I am a family physician running a clinic in Kealakekua. Every day I am offered jobs for twice as much pay, working fewer hours, in places where the cost of living is a fraction of what it is in Hawaii. I keep my clinic open out of dedication to my staff and my patients — I care deeply for the well-being of this community and continue to make sacrifices to serve whoever comes through these doors.

But make no mistake: In the three years I have lived here, I made more in the equity in my house than I have brought home in pay, this despite working six days a week to grow my clinic and serve more people. I have recently had to start an additional job at a hospital in an attempt to make ends meet.

The problems affecting me are no different than the problems affecting all of Hawaii. Hawaii is ranked No. 1 for health care by U.S. News and World Report, a statistic that seems preposterous when 20% of Hawaii residents have considered moving to the mainland or to another island due to health care issues. As of 2020, Hawaii County is short 287-plus primary care physicians and has the third-worst primary care shortage in the U.S.; Maui and Kauai are ranked at fifth and 13th.

There are severe shortages in colorectal surgery, pathology, pulmonary, infectious disease, allergy/immunology and hematology/oncology. My patients must fly to see specialists primarily to Oahu, but patients who have homes or families on the mainland get their specialty care on the mainland to receive services that are either unavailable or would be delayed in Hawaii.

My clinic has suffered the same inflation as the rest of the planet this year. To add insult to injury, Medicare reduced physician fees by 2% on Jan. 1. Hawaii already suffers from the lowest Medicare acceptance rate in the nation. Further, 75% of Hawaii’s hospitals were already in danger of closing before this change. Medicaid payments to physicians and specifically primary care are some of the lowest in the country.

Hawaii is the only state in the country that taxes Medicare and Medicaid services. These costs cannot be passed on to the patient and are based on gross income. As I take home less than 25% of what comes into the clinic, I essentially spend over 20% of my income paying the general excise tax. Removing this unjust tax would essentially give every physician in private practice a raise, a raise that might make the difference between their doors staying open or closing forever.

The Hawaii House of Representatives has allowed bill after bill that would have repealed the GET from health care to die in the Finance Committee. It is nonsensical — the revenue lost from the clinics closed or never opened due to lawmakers’ shortsightedness would have generated more than revenue collected from the GET.

I write this in hopes that you, the readers, will see your physicians as human beings. I write this to stress that the problem is financial. I write this because I am invested in the health and happiness of my community, and want to continue to serve your mothers, grandfathers, children and friends. I write this because I need your help to do so — please speak to your local representative about exempting health care from the GET, and further, to increase payments to physicians through the state Medicaid program.

Esther Yu Smith, M.D., is a family medicine practitioner in Kealakekua and member of the Hawaii Provider Shortage Crisis Task Force.