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"We have to recruit them from the mainland. About half of the ones who do come here leave within a few years.”
"Other reasons doctors don’t stay include the inability for a spouse to find employment"
"Doctors also don’t earn as much in Hawaii as they do on the mainland, Withy said."
I think you have an extremely unique situation RugbyDave.......
The article talks specifically about generalists and even more specifically about hospitalists (the very thing I am trying to talk about as well), though it did touch on specialists down the page, briefly, though only talking about the wait time to see us). You need to understand that, by having more specialized services on the other islands, we are not relying on O'ahu for everything. Both Maui and the BI are seeing two new places, and I am hoping to help mitigate these wait times. Everything is bottlenecked into O'ahu and there are fewer services on the other islands. I, for one, am attempting to help that out, in whatever small way I can!
I am mostly arguing, as you can see from my words, from a private practice specialist. If a clinician chooses not to go into private practice, then they are of course bounding themselves to their contract salary. However, this is the case anywhere.
I've said time and time again that I understand many older, hospital-working generalists may make less money. But that's not my argument, if you read my posts. I'm arguing that specialists, and even younger clinicians, working in their own private practice can make whatever they choose to, depending on the type of care they provide, how much they work, and what type of clinician they are. I'm never arguing with anyone's point of view, but just simply providing my own and attempting to get some of you to recognize that all clinicians are *not* the same. Some go to school longer to specialize and focus on more specific areas.
So I would agree with you by saying what I said above: many older, hospital-working generalists may make less money here than other places. However, that is not the summation of my argument, which is that many private-practicing specialists may make more money here than other places. That's it. I'm also just trying to pass on the info that it's not just salary that makes people leave. Nowhere in OpenD or Mikala's posts did I read anything about CME credits, lack of centralized training, lack of supportive fellowships or a solid residency program. Nowhere did I see a separation of the different types of clinicians. Because of that, it's sort of just basic to say "people don't stay in the medical field because of money" - that's too glib of an answer. Sure, it's a place to start for a dialogue on the issue, but it's only that - a starting point. As that article touches on, these things I point out are an endemic problem to Hawai'i.
BUT, we can change that! Which is partly what I am trying to do - set up good practices with fellowships and residency programs to help attract and KEEP good clinicians, whatever the specialty.
An example, you ask? Gladly: I am bringing my endoscopy equipment and will provide trainings within Hawai'i in this field. Clinical ENT is scary without good imaging, and it's quite scary that they tend to use older protocols, like modified barium swallows (MBS), which, in most states, are considered quite antiquated. I assess many patients using MBS, and I am trained on it, but with endoscopies, you can actually SEE an image and there is no need to introduce radiation to patients. Plus, using a radiologist is more cost-burden, whereas an endoscope can get pretty much everything I need anatomy/physiology wise with literally 3/4 the cost of a radiology study. See what I mean? It's things like that that scare good clinicians away!
but again, I wear it on my shoulder, whtviper1: this is just my opinion and my point of view from the NEW generation of clinicians. This paradigm of 1950s-medicine is slowly going the way of the betamax. I was just sharing my thoughts, as I hate hearing "its just the money" excuse for medical fields here. You gotta separate it out a bit more.
Quote:
Originally Posted by PaliPatty
Dave, I really appreciate your input here and was wondering... can you clarify something (and forgive me if I missed it in previous posts)?
Are you a physician? Again, I apologize if you already stated your medical background on the forum.
Thanks for sharing!
Not a problem -I've posted it in some other threads, but I'll just send you a PM!
Quote:
Originally Posted by Jungjohann
What the internet really needs, is some kind of a device, that you would connect to part of your body, perhaps your 'da kine', (read that however you like), and this device would incorporate a sensor, which would automatically record exactly how much BS each and every post one put up here contained.
Pfft, we'd never hear from RobinRossi again if that were the case! (kidding RR).
But really, it's way more fun to talk about this stuff in person - I'm meeting with two forum members next week to do some assessments! This forum has been a great help and I take most people at their words. I just know there's a lot of 'unknowns' within my field, especially with the gap in good medicine here, so I enjoy sharing my experience in hopes of helping other people to see the realities of it. I can just as easily clam up too
Last edited by RugbyDave; 07-03-2013 at 06:50 PM..
