Lei’d Up Health Care by Pat Conrad MD

It was surprising to read that Hawaii of all places has a worsening physician shortage.  Elvis, Steve McGarrett (the cool one, not that millennial fakery), and Thomas Magnum were all in good health when they lived there, so what the hell happened?

I’ve never been there, but rumor has it that Hawaii is a beautiful place to visit, and a lot of people end up wanting to live there, leading to some pretty steep real estate costs.  Consumable and durable goods are also very expensive relative to mainland U.S.A., and of course shipping costs also add on to a cost of living that is significantly higher than the average consumer price index for the rest of us.

“Hawaii lost 51 full-time doctors from 2017 to 2018, the first loss since 2014 when 92 left the workforce, according to the latest physician workforce survey by the University of Hawaii. The state gained 75 doctors last year, 97 in 2016 and four in 2015, the survey showed.”  That equates to an average loss of 16 docs per year over the past four years, amongst an island population of roughly 1.4 million.  Fun fact:  Hawaii’s medical school did a survey that estimates 1 practicing surgeon per every 25,000-plus residents.  They estimate a state-wide shortage of 890 doctors.

“‘Factors contributing to the shortage include better pay on the mainland, frustrations over lower health insurance payments and increasingly onerous regulations to practice medicine,’ said UH professor Kelley Withy, who conducts the annual survey.”  Hawaii, one can humorously note, signed on to the recent ACA-encouraged Medicaid expansion, and now boasts 25% on the program.  “While nearly 10,000 physicians are licensed in the state, only about 3,400 are practicing.”  While losing a net 2% of your doctors over the past 4 years doesn’t sound catastrophic, that is in the context of pre-existing significant shortages compared to the mainland.  Specialists are booking appointments several months into the future, and patients discharged from the ER often can’t get follow-up appointments for weeks or months.

Hmm, what to do?  According to the Hawaii’s John A. Burns School of Medicine:

  • Create a state loan repayment program.
  • Increase the local number of med school grads
  • Increase rural training sites to give med students more exposure to underserved areas.
  • – New booklets, and a new website to promote interest in Hawaii health care job opportunities.
  • – “Increased training programs to support practicing physicians who are transitioning into
  •     electronic records, new federal healthcare requirements, etc.”
  • – “Recruitment of 1,203 volunteer faculty MDs to assist JABSOM statewide.”

Honestly I feel sorry for them.  It’s hard enough to fight uphill against the worsening opposition of flat fees, increasing overhead, referral shortages, and (relatively) more patients.  A remote locale and increased costs of living with no way to independently raise one’s fees make it a worse telling of the mainland story.  Some say the Hawaii legislature is dragging its feet on opening up DPC, while others are making a go of it.

Barring someone laying down some serious extra cash, it’s the same old pig roast.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  3 comments for “Lei’d Up Health Care by Pat Conrad MD

  1. PW
    September 19, 2018 at 6:44 pm

    You know health care is f—d up when you can’t get docs in Hawaii.

  2. September 19, 2018 at 10:05 am

    I was stationed in Hawaii for a few years in the 1990s. I did some moonlighting and new several civilian docs there. Then, the problems were as described above. Pretty much the only care available was through HMOs that were headquartered on the West Coast, such as Straub and Kaiser. The cost of living was significantly higher in Hawaii than it was in California, but there was no cost of living adjustment in salary. Doctors in those clinics were beaten like rented mules.

    Also, there is pretty much no middle class in Hawaii. Either people are rich enough so they don’t care about cost of living, or they are poor enough so that they are on several state entitlement programs. Even people who would be upper middle class anywhere else, such as doctors, lawyers, and other professionals, would pay premium prices for housing not much better than your average garden shed, and would be living month to month, racking up credit card debt.

    I am sure that with all the Medicaid expansion and ACA BS, the situation is a lot worse now.

    Hawaii is a beautiful place, but the cost of living in paradise is too high if you want to raise a family or save for retirement.

    (P.S. I worked with a primary care doctor there by the name of Kelley Withy. She was awesome. It appears that she got out of the rat race and is now a professor. Good for her…but it doesn’t help their physician shortage….)

  3. RSW
    September 19, 2018 at 8:08 am

    “Increased training programs to support practicing physicians who are transitioning into
    electronic records”

    That sound appealing. I’m packing my suitcase.

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