Madison Williams, who grew up in Kula, Maui, hopes to do her bit to address the doctor shortage by returning to her home island as a physician, probably in primary care, where the need is pressing.

She’s one of the lucky ones who got into the University of Hawaii’s John A. Burns School of Medicine, which has spots for just 77 students each year from among 2,000-plus applicants. And she thinks legislators should approve a plan to expand the medical school to Maui so more people will get that chance.

“I think it’s about time,” said Williams, a graduate of Kamehameha Schools Maui and UH Manoa who is midway through her first year as a medical student. “I don’t know why it took this long for talk to get started about this. There are so many smart kids on Maui, but it’s harder because they’re from the outer islands.”

The gap between supply and demand for doctors in Hawaii has grown by 65% since 2010, reaching 507 full-time equivalent positions in 2019, according to the latest report from the Hawaii Physician Workforce Assessment Project, issued in December.

While the shortage is statewide, the neighbor islands are hit hardest. The report pegged Oahu’s physician shortage at 16%, compared with 44% for Hawaii island, 36% for Maui County and 32% for Kauai.

The proposal for a satellite medical school on Maui is part of the university’s supplemental budget request and was included in the state operating budget approved Tuesday by the House. The plan calls for enrolling up to six students a year, or 24 altogether for the four-year program, which could be a model for other neighbor islands.

The $1.4 million price tag would cover eight positions on Maui, largely physician faculty in several specialties, and operational costs including some travel. The physicians would teach and also treat patients part time, generating some of their own salaries and offering more local medical care as well as clinical opportunities for students.

“You would get not just direct patient care and more doctors on island; you would get the training, too,” said Dr. Kelley Withy, principal investigator for the Physician Workforce Assessment Project. “You would generate the pipeline for future doctors.”

RURAL CARE DEFICIT

Physicians have a ripple effect on their communities. A 2018 American Medical Association Economic Impact Study found that each practicing physician in Hawaii supports an average of 12.6 jobs, both directly and indirectly, accounting for about $1.2 million in wages and benefits.

Dr. Nicole M. Apoliona, medical director for Kula Hospital and a family medicine physician, considers the $1.4 million budget request for the Maui school “a fabulous investment.”

“That front-end money may sound like a lot,” she said, “but it actually buys you much more in the end.”

From her perch at Kula’s community hospital in lush Upcountry Maui, Apoliona is on the front lines of the rural doctor shortage. And the figures are daunting.

“We’re short 43 primary-care physicians and 153 physicians total on Maui,” Apoliona said. “That’s a 27% shortage in primary care. We are recruiting in the ones and twos and threes in different practices that have vacancies. But 43 is huge!

“The way to solve the problem has to have a lot of different inputs, and I’m supportive of any and all of the ways that we get there,” Apoliona said. “That includes loan repayments, educating medical students here, more exposure for high school students, medical training rotations, residencies and efforts to increase physician reimbursements in rural areas. That’s how we are going to chip away at that deficit.”

LOOKING BEYOND OAHU

Withy, who prepares the annual physician workforce report to the Legislature, is intimately familiar with the challenge. The UH medical school has already increased its entering class to 77 from 62 students without adding space or faculty, and it needs to look beyond its Kakaako campus.

“The only way we’re going to increase our medical school class size is by training on neighbor islands,” Withy said. “This program would allow students to do most of their training on Maui in hopes that they will then stay on Maui. It’s really beautiful.

“Most of medical training is working in the hospitals or in the community with physicians,” she added. “The community physicians (on Oahu) are overburdened already and can’t do more.”

The Maui teaching hub is expected to attract new doctors as well as ones already on island. Even though they are busy, some physicians are eager to train students.

“It’s easier to recruit a doctor who gets to teach, I believe, because it’s not all patient care,” Withy said. “It’s a diverse employment opportunity. I have no doubt we’d be able to recruit.”

Dr. Colleen Inouye, a obstetrician-gynecologist, runs a busy private practice in Kahului but still makes time to mentor students, even high schoolers. She also interviews applicants for the UH medical school.

“I had six very well-qualified students that I interviewed last year,” she said. “But unfortunately, I know that just because of the number of spots, only probably two at the most will go ahead and be selected for JABSOM.”

Inouye, who has practiced on Maui for 35 years, says some of her patients rely on her as their main doctor because they can’t find a primary-care doctor. She sees as many as 25 patients a day out of her patient pool of 2,000. That daily load used to reach as high as 35, but she dropped obstetrics to focus on gynecology a decade ago after delivering more than 7,000 Maui babies.

The shortage of primary-care doctors means patients might wait until their problem becomes urgent before seeking help, compromising their health and pushing up the cost of care with emergency room visits, she said. And the lack of medical specialists in fields from endocrinology to pulmonology means some patients have to travel interisland.

INCENTIVE TO STAY

Medical school Dean Jerris Hedges said the Maui satellite hopes to use classroom space at UH Maui College and work with Valley Isle doctors and hospitals to place students in their clinical locations. It could serve as a base to expand residency programs.

Residents who go to medical school and do their advanced training in Hawaii have a more than 80% chance of ultimately practicing in the islands, Withy said. She credits the Hawaii Island Family Medicine Residency program with increasing the supply of doctors in that field on the Big Island.

“In the last 10 years we have gone from a deficit of family medicine physicians to a surplus,” Withy said. “I attribute that largely to the fact that there’s ongoing training in family medicine on-island.”

Apoliona said medical students who get a chance to work on a neighbor island might well choose to stay.

“It’s so essential that students and people in training get to have exposure to a rural area because it’s not what they think it is,” Apoliona said. “We practice great medicine, and we have great relationships with our patients.”

Withy thinks the Maui satellite medical school could become a model.

“If Maui can do this, there’s no reason Hawaii island can’t do this,” she said. “If we can create the model, there’s no reason we can’t spread it over the state.”