Report: Doctor shortage worsens (low income, insurance, lawyers)

[terracore]

More than half of the doctors in Hawaii will reach the retirement age of 65 within the next decade, according to a new report submitted Thursday to the state Legislature.

The University of Hawaii Physicians Workforce Assessment says of the 8,900 physicians licensed to practice in Hawaii, roughly 2,903 full-time physicians are actually practicing medicine. The report emphasizes that supply of new physicians is not keeping up with demand and Hawaii is at a critical juncture.
“Demand grows by 50 … per year, and we lose 50 physicians per year, so we need 100 per year to maintain the current staffing levels,” the report concludes.

Who, then, will be your doctor if about half retire or cut the amount of time they serve patients in the next decade?

“We do have this big population of physicians that will be at retirement age fairly soon,” said Dr. Christopher Flanders, executive director of the Hawaii Medical Association.

Flanders, 60, has himself taken on an administrative role with the HMA, meaning he isn’t currently treating patients in his specialty of neurological pathology — something that likely will be increasingly true in the next few years for many of the state’s physicians near retirement.

“I live on the Big Island. So I live with that shortage. It’s concerning,” Flanders said.

According to the report, 15 percent of the state’s physicians already are between ages 66 and 75. The university estimates Hawaii needs the equivalent of an extra 707 full-time physicians in order to meet current patient demand.

In Hawaii County, it is estimated the population needs three allergists, but there is only one. Six infectious disease specialists, three neurosurgeons and three neonatologists are needed. But there are no physicians in the county with those specialties.

Primary care physicians are among those who will be in the biggest demand statewide. And, in Hawaii County, the university estimates there’s already a shortage: the need is for 180 to meet patient demand, but there are only 143.

Flanders said part of the reason is the cost doctors pay to complete medical school.
“When they walk out of medical school with a quarter-million dollars in debt, they have to be careful about what positions they take,” he said.

Flanders said the medical association thinks the Legislature should take a dual approach.

First, he said, legislators should consider the long term and start a rural-medicine education program.
Even if that were to start tomorrow, he said, “it’ll still be seven years down the road” because it takes four years for medical school and then a three-year (at least) residency program to begin treating patients independently.

Secondly, Flanders said, the Legislature should look short term at where Hawaii is falling short in terms of recruitment and retention.

The Legislature and medical organizations will need to figure out how to make jobs more available for physicians’ spouses and to address student debt new physicians typically carry.

“It just doesn’t compete in recruiting. A lot of times they don’t stay very long,” Flanders said.


Report: Doctor shortage worsens | Hawaii Tribune-Herald

[Irish Eyes_Mrs. Z]

Don't doctor programs/states/licensing boards do anything similar to what can be done with teachers to both meet the need in underserved areas and deal with student debt?

When I was teaching (SpEd), teachers of all stripes and endorsement levels could apply for jobs in rural areas with a need, or in Title 1 schools where low income students were in the majority, etc. If they committed to a certain amount of years (generally 5 in Oregon), they could have 1/5th of their student debt forgiven for each of those 5 years, and come out of the contract owing nothing for their education. And the hope always has been, that as a teacher spends 5 years in a school, they'll become attached enough to it to stay on past their 5 years contract.

I don't know how that would work with doctors, who generally come out of uni/residency years with massive debt, but perhaps there's a way it could work, if there's no such program already in place in Hawaii. A ten or 15 year commitment to a certain area where the need is great, and their $150K debt could be wiped clean.

It seems from, what I've read, Hawaii and Alaska and such places aren't the only place with doctor shortages, especially when it comes to GPs (specialties pay better, after all). It seems to be a nationwide problem, for the most part. There needs to be some incentive, everywhere, to encourage more people to become GPs and other underserved doctors. Debt forgiveness could be a major incentive, I'd think. Everyone needs healthcare, no matter where they live, after all.

[mxg67]

While some docs may not stick around due to professional reasons (Hawaii is mostly private-practice style, not very academic or cutting-edge medicine) or personal reasons (island fever), most doctors in any specialty would agree the main issue is money. Compared to their mainland counterparts, Hawaii doctors are on the lower end of the salary spectrum. There's a good sized elderly and low-income population in the islands, which I'm sure puts a financial strain on the healthcare system. Medicare reimbursements are weak, medicaid is pathetic, even private insurance reimbursement is sad. Add school debt, the high cost of living and practicing in Hawaii, it's no wonder why doctors don't want to come to Hawaii, including those who grew up in Hawaii or even went to med school at UH.

Debt is not the only reason someone may avoid becoming a PCP, while debt forgiveness would be a nice touch, the salary is still on the lower end. For a few more years of training or an entirely different specialty, they can make much more money for just as much or even less work and stress, providing themselves and their family for a nicer lifestyle with less worry of encroachment from midlevels. In some parts of the country, NP's are pushing for more independence and a scope of practice similar to that of an MD. Why would someone go through 4 years of med school and 3 years of residency only to compete for jobs with someone with less training?

[Bygeorge]

How many trial lawyers do you have in HI? HI is thousands of miles from families. Isolation is real. On a GP wage a young doctor can live better off island than on. HI is noted to be the "happiest" state and one of the healthiest. That is not good for business.

Best solution is to recruit foreign born doctors from say India.

[stan4]

Bad pay, bad support, bad malpractice environment, being left put to dry when you cant get subspecialty help (bc there aint none), bad public school system (and not really making enough to send your kid to a good private), state income tax...all the reasons I don't work there despite loving the state.