A proposal to help address the doctor shortage by expanding the University of Hawaii’s medical school to Maui sparked interest among legislators at budget briefings last week.
The UH plan aims to train and keep more doctors in Hawaii, especially in rural areas, and to attract faculty physicians who would teach the next generation while treating patients on Maui.
“Our goal is to retain these practitioners in Hawaii. Our belief is that many will choose to practice where they are taught,” said Dr. Jerris Hedges, dean of the John A. Burns School of Medicine.
The medical school attracts more than 2,000 applicants
every year, including roughly 250 from Hawaii. The current first-year class at the campus in Kakaako is the largest ever, with 77 students, and 80% of the student body is from the Aloha State. But the school has run out of space and cannot keep up with demand for doctors in Hawaii.
The proposed Maui satellite operation anticipates enrolling up to six students a year, or 24 over the four years of medical school. It would also serve as a base to expand residency programs for post-graduate specialty training, which are seen as crucial to building the local physician workforce.
“I would really like to see us growing our own physicians for Neighbor Islands,” said Sen. Sharon Moriwaki
(D, Kakaako-McCully Moiliili) at a briefing for the Ways
and Means Committee on Thursday.
The $1.4 million request in the 2020-21 supplemental budget would cover hiring eight faculty members, almost all of them medical doctors in various specialties, along with operational costs.
In addition to their teaching duties, the physicians would generate part of their salaries by treating patients. That would provide needed medical services to the community while opening up more clinical opportunities for students.
The satellite operation may be able to use classroom space at UH Maui College and would collaborate with Maui Memorial Medical Center and other physicians on Maui, Hedges told legislators.
Mandy Rock, a second-year medical student at UH reached by phone Friday, said she is excited for future medical students if the proposal pans out — and wishes it had been available for her.
“If only it happened sooner!” said Rock, who grew up in Haiku, Maui. “I really think it’s going to open doors for a lot of people back home.”
“Medical school was not on my radar because you tend to look at what opportunities are available at home,” she said. “I was fortunate to go through nursing school at UH Maui College and I fell in love with medicine enough that I wanted to keep going. Having a satellite school there will make it more attainable, tangible for students back on Maui.”
The proposal has also drawn interest beyond Hawaii, according to Hedges.
He said, “The interesting thing is, since we’ve started talking about this, we have colleagues around the country who say, ‘Let us know when you start a teaching program, because we’d like to leave our institutions and work there, but we don’t want to practice there unless there is a teaching component.’”
Although the medical school is educating more students than ever, it does not graduate nearly enough to meet the need for physicians in Hawaii.
“We lost 150 doctors last year,” said Sen. Michelle Kidani (D, Mililani-Waikele-Kunia). “I would like to increase the amount that stay here and have their residencies.”
The statewide shortage of active physicians is estimated at 509 positions, according to the latest Hawaii Physician Workforce Assessment Project Report, released Dec. 30. And the supply of doctors is distributed unevenly around the islands, making the shortfalls worse in certain specialties and areas.
Last year, 152 doctors moved away from Hawaii and 91 practicing physicians retired, according to the report, but there was a net gain of 47 active doctors as others started practice here.
Hedges said the Burns School of Medicine has a relatively high rate of graduates choosing to work in the state compared to other public medical schools across the country. About 51% of UH graduates are practicing in Hawaii eight to 10 years after receiving their medical degrees.
But a lot of local graduates do settle elsewhere, often after completing post-graduate specialty training, known as residency, on the mainland and building family ties there.
Residency programs in Hawaii are limited, with none offered in certain fields, including emergency medicine, neurosurgery, dermatology and ophthalmology.
Rock, who would like to go into emergency medicine, said she will have to spend at least three years on the mainland, before she can return to Maui, where she hopes to practice.
A Maui satellite medical school could serve as a base to expand local residency programs and would give students more exposure to practicing on the neighbor islands, Hedges said.
At the House Finance Committee’s briefing Thursday, Rep. Troy Hashimoto (D, Waihee-Waiehu-Wailuku) suggested a novel way
to keep more medical
graduates in the islands.
“If they want to get the benefit of in-state tuition, can we say, ‘You have to stay in Hawaii for at least five years’?” Hashimoto asked. “To me, it’s a pipeline issue. We’ve got to expand in Hawaii.”
Hawaii residents receive a nearly 50% discount on tuition at the medical school. In-state tuition is $36,672 a year for local residents compared to $71,328 for nonresidents.
Rep. Scot Matayoshi (D, Kaneohe-Maunawili-Kailua) suggested that the discount could be considered a loan that would have to be paid back to the state if students don’t practice in Hawaii after their residencies, and a scholarship if they do.
Rock said the idea would be problematic for many students. Hedges said it could have “many unintended consequences that we would have to sort through.”
Amid a national physician shortage, the UH medical school competes for the best students, some of whom are lured away from the islands with offers of free rides. It also serves many students with financial need for whom even in-state tuition is a challenge.