Dave, I really appreciate your input here and was wondering... can you clarify something (and forgive me if I missed it in previous posts)?
Are you a physician? Again, I apologize if you already stated your medical background on the forum.
Thanks for sharing!
Quote:
Originally Posted by RugbyDave
Not a problem -I've posted it in some other threads, but I'll just send you a PM!
Thanks for the PM, Dave, and the clarification. Forgive me, but I thought you were a physician and must have missed when you told us you were a Speech Language Pathologist. My fault for not reading.
I do see, from you PM, that as an SLP you do many things and it's great that you chose to bring your skills to Hawaii!
Erm, I'm actually a Medical Speech-Language Pathologist, and did a Post-Doc Residency in Medical SLP at the Mayo Clinic. Regular SLPs can't practice internally, where I do (endoscopies, botox, anesthetic, etc). SLPs also don't tend to be in neurosugery suites or work in Clinical Neurology, and general SLPs certainly don't work around the goopy blood. Sorry, I'm not trying to be pedantic in any way! I don't do a whole tone of traditional SLP work (e.g., language,communication), as my specialization and post-doc fellowship was more in clinical Neurology/ENT. The Mayo Post-Doc can be tailored to your needs, as they only accept one person a year! I tailored mine more towards Clinical Internal practices (endoscopies, botox, etc). There were great modules in Cardiology and Pulmonology on placing shunts and alternative feeding/breathing devices. We did grand rounds in a multitude of fields.
Regular SLPs only go to school for 6 years, while I did close to 10 (approaching 11 if you count fellowship/residency year). Sorry if it seems like the same to you, but there's a HUGE difference between a Speech-Language Pathologist and a Post-Doc Medical Speech-Language-Pathologist.
As I said, few of us are true Medical SLPs (trained by the Mayo, and work in surgery suites). I did my extra training and specialized in a lot more. Our scope of practice is pretty broad, which is great, and we work between the brain, head, and neck. We flit between Clinical Neurology (many of us have our Doctorate in Neuro), Clinical ENT and Surgery Suites. I've done training in Trauma, Inpatient, Outpatient and Rehab. I place breathing tubes, feeding tubes and have just finished my Laryngeal Injection certification. Also something Regular SLPs don't ever do. I have done some clinical training and conduct a lot of research into venom and its abilities to help treat a variety of neurological disorders.
Again, few SLPs go this highly specialized route - But then again, I always preferred to be an autonomous medical personnel - I work well with others but would rather own my own practice and help train future clinicians in some of this stuff. Pretty cool stuff to me, but I imagine it's quite boring to most. We get the fun cases that generalists can't figure out or who can't legally/ethically treat due to their lack of training.
I wish there had been some posts like this when I was moving here again - this is fun to discuss and dialogue about in order to help our state grow and attract/keep more clinicians. It's very on topic as many people choose not to move here because of the medical issues in the state.
The doctors I am referring to are all private practice, some are GPs and a couple are specialists.
It's not income alone, it's the cost of living here among other things. All of them were born here. I only know about 10 doctors socially, so that's my basis. Well, that and a bunch of news articles essentially saying the same thing. Of course there are going to be exceptions, but from everything I've read and heard, doctors experience a raise in lifestyle when they move out of the islands.
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Of course there are going to be exceptions, but from everything I've read and heard, doctors experience a raise in lifestyle when they move out of the islands.
Yes, exactly.
I'm glad to hear that RugbyDave has his own life on a short leash right now, but frankly I just don't see anything he's shared making any difference at all in my life.
Doctors are in short supply in the Big Island, Dentists too, all of the medical arts actually, and the situation is getting worse, mostly because of doctors leaving or not coming here to begin with for financial reasons. Experienced nurses have been going through deep layoffs, and new nursing grads can't find jobs. Many doctors are not accepting new patients. Make that "most."
I wish Dave well, I really do. I just don't find any of what he's shared to be relevant to life down at my end of the funnel.
