Hawaii County has the third biggest shortage of primary care providers in the country, according to a recent study.
NursingEducation.org, a website that provides information and resources for nursing students, analyzed 2021 data from the Health Resources and Services Administration’s Health Professional Shortage Area tool to rank counties with the largest shortages of health care workers.
The analysis, published in June, identified 15 counties in the United States with the biggest primary care provider shortages, based on available data for 916 counties.
“Hawaii County has 53% fewer doctors than similar-sized communities on the mainland United States, according to a 2020 Hawaii Physician Workforce Assessment,” the ranking reads. “It has 287 fewer doctors than it needs, the biggest shortage in the state. Over the past year, across the state, 110 doctors have retired, 139 have moved and 120 worked shorter hours. Hawaii is the only state that taxes Medicare benefits, and only one of two that taxes health care services.”
Maui County ranked fifth on the list, with a physician shortage of 43% while Kauai County was 13th with a 33% shortage as of December 2020.
“That doesn’t surprise me in the least because Hawaii County, we have the largest health disparities as well,” Lisa Rantz, president of the Hawaii State Rural Health Association and executive director of the Hilo Medical Center Foundation, said of the Big Island’s ranking. “We have the lowest socioeconomic (levels). There’s just a lot of factors we need to address.”
Rantz, however, said more details and plans on how to further address the shortage will come as an upcoming health care needs assessment is completed.
But the growing health care provider shortage in Hawaii and the Big Island is nothing new.
There have long been difficulties in recruiting younger physicians to Hawaii, which means the state is left with an older cohort of providers, many of whom have deferred retirement, the Tribune-Herald reported previously.
Reimbursement rates from insurance companies and Medicare and Medicaid, as well as high overhead and the state’s general excise tax on medical services, are among some of the factors that make it difficult to attract and keep health care providers here.
Additionally, Rantz said federally qualified health centers and rural health clinics have all received federal coronavirus relief money to support their efforts, but private practice providers don’t get the same benefits.
“(Private practice doctors) don’t get enhanced reimbursement rates and they’re not getting funding through the American Rescue Plan.”
But the provider shortage is much more complicated than low reimbursement, taxation and the challenges of living in Hawaii, according to Susan Mochizuki, executive director of Big Island Docs, formerly East Hawaii Independent Physicians Association.
There’s a “systemic problem with how Hawaii health care is structured,” Mochizuki said.
Mochizuki said in an email to the Tribune-Herald that much of health care is delivered by small, single-practitioner clinics that are not able to invest in technology or staff training to take an increased number of patients.
These small practices provide “personalized, compassionate care,” but the business models do not fit with the times, she said.
“I would argue that we have many physicians but their clinics are limited in size and cannot accommodate new patients,” Mochizuki continued.
Additionally, younger providers want to be employed, she said.
“They would be crazy to start up their own small practice without a lot of resources,” Mochizuki said.
One younger provider has been successful at “inheriting” the patient list and business from a retiring provider, she said, but these cases are far and few in between.
Mochizuki said, too, that young health care providers also want a work-life balance and don’t wish to spend all of their extra time trying to run their business and take care of patients.
“We are at a tipping point,” she said. “Our (independent physicians association) has thought about providing administrative services for our independent physicians so they can transition to the new ways of doing things. But physicians tend to be risk adverse and are resistant to handing over management of their private clinics to others.”
Additionally, Rantz said that amid budget shortfalls, the state Legislature was unable to fund the Hawaii State Loan Repayment program.
The program is a federal grant to pay off educational loans for primary care and behavioral health providers who serve patients at nonprofit organizations in a designated health profession shortage area.
According to Rantz, 84% of medical graduates have over more than $100,000 in debt while 54% have more than $200,000 in student debt.
However, Hawaii County, through a Shippers’ Wharf grant, gave $100,000 to the Hilo Medical Center Foundation to provide funding for providers in Hawaii County. That grant supported eight Big Island providers.
But because of that funding, Rantz said the Hawaii State Rural Health Association was able to secure $65,000 from Maui County to support two providers on Molokai.
The DOH provided another $100,000 to fund loan repayment for primary care providers, she said.