State support vital to grow local doctors

We face a future where our aging population will likely find personal physicians in short supply ("Doctor shortage grows," Star-Advertiser, Jan. 20).

Three factors — population growth, aging and projected physician retirement rates — will combine in a perfect storm where demand for health care services will outstrip projected supply.

Hawaii is already nearly 900 physicians short when compared to national norms.

Fortunately, Hawaii has many pieces in place that, with coordinated action, could avert this crisis. At the John A. Burns School of Medicine — Hawaii’s medical school — kamaaina make up about 90 percent of each class. But newly minted doctors can’t open up practices the day after they get their degrees. To become board-certified in a medical or surgical specialty, medical school graduates must complete three or more years of graduate medical education (GME).

The UH, in cooperation with Hawaii’s major teaching hospitals, puts 240 doctors to work every year as physician-trainees in GME. They span the major specialties, including internal medicine, pediatrics, geriatrics, surgery, psychiatry, obstetrics and gynecology, and family medicine, among others.

Seventy percent of the physician-trainees earn a modest salary paid by federal government dollars; the other 30 percent are paid by the hospitals or private funds, but medical school clinical faculty trains all of them.

How do we know that growing local doctors with this GME training after medical school works? Of the number of medical doctors (MDs) who complete their medical degree and GME training in Hawaii, 80 percent remain and practice in Hawaii. This retention rate is the highest of any medical school GME program in the country.

Many states facing primary care shortages, yet recognizing the cost savings of a robust primary health care system, have augmented the federal funding for GME. This important piece of the puzzle is missing in Hawaii. The state has not yet directly invested in the medical school’s GME training.

To be sure, state funding has been essential for the medical school’s undergraduate program since the school’s inception 50 years ago, and has been rewarded with a remarkable outcome. Almost 50 percent of doctors currently treating patients in Hawaii either trained or are teaching with the UH medical school.

State support for GME would allow the UH medical school to expand the post-MD training of new doctors. Adding eight new GME trainees per year will add 80 additional doctors over the next decade. Even while in training, these doctors are caring for patients while being supervised by our UH clinicians. Our goal is to add new physician-trainees in the specialties and locales where Hawaii’s doctor shortages are greatest.

In our family medicine GME program, we’ve already charted how effective the investment can be. For over 23 years, the UH Family Medicine Residency Program has produced 111 family physicians, 52 percent of them starting as graduates of the UH medical school, 14 percent of them Native Hawaiian, with 70 percent of them staying in Hawaii practice, including on the neighbor islands.

Building on strengths we already have by investing in our own physician training pipeline will provide an enduring solution.

We hope the state will consider allocating money to expand GME (at the UH medical school and at other locations throughout the state, including the Hawaii state hospitals) through the existing, but so far unfunded, Hawaii Medical Education Council.

The Council, charged with advising the state government on GME strategy, consists of appointees already approved by the Legislature.

This Council would provide clear oversight of state monies going into physician training, thus providing a coordinated, strategic deployment of those monies and ensuring the health workforce will be in place for future generations.