Residency aims to provide more rural doctors


HILO — A residency training program starting in Hilo with the goal of increasing rural family doctors statewide could get a needed infusion of funds in this year’s legislative session.

The Hawaii State Association of Counties, meeting Monday in Hilo, heard a pitch for its support as bills seeking $2.8 million annually for the program wend their way through the state Legislature. One bill, SB 664, sponsored by Sen. Josh Green, D-Kona, a physician himself, last week passed the Senate Health Committee he chairs. A House version, HB 417, sponsored by Rep. Mark Nakashima, D-Hamakua, is scheduled to be heard by the House Health Committee on Wednesday.

The Hawaii County Council last month passed a resolution asking the Legislature to support the measures. Hilo Councilman Dennis Onishi, the island’s representative on the state association, urged his colleagues to get their councils to also submit resolutions, or failing that, send a letter of support to the legislative committees on their own.

The primary care training program began in 2006 as a partnership between Hilo Medical Center, the John A. Burns School of medicine at the University of Hawaii and various members of the community. But funding ran short and the program couldn’t gain traction.

The new partnership, between the Hilo hospital and Hawaii Health Systems Corp., aims to train 12 primary care residents, four in each year of the three-year program. It also seeks to train clinical pharmacists, advance practice nurses and psychologists specializing in rural health care concerns.

“This program is but one spoke in the wheel of what we’re trying to do to improve health and respond to the needs of the people of this state,” said Howard Ainsley, HHSC East Hawaii Regional chief executive officer.

The program is especially needed on the Big Island, said Dr. Kristine McCoy, the program director, because the island is expected to have fewer than 300 physicians, less than half the number needed, by 2020. A 2012 UH-Hilo study found that one in three physicians currently practicing on Hawaii Island doesn’t plan on doing so within five years.

A residency training program on Oahu in conjunction with the medical school has shown that most residents stay on to practice medicine on Oahu.

“Neighbor islanders really haven’t benefited too much from the current training program,” McCoy said. “I think it’s really important for us to demonstrate the need for this across the state.”

Each additional primary care physician per 10,000 people reduces population mortality by 5 percent, studies have shown.

Most doctors on the island are nearing retirement age, and there are few young doctors taking their place. Doctors tend to settle down and build a practice in the area they complete their residency, McCoy said.

The training center plans an interdisciplinary approach that will stretch physicians’ services. Teams can care for up to 10,000 patients, while a doctor working alone can see about 2,500 patients, she said.

HSAC members in general seemed supportive of the program. But some also had concerns.

“My only concern is they’ll come here and train and then they’ll go somewhere else,” said HSAC President Mel Rapozo of Kauai.

While the training staff “can’t hook lie detectors” up to the candidates during the interview process, there is a way to select candidates who have plans to stay on the islands, McCoy said. She said long-term plans to stay will be a priority requirement for successful applicants.