The doctors I am referring to are all private practice, some are GPs and a couple are specialists.
It's not income alone, it's the cost of living here among other things. All of them were born here. I only know about 10 doctors socially, so that's my basis. Well, that and a bunch of news articles essentially saying the same thing. Of course there are going to be exceptions, but from everything I've read and heard, doctors experience a raise in lifestyle when they move out of the islands.
I'm in my fourteenth year here, living and working as an RN in Oahu teaching hospitals. Being here more than long enough to see newbie residents go on to become practicing physicians and established physicians come and go, I've been able to make a few observations.
As far as residents go, they almost all leave for the mainland once they're done with their residency here. The few that stay, IME, become hospitalists or join the staff of free-standing medical centers. Regular hours, no on-call issues, no costs that would be incurred by opening up their own offices. I have a hard time thinking of any residents in recent memory who have gone into private practice.
Quite a few years ago there was a wonderful Hawaiian resident who said he was going to Molokai after he was done training. I'm pretty sure he did.
Of the many docs I know who have come here from the mainland? Few remain. Why did they leave? So many reasons but the most often cited are the lack of opportunity, isolation, poor schools for their kids, ridiculous housing costs. When I hear "do you know what I could get in (fill in almost any mainland town) for what I would have to pay for a little house on a postage stamp here," I know I can start the countdown.
And I won't get into it on this forum but there is more than a bit of old-boy croneyism and institutional politics that comes into play. Disheartening, to say the least. 'Nuff said on that one.
I'm glad to hear that RugbyDave has his own life on a short leash right now, but frankly I just don't see anything he's shared making any difference at all in my life.
<snip>
I wish Dave well, I really do. I just don't find any of what he's shared to be relevant to life down at my end of the funnel.
Then count me as the happy exception to the rule, guys! At least now you can't say "every clinician I talk to thinks XYZ."
And you may not need my specialty now, but I'll still gladly help you if you ever need it friend, whether I know it's you or not. I moved here to help out this community, regardless of whatever your own opinions and attitudes are. My goal is to help bring some more specialized medical services to this Island - you may not appreciate it or care, but your family and friends may; Other people here do. It's one major reason that people choose to stay away from living here long-term. Few people actually BRING something to this Island which I'm still glad to, in spite of your warm welcome.
Not all specialists go into private practice, but my only point is more that, some of those who do find great work and salaries here. We know that hospitalists and generalists tend to leave. I am not arguing that, simply presenting the other side that private practice specialists can do good here; At least some lurkers or future potential medical personnel can have these posts for their own thoughts. The reasons many medical personnel leave is way more than 'just salary' - the problem is deeper than that, and I argue with a few small fixes, we could see some better change in our state (e.g., funding better fellowships and resident training programs, offering more specialized training courses, offering better CME availabilities, holding more unified conferences, etc) - This is my major point.
Though I'm unsure if it was meant or not, your words actually make me feel kinda low right now to be honest, as I've only experienced happiness with bringing what I have to offer to this island. I'd never assume anything in my life, but I guess you and I are different in that regards. I'll continue to stick with trying to actually help the situation in real life, versus arm-chair/passively-aggressively debating it on the internet. Good luck in life with that attitude, OpenD - yeesh
Glad to find such a open, warm bunch here - had more fun as a lurker but am simply trying to balance the scales with this issue. Received the message loud and clear and will go back to lurking.
Last edited by RugbyDave; 07-03-2013 at 10:09 PM..
I'm not the first person you've misjudged here. It's not a winning strategy.
Quote:
I'll stick with trying to actually help the situation versus arm-chair/passively-aggressively debate it.
I didn't put you down, I didn't judge what you are doing. As a matter of fact I think it's all admirable and wonderful and and it makes me feel warm and fuzzy and I wish you well with it. I really do.
What I said, and what I meant, is that I don't see your unique and individual situation as having anything at all to do with the big picture here. It certainly doesn't impact my life in any way. There is still a large and growing doctor shortage here and the projections look even worse, and the largest single factor is that doctors don't make the money here that they do on the mainland, etc...
OK? You're not wrong about you. I never said you were. Please afford me the same courtesy.
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