More Hawaii doctors have left their practices over the past year and likely will continue to do so just as the first major piece of federal health reforms rolls out.
More than 60 doctors left the market within a year, shrinking the workforce by 2 percent after two years of growth, according to preliminary data from the Hawaii/Pacific Basin Area Health Education Center.
The latest estimate places the shortage at 747 doctors this year and nearly 1,500 by 2020. A year ago the shortage was estimated at around 600, based on statewide supply and demand figures. The data will be presented at the 2013 Hawaii Health Workforce Summit on Saturday at Hilton Hawaiian Village.
"It alarms me because in 2020 we could have 40 percent fewer physicians than we need," said center Director Kelley Withy. "There are many changes coming to medicine that some physicians might not like. They will in time help, but if someone is close to retirement, they might not want to invest in the necessary changes such as electronic health records."
Under the federal Patient Protection and Affordable Care Act, the most significant changes of which take effect in January, doctors will face penalties, including reductions in already low Medicare reimbursements, if they do not use electronic medical records and electronic prescribing in their practices.
Penalties start at a 1 percent Medicare payment reduction to as much as 5 percent over the next few years, she said.
Withy, a supporter of health reform, also known as Obamacare, recently stopped practicing medicine after working as a family physician for more than 20 years. She now does research and teaches full time at the medical school.
"In part it’s the hassles of practicing medicine in the current times," she said. "There’s more paperwork, electronic requirements and changing in the rules. There’s more audits now. Things are always changing, and it’s so hard to keep up with."
The state is seeking ways to attract and retain its physician workforce.
Lawmakers are deliberating a bill today that in part would appropriate funds to address the primary-care physician shortage and continue a loan repayment program for doctors who practice in rural communities.
State officials also are using a nearly $1 million federal grant to create a plan that in part seeks to reduce administrative burdens placed upon doctors, streamline regulatory paperwork and develop a team model of care. The state plans to apply for follow-up grants of up to $60 million to implement new health care delivery and payment models.
"There are ways that we can help ease the transition so that people who have been in practice for a long time can successfully transition to a new model — this new model that really we need for a sustainable system," said Beth Giesting, the state’s health care transformation coordinator.
The study puts the average Hawaii physician’s age at 54 years, though many older doctors are opting to retire now because of the changes in medicine as well as the improving stock market that has grown their wealth and financial stability, Withy said.
"Until we improve working conditions (the trend will continue)," she said. "In the next couple of years, we’re going to see a lot of people leaving. My fear is that a lot of doctors didn’t retire that we had projected to retire. The workforce is getting older, and if all those doctors retire at once, we’ll be in big trouble."
