Editorial: Health careers should start here

An inaugural health care workforce study sizing up the non-physician job supply found concerning gaps in various counts of workers with skill sets needed to meet demand for services. Statewide, there are more than 2,200 job openings in hospitals and health care facilities that are taking as long as a year to fill.

The Hawaii Healthcare Workforce Initiative 2019 Report, released last month by The Healthcare Association of Hawaii (HAH), is well timed as increasing counts of non-physician professionals are key to help offset a shortage of physicians.

The state’s current doctor deficit is approaching 800, with primary care physicians, especially on neighbor islands, representing up to one-third of that gap. Among contributing factors are low pay (when adjusted for cost-of-living issues) compared with mainland counterparts; and baby boomers aging out. At least half of practicing physicians are in their mid-50s or older.

The overall trajectory is unsettling as Hawaii glimpses the silver tsunami. By 2030, the age-60-and-older group will account for more than one-fourth of the state’s population. During a span of three decades ending in 2030, the overall population is on pace to increase by 20% while the increase for those in the older group is gauged at upwards of 90%.

While those in the tsunami bracket will need the most health care services among adults, there’s also worrying issues spanning all ages, such as prediabetes and Type 2 diabetes. Together they affect nearly 600,000 people — roughly 1 in 2 Hawaii residents, with Native Hawaiians and other Pacific Islanders two times more likely than other ethnic groups to have diabetes.

To address looming demand in the non-physician sector, HAH intends to refine its study with updates every two years and continue to collaborate with health care facilities, which clearly have a responsibility to partner with secondary and post-secondary schools in training and certification of health care professionals.

Based on the last quarter of 2018 and this year’s first quarter, the HAH survey of 76 jobs found the most vacancies among specialty registered nurses with 463 open jobs, followed by certified nursing assistants at nearly 300.

In 19 of the jobs surveyed — including high-demand fields, such as physical therapy and RN case management — there are no Hawaii-based education or training programs. Establishing programs here should be a priority as a means to help stem health care “brain drain” to the mainland.

Crucial to patient care is a harmonious relationship with “patient-facing” health care workers as well as doctors. And in a relatively isolated place like Hawaii, having local ties and a solid understanding of local culture can help establish trust and rapport needed to move the health needle.

In response to alarming projections, such as that the state’s doctor shortage could climb to 1,500 within a decade, the University of Hawaii John A. Burns School of Medicine is rightly stepping up efforts to expand and diversify offerings, giving homegrown students focused attention.

Also, in response to the spectre of curtailed access to prompt services, Hawaii enacted a law this year that aims to make it easier for physician assistants to practice in the islands. PAs can serve as a principal health care provider — diagnosing illness, developing and managing treatment plans and prescribing medications.

Hawaii is now among the majority of states that allow renewal of PA licenses by meeting continuing education requirements rather than by certification requirements, which are widely regarded as overly burdensome.

In coming decades, the caliber of care here will hinge on a sustained push to successfully grow the ranks of both non-physician and physician workforces.