Doctor shortage worsening


BY COLIN M. STEWART | STEPHENS MEDIA

HILO — A new survey of Big Island physicians reveals that 32 percent plan to end their service here within the next five years.

The results of the survey, which are to be published in April in the Hawaii Journal of Medicine & Public Health, indicate that current efforts to attract more doctors to the island aren't accomplishing enough, and the community should address the problem with "increased urgency."

Twenty percent of the physicians surveyed reported that they planned to retire within five years. Meanwhile, 16 percent of those who were not planning on retiring responded they did not anticipate practicing medicine on the Big Isle for the next five years.

"Combined, this suggests that Hawaii Island will lose (about a third) of its current physicians within the next five years," wrote the author of the report, Karen L. Pellegrin, director of continuing/distance education and strategic planning at the University of Hawaii at Hilo College of Pharmacy.

"These findings indicate that increased urgency to find solutions is warranted. While efforts to improve the pipeline of medical students and residents with extended training on Hawaii Island are greatly needed and should continue, it is unlikely that these efforts will be sufficient to address the current and projected shortage."

Among such efforts is Hilo Medical Center's Family Practice Residency Program, which provides on-the-job training for new doctors. Studies have shown that up to 80 percent of doctors who go through such rural residency programs remain to begin their own practices.

Supporters say that the program is the Big Isle's best hope for attracting and retaining physicians. But, the program has faced a rocky beginning since its launch in 2006, with the state withholding funding because of budget shortfalls. Big Island legislators have introduced a bill this session seeking funding for the coming year. Meanwhile, the residency program has yet to host its first class of doctors, but organizers say that may happen by the summer of 2014.

The survey was completed by 127 Hawaii Island clinicians in the summer of 2010, including 96 physicians, 15 nurses, five pharmacists, four physician assistants, two social workers and five other health care workers.

The questions, according to Pellegrin, were designed to measure clinicians' ratings of the general environment of the Big Island community, as well as aspects of the environment specific to health care. Respondents were asked to rate a variety of those aspects using the descriptors "excellent, very good, good, fair, and poor."

The results showed that the majority of physicians who relocated to Hawaii Island did so primarily because of quality of life issues; few relocated to improve their earnings, Pellegrin said.

"However, the best predictors of retention were financial sustainability, professional opportunities, community support and access to good K-12 schools," she wrote. "Not surprisingly, these were also the strongest predictors of physician recruitment of colleagues to Hawaii Island."

There has been plenty of "clear documentation" of the isle's doctor shortage, said Sharon Vitousek, director of the Hawaii Island Healthcare Alliance. But Pellegrin's new report shows that the future picture of health care on the island is even grimmer than originally thought, she said.

"There's now an even greater urgency," she said, "because the shortage is simply getting worse."

Vitousek added that the impact of such a shortage goes beyond the number of physicians on island. Each doctor who sets up shop here spurs the need for an average of five directly related jobs, such as nurses and clinical staff, as well many other jobs not directly tied to his office, such as with insurance companies handling new claims, equipment suppliers and others.

"That means new tax dollars for the state, not to mention the impact on economic development," she said.

In a Tuesday afternoon phone interview from a conference in Washington, D.C., Pellegrin said that no single approach would be able to combat the island's doctor shortage alone.

"The work being done by the College of Pharmacy, Hilo Medical Center's residency program, and through the ($16 million) Beacon (Community) grant, medical home initiatives ... and others, all of those efforts are about making better use of the resources we have," she said.

"We're looking at, are there other types of care providers that you can add to a primary care team to expand the reach of each physician?"

By implementing more support personnel, including pharmacists, nurses and others, in caring for residents, the Big Island health care community can make the best use of the doctors it does have, she said.

cstewart@hawaiitribune-herald.com