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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...
It's alright man, I can agree to disagree and am happy to help continue to try to fix this problem in real life, as I said. I'm glad to work here and live here and make my practice here. I am glad that this doesn't impact your life right now, and hopefully you will never need our services. But if you do, I hope you will be glad that some people on your island are trying to remedy this situation. I work in this field and am just as frustrated as you are with our shortage here. But just throwing money at it is NOT going to help - that article whtviper1 highlighted many of the things I was talking about in a previous post. My opinion in being in the field (and not just having friends in the field) is that simply increasing salaries won't RETAIN people. Sure, it may ATTRACT people, but the issue, friend, is keeping them here. How do we do that? Give us what we need to survive LONG-TERM (e.g., the things I listed above). That's all I'm saying - we can't just jimmy-rig a short-term solution (e.g., money) to really fix the gap here.
I've pretty much said my piece here and it's saved for any future people, so at least that information is out there. It's cool, I really shouldn't take what some people say on the internet to heart so much. I'll gladly take the blame for that.
But we do not need to continue to beat a dead horse here, guys, so no need to keep the sticks up; I'd rather use mine to paddleboard anyways. I've said my opinion and my point-of-view and I'm happy to stick by it. Good tangential discussion for sure on this thread, but we can continue with the original theme if so needed.
I assume Dave you don't take rely on insurance very much (HMSA) they are much of the problem with low reimbursement rates. And with so many old folks on the BI, Medicare payments aren't so hot either. Do you accept insurance?
And with so many old folks on the BI, Medicare payments aren't so hot either.
It's not that much different from Oahu... according to the US Census the 65+ portion on the Big Island is 15.9% of the total population, on Oahu it's 15.1%.
I probably need to read this whole post - feel free to flame me.
Aren't doctors getting screwed pretty much everywhere? I know med school must be high as heck to pay for and the insurance companies are going to tell a doctor what they can charge for procedures when the doctor has to carry liability and pay his staff - anesthesiologists, RN's, etc etc... I feel bad for doctors. Dave you should have been a veterinarian!
Well, I'm pretty disapointed in this forum. It seems like trolling is more prevalent than honest discussion here, and from some of these people's post counts, I wonder if anyone ever gets banned here. Are there any mods?
The forum is called City-Data, and yet most of what I've found here has been conjecture and purely anecdotal. If you guys want to continue to believe the "Hawaii cost so much" myth, go right ahead, but there are plenty of places far more expensive. And by the way, in this argument, we compared Hawaii with LA and SF. None of the people arguing with me claimed to have ever lived in either of these California cities, and I've lived in both. So if you've never lived in LA or SF, and I've never lived in Honolulu, we are equally qualified to discuss this. Except, well, I actually know the facts.
I have worked in fact checking both at a media outlet and a well known talent agency. I worked on a program that disproves myths (you may have heard of it), as a fact checker. One of you told me to sit back and listen to people who "actually live here". Yeah, okay... You might want to sit back and think about reality, and what the FACTS actually indicate, not your buddies or what you read somewhere or heard one time.
This is my wheelhouse, and I'm not interested in wasting my time arguing with people who's idea of "data" consists primarily of unsubstantiated quotes from an article, or their feelings. I provided solid counterarguments backed up with actual, real data that directly contradicted your points. Every time I provided evidence, your arguments changed to a new unsubstantiated claim.
So, bye guys, I wish I could say it was fun... but, well, it was just annoying.
I've lived in San Francisco and still own property there. I find cheaper than Honolulu, AND I find I get more for my dollar there housing wise, though there are some trade-offs, such as size. I've never had to do anything with medical there though.
In SF, I find groceries much less expensive and the utilities. Even tax is comparable when you consider ours is an excise tax and their's is a sales tax.
If you prefer data versus anecdotal, most of the cost of living calculators show SF being a little cheaper than Honolulu.
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Ah, shucks. Mistahjay is another one of those posters who doesn't live in Hawaii, probably never been, yet knows a whole lot more about reality than those of us who live here. Some of the more frequent posters have lived in Hawaii for many years, but newcomers still argue with us when we try to tell them the facts of life. Personally, I'm glad to see Mistahjay go, because he didn't contribute any useful information.
I assume Dave you don't take rely on insurance very much (HMSA) they are much of the problem with low reimbursement rates. And with so many old folks on the BI, Medicare payments aren't so hot either. Do you accept insurance?
