Hawaii Physician Shortage Problem Must Be Given Higher Priority

The shortage of physicians nationally and in Hawaii has been as the saying goes watching a train wreck in slow motion. Data projecting a shortfall has been available for some time, even before the COVID-19 pandemic that exacerbated the situation to its current grim levels.

But just like the multiple pitfalls of the US healthcare system – runaway drug prices, runaway healthcare costs (all out there for everyone to see and struggle with) – the problem of a physician shortage was left ignored, and because of the economic instability caused by COVID-19 that we find ourselves facing, will most likely be put aside for yet a longer period of time.

Some of the reasons for the shortage in Hawaii include the aging of physicians and retirement; not enough new physicians are coming to practice in the state; the high cost of living is driving doctors to leave the islands; insurance reimbursement is lower in Hawaii compared to other states; Hawaii lacks adequate residency training positions that forces local graduates to move; administrative tasks got too complicated; and newer technology also got too complicated for older physicians not tech savvy.

Some of these problems are not unique to the healthcare industry. Certainly, technology has pushed many seniors into early retirement in many industries from accounting (new software rendering old-school methods obsolete) to engineering.

Some of these problems are as natural as the earth’s rotation in a given year – that physicians get older and leave the workforce.

Some of them are more complex to solve like the high cost of living in Hawaii (that won’t change) because its tied to fixed market forces like the lack of land space affecting lease space and isolation affecting shipping fees. Both drive the cost up in every aspect of Hawaii life, that also impact all small businesses. Healthcare, ultimately a business, is not immune to such market forces.

Then there are bigger problems for the physician shortage rooted in the sickness of the healthcare industry itself – the overburdening requirements by the insurance companies and government — that requires a large, costly and specialized administration staff. This doesn’t look like it will be changing anytime soon.

Coupled with the higher-than-average (compared to the mainland) fixed costs of doing business in Hawaii and the hefty administrative costs, it’s no wonder why some Hawaii physicians are opting to leave; and younger, more entrepreneurial physicians are choosing to set up practice on the mainland.

Doctors are trained to heal people not be businessmen and businesswomen. So as the healthcare industry (particularly in Hawaii) transforms to a more business-oriented environment, it was almost certain that physicians not trained in business or have no interest in it, find themselves leaving solo practice to work for large physician-groups (better paying options on the mainland) or taking an early retirement.

UH Medical School is Key to dealing with physician shortage

The central challenge, the long-term goal is how do we get younger physicians to stay in or move to Hawaii to meet the local population’s medical needs?

There is a bright upside to this. Hawaii is still a very desirable place to live and work. When the state economy stabilizes, more aggressive steps can be done to increase the UH Medical School’s admissions level and its residency programs. Both will help tremendously to retain new graduate physicians to stay in Hawaii.

In the meantime, there needs to be more efforts in recruitment. And there already are initiatives by the state and physicians-groups working on this. But are their recruitment efforts too narrow in scope, is the question.

Tapping into the foreign workforce pool should be an option. Incentivizing foreign physicians to help with the medical labor dearth locally arguably is the fastest and immediate way to deal with Hawaii’s physician shortage problem.

Further down in the far future, perhaps the state investing in a UH Medical hospital where graduates can do their residency (opposed to relying on local hospitals and clinics) as we see in other major universities would do wonders in providing a steady stream of physicians wanting to stay and work in Hawaii.

Structural Problems

In addition to the structural problem of excessive regulations the health insurance companies and government require (a situation with no easy way to fix because it’s a political one; not to mention some government regulations are actually preferred as a check on the industry), there is the other structural problem that the healthcare industry must contend with that is putting Hawaii at a disadvantage – the high cost of education.

Medical school students upon graduating facing a quarter-to-half a million dollars in debt, then having them practice in Hawaii with its exorbitant cost of living is certainly a disincentive, to say the least. This is why the state-federal repayment program must continue. How it works? Qualified physicians must commit to practicing in Hawaii for set years in exchange for assistance with their educational loans.

Shortage Consequence
The collective remedies to correct the local physician problem cannot be left as they are now — small, incremental, loosely coordinated efforts. The situation is dire; but it could get worse where patients’ medical needs will not only be an inconvenience to meet (long-wait times, traveling farther distances, substandard care), but it could also have a consequence of death due to lack of timely access.

Every industry is subject to change prompted by technology and often competing interests. The healthcare industry is no different. What makes the healthcare industry arguably more unique is the gravitas of its work of patients health, and the consequences that could mean life or death.

We’ve already seen how short-sightedness and a lack of funding in public health have harmed our communities vis-à-vis COVID-19.  And we certainly don’t want to be playing catch up as what the entire pandemic is, a reactive response to what was already known, that a major pandemic was (and is) looming.  This is all the more reason why dealing with the physician shortage problem must be given higher priority.

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