BI physician (Hilo, Kailua, Waimea: low income, real estate, insurance)

[hoj]

I am a board certified Family Med physician considering a move to the BI. I have already weighted the fact that physician reimbursement is lower in Hawaii and the cost of living maybe higher (I live in Chicago and the cost of living here is pretty high when considering all of the taxes and real estate prices in downtown so not a tremendous difference from the BI). Any information on the actual practice of medicine on the island would be greatly appreciated. Additionally, other threads lead one to believe that the quality of care on the BI is poor therefore a high quality practitioner could find himself too busy in a short time. Any comments?

[CyberCity]

Originally Posted by hoj

Additionally, other threads lead one to believe that the quality of care on the BI is poor therefore a high quality practitioner could find himself too busy in a short time.

That is the wrong impression, and does not sound like a well researched assessment of the health care situation. Health care on Hawaii Island is limited, but the quality is certainly not "poor".

[hoj]

No offense intended. I was just stating the impression I had from reading other threads. Some even stating if they were sick they would fly over to Oahu. I would suppose due to the lack of a tertiary care center extremely ill patients would go to Oahu. Let me restate my original question: what is the general impression of the quality of care on the BI? Thanks.

[CyberCity]

The quality of physicians is good. But, there is a lack of physicians, so getting an appointment can be stretched out. As with many rural areas, physicians that will accept Medicare and private insurance are in need, and those that will work in the more rural communities would find ready patients. [Of course, to be respected it the fact that it is expensive to become a doctor, and expensive to run an office (staff, benefits, liability ins, etc), and expensive to cover the overhead such as rent, etc.).

Many patients go to Oahu for testing, and non-emergency surgery. But that is inconvenient for the patient. PETs, second opinions that require pathology, Kaiser (insurance) patients, etc, often head to Oahu due to that being where the facilities are. But given a choice, we'd rather stay home on the Big Island if we could, close to our own dwellings, transportation, family, and support systems.

Serious injuries and life-threatening conditions are sometimes airlifted to Oahu, because there are hospitals there that have more advanced surgical facilities,etc. But that is similar to living in any rural area ... limited medical care.

[whtviper1]

Originally Posted by hoj

Any information on the actual practice of medicine on the island would be greatly appreciated.

What is it specifically you'd like to know?

I work with about a dozen physicians on the Big Island. The practices range from solo practictioners (one even practicing at his house with an addition he built) - to a more formal physician center - to partnerships - and salaried physicians - what is it you are looking to know?

[hotzcatz]

As noted, the quality of care is generally good, although the amount of care is limited. We just don't have the density of population to support as large a medical facility as Oahu can so it is a lot less expensive to fly the patients over to Oahu when they need some sort of procedure which uses expensive equipment. Things such as CAT scans are generally an Oahu procedure, at least if you are a Kaiser patient.

There seems to be a trend towards non-traditional medicine lately, even at the larger facilities. Acupuncture, stuff like that. I've not been to the hospital much myself, but I hear about other folks going and getting some interesting treatments. I'd call it "naturalistic" and "homeopathic" but I'm sure those terms have specific meanings that I'd not be aware of.

The two basic health plans on the Island of Hawaii seem to be Kaisers and HMSA. There are some funded by the state for low income, too, QUEST or SHIP or some such. I don't know if you as a physician would be overly enamored of the low income plans.

[HiloDiver]

I haven't needed medical care since my arrival, but people generally tend to say that Kaiser is a better plan for patients than HMSA is.

[hoj]

Thanks to all; its informative to hear from people who actually live on the island. Specifically as a Family Medicine physician - is the culture such that of a recently relocated physician it would take time to build a practice or the extreme end where due to lack of physicians I would be busy from day one? Is it difficult hiring staff everything from office staff to nursing staff? I have been traveling to the BI once or twice a year for the past 10 years - I would think the best locations for a primary care practice would be either Hilo, Kailua Kona, or Waimea. Opinions?

[whtviper1]

There are 2 options for you - look around for the salaried physician positions - or, I'd contact one of the Independant Physician Organizations - if you joined a IPA, you'd probably be able to ramp up relatively quickly on the BI - the compensation can be pretty low by mainland physician standards.

Here is one I work with:

https://easthawaiiipa.com/

[khyron]

Originally Posted by CyberCity

The quality of physicians is good. But, there is a lack of physicians, so getting an appointment can be stretched out. As with many rural areas, physicians that will accept Medicare and private insurance are in need, and those that will work in the more rural communities would find ready patients. [Of course, to be respected it the fact that it is expensive to become a doctor, and expensive to run an office (staff, benefits, liability ins, etc), and expensive to cover the overhead such as rent, etc.).

Many patients go to Oahu for testing, and non-emergency surgery. But that is inconvenient for the patient. PETs, second opinions that require pathology, Kaiser (insurance) patients, etc, often head to Oahu due to that being where the facilities are. But given a choice, we'd rather stay home on the Big Island if we could, close to our own dwellings, transportation, family, and support systems.

Serious injuries and life-threatening conditions are sometimes airlifted to Oahu, because there are hospitals there that have more advanced surgical facilities,etc. But that is similar to living in any rural area ... limited medical care.

Informative, detailed, accurate, and dispassionate...MAHALO dude. Fantastic contribution.