Isles face widening shortage

Health officials are bracing for a significant physician shortage as demand for services grows among Hawaii’s aging population and more doctors leave the workforce.

The state is currently facing a shortage of more than 700 physicians, a statistic that is expected to double by 2020, according to preliminary data collected by the Hawai‘i/Pacific Basin Area Health Education Center at the University of Hawaii John A. Burns School of Medicine.

It took three months for Hilo residents David and Helen Bradbury to find a primary care doctor when the Oregon retirees moved to the islands four years ago.

"We had about two or three refusals before we found one that would accept our Medicare and TRICARE insurance," said David Bradbury, 77. "They just weren’t taking any more of that insurance or weren’t taking it at all or were slowing down (their practices).

"It’s getting worse all over the U.S. It isn’t just Hawaii. It’s hard in small communities now to keep physicians. As the older ones retire, new ones aren’t coming in."

Right now Hawaii needs 3,537 doctors but has only 2,795. The greatest shortage is in primary care where the state is lacking more than 300 doctors, the data show.

As a result, many young adults can’t find a provider when they’re too old to see their pediatrician and neighbor island residents don’t get their cancer treated promptly, said Kelley Withy, head of the Hawai‘i/Pacific Basin Area Health Education Center.

What’s more, the state has less than half the number of specialists — heart surgeons, cardiologists, neurologists, general surgeons and radiation oncologists — necessary to meet the needs of the population, she said.

"If you need a doctor and you can’t get one, then it’s urgent," she said. "It’s probably threatening the health of a number of people who can’t get physician services."

The findings will be presented Saturday at the 2014 Hawai‘i Health Workforce Summit, which will include a job fair for 400 health professionals and students.

Many older doctors are opting to retire now because of the changes in medicine, added Withy, who stopped practicing medicine last year after working as a family physician for more than two decades. She now does research and teaches full time at the medical school.

Those changes, spurred by the Affordable Care Act, also known as Obamacare, include penalties and reductions in already-low Medi­care reimbursements if doctors do not use electronic medical records and electronic prescribing in their practices.

"Obamacare may be encouraging some older doctors to retire because of penalties it includes for not complying with provisions," she said.

In addition, the state doesn’t train enough doctors and is constantly trying to recruit from the mainland, which has a shortage of its own in rural communities.

"They’re already short of physicians and our salaries are lower and cost of living is higher so we tend to lose half of the new physicians who come here within a couple years," she said. "Because we don’t have enough physicians, we don’t have as robust a medical community for them to come into. Some of our hospitals are not updated so they may not be as attractive to physicians, therefore we depend on our locally grown ones but we’re not growing enough."

The state this month was awarded more than $300,000 in federal grant funds to repay loans for doctors going into primary care and behavioral health. But the program can access only $100,000 because the state must match the funds, Withy said.

"We can only take as much money as we raise locally," she said. "There’s $200,000 sitting on the table we can’t use because the Legislature doesn’t give us any money."

The AHEC program is trying to raise matching funds at www.ahec.hawaii.edu.

Senate Health Chairman Josh Green (D, Naalehu-Kailua-Kona), an emergency-room doctor at Kohala Hospital, said he is working with the Department of Health to use tobacco tax dollars to match the federal funds.

He also hopes lawmakers will help the medical school expand by at least 15 percent to 20 percent to meet the needs of the state.

Green said he is working with insurers to increase reimbursements for doctors who work in so-called patient-centered medical homes, a team-based medical model that coordinates care among doctors, nurse practitioners, physician assistants and other health providers to care for a group of patients.

The physician shortage "remains a very serious threat," Green said. "We need to work with a team to get more people to commit to primary care. If people continue to leave the islands, our system will crash."

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