A preliminary analysis of this year’s surveys of licensed physicians in Hawaii shows that the supply of working doctors has decreased by more than a hundred doctors in just one year.
Of particular concern is that a big chunk of those doctors left the state.
The updated 2019 Hawaii Physician Workforce data was presented at this past weekend’s Health Workforce Summit hosted annually by the University of Hawaii Manoa (UHM) John A. Burns School of Medicine (JABSOM) Hawaii Pacific Basin Area Health Education Center (AHEC).
Kelley Withy, MD, PhD, AHEC Executive Director and Principal Investigator of the Workforce Report, said the current supply of licensed doctors who are working full-time, according to the preliminary data, is 2,819 physicians statewide. There are 108 fewer practicing physicians than at this same time last year. Her data show that 49 physicians retired the past year — perhaps not surprising given that well over a quarter of Hawaii doctors are past the age of 60. Another 58 physicians reduced their work hours, entering into semi-retirement. But the number that got a lot of attention was the one showing 39 doctors left the state.
“The stressors physicians are facing have increased dramatically the last 20 years,” said JABSOM Dean Jerris Hedges, MD. “There is no doubt that the environment for practicing medicine has changed and the pace of that change is happening more quickly.”
Some of the changes began with increased documentation expectations required for care reimbursement and use of Electronic Medical Records to provide that detailed and often redundant documentation. Additional requirements for process based “quality metrics” attached to government regulations or reforms imposed by providers of health insurance have added to physicians’ administrative burden. Increased patient care reporting requirements (some unique to each insurance company) take additional time away from seeing patients, in some cases requiring practitioners to hire additional staff to help with those tasks. “For example, there are five different Medicaid insurance carriers in Hawaii alone,” Hedges said, each with its own physician credentialing and patient documentation/quality metric requirements to be met.
Increasingly doctors will seek out large physician practice groups where third parties in the practice can do more of this administrative burden. Were there only one insurance entity, the burden would be more reasonable, but with multiple insurance companies the administrative burden adds up, and impacts career choices.” said Hedges.
Seeking Solutions
Dean Hedges says the situation is not hopeless. Health systems are beginning to explore growing larger employed physician groups to bring about economies of scale and reduce physician administrative burden.
Further, the medical school and state leaders have moved forward to ease the economic burden on physicians in several areas. A Hawaii State Loan Repayment fund has been established to help ease the educational loan burden of doctors and some other health care professionals who agree to work in Hawaii health care need areas. A tax credit has been approved by the state to assist some private health professionals who train learners in their practice.
There is also a need to train more physicians who are prepared to practice in a transformed healthcare environment. The medical school has taken in more students, and in the works, is an ambitious plan to branch out year-round teaching on the neighbor islands.
JABSOM has increased admission in every incoming class since 2010, expanding the entering class size from 62 students to 77 without adding faculty or new classrooms. Now the University and medical school hope to get permission from the Regents to ask the Legislature to support the teaching of medical students across all 4 years on Hawaii Island and Maui. A state investment of about $1.4 million per site annually would be required, primarily to support additional faculty and staff. The learning classrooms would be provided using existing UH facilities on the neighbor islands and clinical settings would evolve through JABSOM’s partnerships with health care providers on each island.
The Shortage: Oahu and Neighbor island points of note
Other data from the Workforce Summit provided snapshots of how dire the situation looks when it comes to specialty care on neighbor islands, and even paints a sober picture regarding the supply of general practice family medicine doctors on Oahu. On Kauai, the data show there are no island-based specialists in infectious disease, critical care, neonatal-perinatal care, neurological surgery, geriatrics, allergy/immunology, rheumatology, endocrinology, or physical medicine and rehabilitation. Maui has no island-based neurological or colorectal surgeons; Hawaii Island has no island-based neonatal-perinatal care doctors, none in infectious disease or colorectal surgery. On Oahu, it is getting more difficult than ever to find a general and family practice doctor — with a 46% shortage of those physicians based on need according.
The 2019 Hawaii Health Workforce Report will be finalized between now and December, when it will be submitted to the Hawaii State Legislature. Through the state, a fee is attached to the issuance of doctor’s licenses in Hawaii to support the annual survey and efforts by JABSOM to support working physicians’ well being. The legislature adopted the annual survey out of its concern over our already critical physician shortages in some parts of the state, coupled with projections that our aging population will need more medical services in the future, not fewer.