Of course I accept insurance but I really enjoy working with some of the disorders that insurance won't cover. In this case, it's a cash business. I also don't find myself having to fight for reimbursement in this speciality. I make my real salaries right now through my HMC/ES salaries and because of that, can do a lot of pro bono work. I'm a single guy with no kids so the salary I make in Hawai'i works wonders for me. As I said, my monthly 'rural health' bonus covers pretty much all my living expenses. It's all about how you situate yourself in this business - if you just want to be a hospitalist or generalist, you'll be stuck making your salary or being capped. But, I'm sort of an 'outside the box' thinker and have found a way to expand my salary while still working with the populations I love here on the Big Island, no less. Granted being single with no kids aids me definitely, I'll concede.
I also do home health contracts which also supplements my salary - I'm guessing few generalists work steady in this capacity (though I'm sure some do). I don't often fight for reimbursement as I see many generalists do. Again, I'm just offering my experience, but feeling slightly sorry to have ever opened my mouth in the first place. And I'll seriously tell you that my skin's not too thin here either. It's no worries because I'm happy to bring my practice to the island to help out and I enjoy the patients and coworkers I work with. I'm happy to still try and change some things here, as small as they may be to others. I've been pretty open with my life and who I am and don't want to overstep too much here. Just though some would be interested in hearing someone with a different experience in medicine here.
Quote:
Originally Posted by hunterseat
I feel bad for doctors. Dave you should have been a veterinarian!
Definitely not. I chose my speciality for the reason of helping others while making money. In private practice, even in Hawai'i, you work for YOURSELF and can make whatever money you're willing to work for. Meaning if I want more money, I just work harder. I still will hire clinicians to work at my practice with/for me, as I enjoy taking the more 'hard to pin down' cases and they supplement my income as well as making money for themselves and helping the community.
In many practices I have worked at, we carry our own insurance. We charge what we want for hourly rates sometimes, and flat rates for others. As a specialist, I'm not bound to the same 'caps' as a generalist. You can hire me for $X/hr, something you could never do with a generalist. This is especially true in diagnostics/assessment. Again, I feel bad for many generalists as well, like you hunterseat - one of the reasons I left that side of things after my first year in school. Many disorders aren't covered by insurance so you don't have to fight or advocate for anyone. As for debt, I made it out with very little. Then again I worked three jobs throughout most of my doctoral and post-doc schooling. Again, single and no kids helped with that greatly. Just my experience I'm sharing here.
Quote:
Originally Posted by mistahjay
Well, I'm pretty disapointed in this forum. It seems like trolling is more prevalent than honest discussion here, and from some of these people's post counts, I wonder if anyone ever gets banned here. Are there any mods?
Yeah there are mods, and I feel somewhat similar to you man. I've only ever found people open and warm in real life but its funny what anonymity behind the computer screen does for some people, especially those that can easily criticize what others are trying to do to actually help the situation here on the islands. You don't have to support what I do, but don't negate those who are tying to help. Not talking to you per se, mistahjay.
It's easy to arm-chair opine, but its a whole other thing to actually spend your life's work and time to trying to bridge the medical gap here. I don't care if anyone likes what I do or even cares what I do, but please note that I'm someone trying to help the situation here with medicine, so people who are thinking of moving here are not so turned off because of the issue. I can't change everything but I sure can throw my life's work into trying. Reading some of the posts/responses here makes me feel pretty disappointed. What are you some of you guys bringing to the table here to fix the medical problem in Hawai'i? Just some posts here and there on an Internet forum...?
I appreciate all the DMs and thanks for the dialogue here, but I think all has been said on this topic. Feel free to keep DMing if there are more questions versus posting here.
As I said above, throwing money at this problem won't fix it. Sure it may attract clinicians in the short term, but its not going to keep them here. My goal is to try to help provide some of those things to help retain good clinicians here. Someone's gotta do it is all I'm saying. I don't need any sacred cow but it kind of stings when people say they don't see a need for XYZ, when I am in this field and saying there is, especially on this island in particular.
It's one of the major problems to be sure. I accept others' opinions on this matter, but can still admit it stings a little, though nothing a walk in the forest won't help!
What am I doing to bridge the medical gap? Out of the goodness of my heart I have developed multiple health problems so I can keep the doctors busy.
I told one of my docs I want recognition because all of my visits HAD to have put one of his daughters through college.
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What am I doing to bridge the medical gap? Out of the goodness of my heart I have developed multiple health problems so I can keep the doctors busy.
I told one of my docs I want recognition because all of my visits HAD to have put one of his daughters through college.
See, that I can get behind Mikala - I knew we had some common ground somewhere
We have a 'wall of fame' in my current practice for kiddos at have been with us for years. It's sad in one small aspect but totally amazing to be able to help these small superheroes in another aspect, especially after what they've been through in their short lives
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Some of the more frequent posters have lived in Hawaii for many years, but newcomers still argue with us when we try to tell them the facts of life. Personally, I'm glad to see Mistahjay go, because he didn't contribute any useful information.
