Isle training of physician assistants is proposed

State lawmakers and health officials are looking at new ways and incentives to train and hire more physician assistants to help alleviate the “severe shortage” of primary care doctors in the islands.

For starters, state Sen. Josh Green, along with local health care providers, is in preliminary talks with the University of Washington to create a physician assistant training program in the state, possibly on Hawaii island. Founded in 1969, UW’s MEDEX Northwest Physician Assistant Program is touted as one of the nation’s first physician assistant programs that aims “to recruit, educate and train PA’s to meet” health care shortage needs.

Green, a practicing physician and incoming chairman of the Senate Human Services Committee, said a partnership “would be a very good development for the state of Hawaii because we have a severe shortage of providers, and to be able to grow our own … means that we can finally get ahead of the shortage.”

In addition, Green said, he is drafting a bill for the next legislative session to give physicians a tax credit of $50,000 a year for two years when they hire a physician assistant or nurse practitioner to practice primary care. “That would enable people to recruit and attract these professionals to come and hopefully stay and work in Hawaii,” he said. “If we don’t provide some kind of incentive or program, then we’ll continue to be out-competed by either the specialties that can pay more for the professionals or other states.”

While still in the early stages, the potential partnership and Green’s bill point to the growing urgency of Hawaii’s doctor shortage. A recent physicians workforce study projected that the state will need between 800 and 1,000 additional primary care physicians by 2020 to keep pace with the current demand, with shortages exacerbated on the neighbor islands and in rural communities.

Health officials in Hawaii are trying to recruit more physician assistants, who work alongside doctors as part of a team, and nurse practitioners, who are qualified to perform routine clinical procedures, treat some illnesses and prescribe medications.

Betty Stewart, clinical coordinator of the MEDEX Northwest Physician Assistant Program, said: “Health care in the Hawaiian Islands is only going to get worse unless there’s innovative ways to meet those needs. You’re not growing your own (doctors) fast enough, and there’s too many incentives for medical students to leave the islands where they get higher pay on the mainland.

“That’s going to continue to be a barrier. By having a local program where they stay and train and are educated in the Hawaiian Islands, they will stay in the Hawaiian Islands and practice.”

UW recently won a $200 million grant from the Bill and Melinda Gates Foundation to fund global health initiatives by which the school might be able to help alleviate health care disparities. The program has four regional education hubs in Seattle; Spokane, Wash.; Tacoma, Wash.; and Anchorage, Alaska, and is looking to make Hawaii its fifth training location, according to Stewart. Officials have targeted UH Hilo as a possible site for such a program, partly because the doctor shortage is especially acute on the Big Island.

There are about 300 actively licensed physician assistants in the islands, not including those in the military, but most work in higher-paying specialties, said Fielding Mercer, legislative liaison with the Hawaii Academy of Physician Assistants. “Physician assistants were intended to be primary care providers in rural areas where they couldn’t get physicians to go,” he said. “Most of the PAs are in specialties; it’s just been a trend over the past several years. It’s opposite of what PAs were created to do.”

The average salary of a physician assistant in Hawaii is between $80,000 and $110,000, compared with doctors, who can make between $300,000 and $1 million depending on the specialty, he said. Most PA programs are three to four years of training on top of an undergraduate program.

Green, the state senator and doctor, said salaries for physician assistants are much higher on the mainland, which makes it “almost impossible” to attract physician assistants or nurse practitioners to work in primary care.

Dr. Scott Miscovich, a primary care doctor and head of Windward Primary Care Physicians and Windward Urgent Care, is also involved in the preliminary effort to create a state-UW partnership. “The bottom line is we’re not training and graduating enough students here from the University of Hawaii program to meet our current needs nor our future needs, since we know we’re going to be over 800 physicians short in the next five years,” he said. “Physician assistants and nurse practitioners are well trained and able to assist in both primary care and specialty care. This has been shown across the U.S. to be a perfect solution to addressing access to care.”