“Thank you, Doc, for starting the Urgent Care in Hilo!”
Many folks tell me that, and although always glad to hear, it also saddens me. If there wasn’t such an unmet gap in our medical care, it wouldn’t be needed.
In 2002, we noted my orthopedic patients were having a hard time getting in to their primary care physician, PCPs. Our community docs were aging, retiring, leaving … and replacements were thin. Those left standing were overwhelmed with patients.
If sick or lightly injured, patients might not get an appointment for many days, leaving the ER as the only alternative. Hilo Medical Center ER is the second-busiest ER in Hawaii, second only to Queens. Wait times can be very long. It’s costly to have resources and skills available 24/7, 365 days a year, for saving lives, severe trauma, so every ER visit is expensive. Very expensive.
(Physician shortages have increased since, making the need worse. Last year’s annual University of Hawaii Hawaii Physician Workforce Assessment shows the Big Island short 206 docs, up from 183 in 2022, increasing its entire history. Why are the docs not here anymore? Because they work too hard and get paid too little to be here.)
In 2002, urgent care clinics were starting to pop up on the mainland. So, we also started one, initially with a few docs, just evenings and weekends, taking care of minor illnesses and minor injuries, lacerations, and X-rays that busy PCP docs couldn’t see immediately. Things requiring prompt attention, but not the severe emergencies only suited for the ER.
We promptly handed the patients back to their PCPs, as a one-and-done treatment visit goal. Continuity of care is essential to optimal health care. That’s what primary care is all about: monitoring, advising and keeping folks healthy their entire life (as opposed to urgent care).
Within a year, Hilo Urgent Care expanded to every day, full day. It’s been helping folks ever since. During COVID-19, when some offices were shut or restricted, it never closed, always saw patients face-to-face, and was an early designated testing site for travel.
In 2008, the Puna population was 50,000. Health care was thin, distant. Bill Walter, President of W.H. Shipman Ltd., kindly allowed us a long-term lease to salvage a decaying building and open Keaau Urgent Care, the first in Puna. At the time, it had the only medical X-ray (except dental) between Ka‘u and Hilo and was the only private practice (non-subsidized) medical care between Kona and Hilo.
My colleague and former UH med school classmate Dr. Lorraine Sonoda-Fogel then started Waimea Urgent Care, helping those folks, again without any outside help.
Thirteen years later, Hilo (and Ka‘u) Medical Center started their nearby urgent care in Keaau, and Pahoa, Ka‘u and Hilo. Like every Hawaii hospital, and Community Health Centers, they are not-for-profit — meaning blessed with federal/state grants, “rural health” higher payments, and tax exemption, which private practices don’t get — and were recently blessed with a $50 million deus-ex-machina very generous gift from Marc and Lynne Benioff.
But private practice docs struggle on, unsubsidized, filling the gap as best we can. No worries, we got you.
Dr. Edward Gutteling is the team orthopedic surgeon for UH-Hilo Vulcan Athletics and one of the last endangered free-range Big Island orthopedic surgeons. This editorial is brought to you by Community First Hawaii a nonprofit serving as a convener and catalyst for solutions to improve health and access to health care. For more information, please visit our website at www.communityfirsthawaii.org or Facebook and Instagram pages at @communityfirsthawaii.
