rural communities to get a doctor. If they’re forced to go to the emergency room for regular care, the cost escalates for everyone.

The John A. Burns School of Medicine Physician Workforce Assessment shows a statewide shortage of 890 full-time doctors—a shortage estimated to grow to 1,500 within five years. That assumes that physicians currently practicing will stay on the job. But it should be noted that almost one-third of physicians practicing in Hawaiʻi right now are aged 60 or over, which indicates that many could potentially leave the workforce.

The current shortages are greatest in these specialties

  • Family medicine (174 additional doctors needed)
  • General surgery (57 needed)
  • Pathology (44 needed)
  • Internal medicine (39 needed)
  • Orthopedic surgery (36 needed)
  • Cardiology (32 needed)
  • Anesthesia (31 needed)
  • Neurology (31 needed)

“We have spent four years monitoring the supply and demand for physicians, and instituted several programs to attract or keep more doctors working in Hawaiʻi,” said JABSOM Professor Kelley Withy, the primary investigator for the Physician Workforce Assessment.

Efforts already adopted

  • Creation of a State Loan Repayment Program for 20 providers a year
  • An increase in the number of MD students annually trained at JABSOM to 265, gradually increasing to 300 annually by 2020
  • Additional rural training sites and providers so medical students can experience first-hand what practicing in those communities is like
  • Outreach to more than 3,000 students a year interested in entering into a health career
  • Creation of a booklet about health careers in Hawaiʻi (available beginning February 1, 2015 online at www.ahec.hawaii.edu)
  • Creation of an online website to inform physicians and other health care workers about employment opportunities in Hawaiʻi
  • Increased training programs to support practicing physicians who are transitioning into electronic records, new federal healthcare requirements, etc.
  • Recruitment of 1,203 volunteer faculty MDs to assist JABSOM statewide
  • A “welcome wagon” service (in cooperation with Hawaiʻi State Rural Health Association) on all neighbor islands
  • Collaboration with the Hawaiʻi Physician Recruiters group to maximize incentives for and outreach to potential providers from across the country

What remains to be done?

Many programs are needed to help attract and retain medical providers. Plus, the state loan repayment program may end if the legislature does not provide matching funding for the $311,000 a year in federal funding obtained by Withy for the next four years.

The loan repayment program allows healthcare providers who commit to serve in rural communities for at least two years to receive money intended to help pay off their student loans. Sixteen health workers are currently in the program, but all with donated funds which are running out—there have been no state matching funds to trigger the $311,000 in federal money.

Also, Withy says there is an overwhelming need for simplification of administrative burdens on physicians. “We researched prior authorization forms from the eight local health insurers in Hawaiʻi and found there are 536 different forms for providers to know how to complete to get patients what they may need,” said Withy.

Another source of relief that is being studied includes ways to increase employment opportunities and inter-professional training among the physician, nursing, physician assistant and pharmacy fields.

—By Tina Shelton