Given the right incentives, would many doctors with Hawaii ties opt to practice in the state?

Despite the high costs of living and myriad challenges in Hawaii, many of the University of Hawaii John A. Burns School of Medicine’s current students and graduates say, given the opportunity, they want to practice here and give back to their community.

Thus far, there has been an overwhelming response to the state’s launch of a loan repayment program for health professionals in return for two years of practicing in Hawaii.

The Healthcare Education Loan Repayment Program — an effort to address Hawaii’s chronic doctor shortage — provides $30 million in educational loan debt repayment to health professionals licensed or otherwise certified to practice in and provide care to patients in Hawaii.

Some 600 applications were received from throughout the U.S. for the first round of $10 million, according to Dr. Kelley Withy, director of the program and the Hawaii/ Pacific Basin Area Health Education Center.

Applications opened Sept. 1 and closed Oct. 1, and had to be filed by either U.S. mail or fax. They reopen again Dec. 1 with electronic filing options, according to Withy.

Christina Tse and Darin Poei, both ‘Iolani School and JABSOM graduates, jumped at the opportunity to apply for the program.

Both are posted in residency programs in Southern California but knew from the beginning that they eventually wanted to return home to Hawaii to practice medicine.

Tse, who just graduated from JABSOM this year, is doing her internal-medicine residency at Harbor-UCLA Medical Center in Southern California.

The plan was always to return home to practice, she said, to be with family and in the community she was born and raised in.

Growing up, she became interested in medicine while helping family members translate, interpret and navigate the health care system. She is the first generation in her family to go to medical school.

“It’s important for me to advocate, to serve my community,” she said. “It was a question of how soon to go back in terms of being able to financially live in Hawaii, so I think having this program really incentivizes us to come home sooner, at least for me.”

Poei, who is a second-year resident at Los Angeles General Medical Center, said his goal is also to work in internal medicine in Hawaii.

“I always had in mind when I was leaving for residency that I was always planning on coming back home,” said Poei, of Kaneohe. “It would be an indefinite commitment for me.”

Hawaii has a unique diversity and sense of community, they said, and is ultimately home although they value the experience of working out of state.

The program offers loan repayments starting at $12,500 and capped at $50,000, in exchange for two years of full- or half-time serv­ice in Hawaii for a broad range of health care professionals — from physicians and registered nurses to social workers, pharmacists and podiatrists.

To qualify, participants must also accept public insurance such as Med-QUEST for at least 30% of their patient care claims while practicing in Hawaii.

Interns, residents and fellows currently in professional training in listed health professions may apply.

Hawaii’s shortage

Hawaii’s ongoing shortage of health care workers spans across many fields, especially for primary care physicians and behavioral health providers, and more so for specialty physicians practicing in rural areas.

Hawaii currently has the equivalent of about 2,962 full-time physicians, according to a report to the Legislature in December, and needs about 776 more to meet the state’s needs.

The greatest shortage remains in primary care, with another 162 needed across the isles.

The greatest subspecialty shortages in Hawaii are in pediatric pulmonology; pediatric gastroenterology; pediatric endocrinology; adult pulmonology; colorectal surgery; thoracic surgery; allergy and immunology; and adult endocrinology.

This physician shortage spans the nation, according to the report, and is expected to continue growing in the next decade due to the growing needs of an aging population along with an aging physician workforce considering retirement.

Additionally, the COVID-19 pandemic had a negative impact on practicing physicians, causing burnout, moral distress and compassion fatigue.

The state is also short of nearly 4,000 health care professionals across numerous fields, including about 1,000 registered specialty nurses, according to a recent report from the Healthcare Association of Hawaii.

Imi Ho‘ola

A long-standing program at JABSOM gives a boost to disadvantaged local students, helping bridge the path between college and medical school.

Lauren and Erin Kim are both first-year medical students, part of the class of 2027, who found their way to JABSOM via the Imi Ho‘ola Post-Baccalaureate program.

Founded in 1973, Imi Ho‘ola, which means “those who seek to heal,” is a pathway program designed to provide educational opportunities to students from disadvantaged backgrounds.

Only 12 students are accepted to the program each year, and not all have completed it. But those who do complete the yearlong program automatically enter JABSOM to become first-year students.

The Kim sisters, Mililani High School and University of Hawaii at Manoa graduates, both knew from a young age that they were interested in medicine.

Erin Kim said having been born with a rare birth condition, she saw specialists while growing up who became role models for her and inspired her to pursue medicine.

The two majored in biochemistry at UH Manoa, with a minor in music, and worked multiple, part-time jobs to pay their way through college.

“I remember thinking getting into medical school is out of reach,” said Kim. “At the time, we were trying our best to support ourselves, so when we heard about Imi, we thought it was a good chance to prove we were both capable and resilient enough to take on medical school and succeed.”

It came as a surprise when both were accepted, and while it was a huge challenge, they said it was all worth it.

“I think I studied harder than I ever did, ever,” said Kim. “Just the vast amount of knowledge and skills, to learn how to learn, is something I’m really thankful for.”

Additionally, they bonded with classmates, tutors and faculty, who became like a second family.

The twins are the first in their immediate family to go to medical school, and both say they would eventually want to work in Hawaii, where they were born and raised — and because they know the state has a shortage of doctors.

“Home is home,” said Lauren Kim, who credited their mom for being their No. 1 supporter. “I think by coming back here, maybe after residency, it’s just a good reminder of where we come from and being grateful and maybe also being able to give back to those in need.”

The Queen’s Health Systems offered a stipend to help foot the costs of the program. Applications for Imi Ho‘ola are currently open and due Nov. 1.

A 20-year retrospective study on the program found it has served as a pathway for Indigenous students to become physicians and that the majority have chosen primary care.

The class of 2027 at JABSOM includes 77 students, including the twins who were enrolled in Imi Ho‘ola, a grandfather, and six from Maui and one from Hawaii island.

Admission to JABSOM is competitive, with more than 2,200 vying for those 77 slots.

An estimated half of practicing physicians in Hawaii have either trained at JABSOM or teach at the medical school.

Tuition at JABSOM is currently listed at $37,444, including fees, for the 2023-2024 academic year for residents and $72,100 for nonresidents, according to the Office of Student Affairs, not including books, supplies, meals, housing and other personal expenses.

HELP was developed by JABSOM, HAH and the state Health Department, and funded by the state Legislature.

HELP (HAWAII EDUCATION LOAN REPAYMENT PROGRAM)

>> Provides educational loan debt repayment to health professionals licensed or otherwise certified in Hawaii who meet qualifications for a two-year commitment in the state.

>> Next round of applications open Dec. 1.

>> Visit www.ahec.hawaii.edu (click on HELP) or call 808-692-1060.

Imi Ho‘ola

>> One-year post-baccalaureate program open to people from socially, educationally or economically disadvantaged backgrounds who have demonstrated a commitment to serve in areas of need in Hawaii and U.S.-affiliated Pacific islands.

>> Application deadline is Nov. 1.

>> Visit jabsom.hawaii.edu/apply/imi-hoola to learn more.