The UH medical school dean is relying on community support to help him improve the level and quality of health care in Hawaii
POSTED: 01:30 a.m. HST, Jul 23, 2010
Dr. Jerris Hedges now has two years under his belt as dean of the University of Hawaii's John A. Burns School of Medicine. Besides taking the helm of the full complement of existing research and education programs at a relatively young medical school, the job presents him with challenges unique to Hawaii, as well as problems he shares with counterparts across the country.
The dean, trained in emergency medicine, has a 30-year career in clinical care, university teaching, research and administration. The administrative tasks here, as at other state-run schools, included paring programs to cope with budget cuts.
This state also faces a doctor shortage, but that's a national problem, too. The fierce competition for doctors is not going to ease up, so the medical school is in the midst of a grow-your-own approach, admitting its largest class of 64 students for this fall.
Recent developments include a workforce summit to discuss the issue and one piece of good news: Gov. Linda Lingle's decision to release $140,000 over the next two years to start a residency training program on the Big Island.
The school provided the data that helped it make the case for such programs. Research showed that, given its population, the state is at least 500 doctors below the national norm. And as doctors near retirement, the gap is expected to widen.
QUESTION: What is the medical school doing to help reduce the shortage in health care providers, especially on the neighbor islands?
ANSWER: Addressing that really requires a multi-pronged approach.
The long-term need is to make sure those living on the neighbor islands who have the drive and background, to direct them toward a health career ... We work with the area health education center to make sure that our schools are tied into the preparatory needs and have the career guidance support to help students choose health careers.
We have next been talking about, how do we have more medical school training on the neighbor islands? This has several positive values. The more time that our trainees spend in the neighbor islands, the more likely they will see this as a desirable practice site.
Coming from a rural area, I understand many of the key reasons one would find practice in that setting desirable. You have close contact with the community, you know the major leaders of the community, it's a very personable environment, it's very trusting and warm in terms of the outreach between the residents. ... The challenge we face is that as you bring the medical students into an urban setting, you get out of the mode of wanting to practice in a rural area. Getting more of our medical students trained on the neighbor islands will help.
The second piece is to do more of our resident training on the neighbor islands and that's where we've set about working in conjunction with Hilo Medical Center, with the School of Nursing and Pharmacy there at UHHilo, as well as our school of nursing here at UH Manoa, to develop an interdisciplinary clinic. ... The facility has been open and functioning for a year.
Q: What are the disadvantages of the school's remote location?
A: The school is about collaboration. I know that is really the mantra for Hawaii. We have to work together, we have to build programs that are meaningful for us and our diverse population, but we also don't have some of the readily accessible resources that you might on the mainland, making us more self-sufficient in many ways and requiring us to collaborate in a way you wouldn't otherwise see a medical school provide.
One of the things that's easier to do if you're running a program in the health care field ... is if you need support services, ... you can often get a response, if not in your immediate community maybe the next state over. But to get those human resources and professional support here in Hawaii, we certainly can bring some folks over on a limited basis, but the cost is quite high and it's hard to sustain that. So it's better to develop the talent within Hawaii that both has a commitment to the state but also will be here year-round and not on an intermittent basis.
Q: Besides the recent allotment of money for the Big Island residency program, what other support has come through?
A: The monies provided by the Legislature have been added to by the community. There have been fundraisers for the Hilo Medical Foundation; there's also been support from HMSA, which has given money to help start the clinic.
Q: What is enabling JABSOM to cope with budgetary constraints?
A: The unions affiliated with the personnel accepted some pay cuts that allowed us to do a little more with the budget we have. ... In some areas we have not done some rehiring; we were able to restructure how we deliver services. In some cases we eliminated an educational program that was less heavily subscribed to.
Q: How do you view the school's principal goals?
A: The primary missions are education (and) also research. It expands the knowledge about how care is best delivered and what the underlying basis of illness is that may interfere with health. But research also is job stimulus for Hawaii, and the medical school alone has contributed to more than $40 million in new jobs for Hawaii.
Q: Besides the obvious physical and multicultural attractions of this state, what persuaded you to take this job?
A: We clearly have had our challenges in Hawaii, in part related to our remoteness and in part related to the recent economic downturn. But I think what made me very interested in this position was the opportunity to be in a setting where you could build upon strong ties to the community. It was that opportunity to be so entwined with the community that was interesting to me.