Incentives can ease physician shortage

The timing couldn’t be worse. The fallout from the implementation of the Affordable Care Act, at least in the short term, includes an acceleration of retirements for physicians who would rather bring their career to a close than adapt to a whole new way of doing things.

At the same time, the wave of aging baby boomers becoming increasingly needy of medical care is looming, straining an island state’s medical system already struggling with a shortage of health providers to serve its rural areas.

Clearly this is a problem that deserves a full commitment by state lawmakers to solve — a challenging mandate in a period of ebbing state revenues.

Already Hawaii is short by more than 700 physicians, 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. And that deficit is projected to double by 2020, said the center’s director, Dr. Kelley Withy, also a professor of alternative medicine at the medical school.

Withy, among the experts addressing the issue at last week’s Hawaii Health Workforce Summit, said Hawaii’s problem may be worsened by an associated shortage in the number of physician assistants and other providers who also shoulder the health care service burden.

"We have fewer physician assistants, so our demand for physicians is higher than on the mainland," Withy said. "We’re really old school here."

One reason, she said, is that Hawaii’s medical profession is dominated by small practices. About 60 percent practice in groups of five or fewer, Withy added. Small practices are less willing to hire support providers, including nurse practitioners.

The ACA has added new facets to the health care system, such as a reliance on electronic medical records, and added emphasis on preventive, primary care and reimbursements based at least in part on health outcomes and working collaboratively across specializations.

Newly trained doctors will be prepared for such requirements, the experts say, but Hawaii finds itself in a difficult transitional period now, one in which new incentives and more intensive recruitment programs are needed to expand the workforce.

There is more than $300,000 federal grant money available to offer loan repayment to new physicians who practice locally, but because of a lack of matching funds, the program can secure only $100,000 of it. An effort to appropriate funds, which failed to clear the state House last session, ought to resume, and even with in the tight fiscal environment, this would be money well spent.

To its credit, the education center is running its own fundraiser for matching funds. Private support does need to be part of the solution.

On other fronts, the medical school is working to add about 10 students to its class size of 66 admitted each year to a four-year training program, said Dr. Jerris Hedges, dean of the JABSOM. One of the limiting factors is the capacity of clinical training programs for that part of the degree curriculum, so the school is working with neighbor island clinicians to take in students.

Additionally, Withy said, nurse practitioner training is ramping up locally, and there are hopes of expanding physician assistant credentialing and postgraduate residency programs as well

One thing Hawaii has going for it is that doctors who are trained here practice in the state to a greater-than-average degree, she said. But in order to keep doctors, the state does have to grow its own. That is a mission that the entire community needs to fulfill, and should embrace now.