Big Island - Opinions

[ginabeena]

Aloha All,

I've been lurking about since the autumn. Last fall, I posted about Leeward Oahu and comments were very helpful.

My husband and I came back from like the 10th trip, after staying for a month on Oahu, playing and working, and did a ton of work----we managed to refine our business to a higher degree. Last fall, I wanted to live on Oahu so that I wouldn't have to hop to HNL to get a flight to the ML, but now, I won't have to travel as often as I would have had to before...

That being said, I am investigating the Ranchos and others mainly south of Kona on Hawai'i. We are internet entrepreneurs, are shooting for a house south of 500K, and want a view with a pool. I love the idea of being on a catchment (even with critter issues), and having solar. Commuting and getting a job are not an issue for us (I am feeling shy about stating this, because I hate to brag, but it is true). We are not big nightlife people, don't have kids, and are into sports of any sort---especially biking, hiking, and water sports.

I have spent a lot of time on Kauai, Oahu, Maui, but only have visited Big Island twice. I loved the energy of the volcano, the vastness and wildness of the Big Island, and of course, the Aloha spirit of the people as seen all over the islands....

Can anybody, given the deep experience here on this board, shoot holes in my plans of moving to the Big Island? Is there something I am missing? I am a big planner (the reason I started an online business was so I could move to Hawai'i---and that was 5 years ago!), and take this seriously----so I appreciate your help dearly!

Mahalo!

---Gina

[alohabear]

I love the idea of being on a catchment (even with critter issues), and having solar. Catchment in an area where it hardly rains can be hard if your not used to it. Ranchos is dry and far from emergency facilities( are you in good health?) . I lived in Ka'u for about 6 years and it is nice, the locals will treat you good, but not until you fit in .

[Beachboy]

Aloha,

I just moved my family to the Big Island at the end of Jan. 31st. I have spent most of my life on the west side of the Hawaiian Islands, Kapahulu, Manoa Valley on Oahu, and Lahaina, Honokawai, Napalii & Kahana on Maui. But now we are living on the Eastside of Hawaii! If you want affordable housing in Hawaii there are only two places(districts) left in all of Hawaii that is affordable. Those two places are right here on the Big Island too! Ka'u & Puna. Ka'u is beautiful in it's own kinda isolated way. Beautiful sunsets, and ocean views from almost everywhere there. But it's a drive for anything, and I mean anything! So with that we decided Puna was for us!
Puna offers more if you have kids too. Plus after growing up on the westside of the Hawaiian Islands moving to the eastern wet side offers a pleasant change. Here it is April, and I'm still using two blankets on the bed!!!

Currently I'm staying at a house that will be on the market in about six months. It's huge by Hawaiian standards 2100 square ft. of living space(4 bedrms 3 baths, and has a built in swimming pool to boot! Plus behind that is a 500 square ft. guest house with one bedroom and one bath! It's going on the market this summer for $590K. It's in Puna in a subdivision called "Hawaiian Paradise Park", otherwise known as HPP to locals. It's 25 minutes south of Hilo, and about 20 minutes from the Volcano. So it's pretty much pefectly placed as far as I'm concerned!

[Beachboy]

Aloha,

I just moved my family to the Big Island at the end of Jan. 31st. I have spent most of my life on the west side of the Hawaiian Islands, Kapahulu, Manoa Valley on Oahu, and Lahaina, Honokawai, Napalii & Kahana on Maui. But now we are living on the Eastside of Hawaii! If you want affordable housing in Hawaii there are only two places(districts) left in all of Hawaii that is affordable. Those two places are right here on the Big Island too! Ka'u & Puna. Ka'u is beautiful in it's own kinda isolated way. Beautiful sunsets, and ocean views from almost everywhere there. But it's a drive for anything, and I mean anything! So with that we decided Puna was for us!
Puna offers more if you have kids too. Plus after growing up on the westside of the Hawaiian Islands moving to the eastern wet side offers a pleasant change. Here it is April, and I'm still using two blankets on the bed!!!

Currently I'm staying at a house that will be on the market in about six months. It's huge by Hawaiian standards 2100 square ft. of living space(4 bedrms 3 baths, and has a built in swimming pool to boot! Plus behind that is a 500 square ft. guest house with one bedroom and one bath! It's going on the market this summer for $590K. It's in Puna in a subdivision called "Hawaiian Paradise Park", otherwise known as HPP to locals. It's 25 minutes south of Hilo, and about 20 minutes from the Volcano. So it's pretty much pefectly placed as far as I'm concerned!



I also forgot to mention, this house sits on a fee simple acre of land too. Plus there is a chainlink fence going around the entire acre. That is good if you have dogs?

[craigwatanabe]

What part of HPP you living in?

[Beachboy]

What part of HPP you living in?

howzit Craig, currently we are living between Kaloli & Paradise on 9th Ave. But I will be moving to 3rd Ave hopefully in May if our house is finished by then. Again, it's between the same to streets too. How about yourself Craig, where do you live?

Craig, know of any good plumbers? My 20 gal water tank in garage is going nuts. I flush the toliet once and it kicks in over 40 times...that seems a bit much don't you think? Now tonight my water pressure is down too? Does Catchment water levels have any thing to do with actual water pressure coming out of fosset?

[SusieMisajon]

I really wanna go home.

[craigwatanabe]

howzit Craig, currently we are living between Kaloli & Paradise on 9th Ave. But I will be moving to 3rd Ave hopefully in May if our house is finished by then. Again, it's between the same to streets too. How about yourself Craig, where do you live?

Craig, know of any good plumbers? My 20 gal water tank in garage is going nuts. I flush the toliet once and it kicks in over 40 times...that seems a bit much don't you think? Now tonight my water pressure is down too? Does Catchment water levels have any thing to do with actual water pressure coming out of fosset?

20-gallon water tank? I'm wondering if you're talking about your catchment pump?

First check your filters. A clogged filter will cause low water pressure and can make your pump run longer.

You probably have a pre-charged tank that your pump sits on. This tank has a bladder that is filled with air to a certain pressure. If the bladder is leaking then your pump will run for long periods.

If your catchment pump is cycling too long or way too early upon flushing it may need an overhaul of the system. I work from 8:30 am to 4:30pm Monday thru Thursday at Home Depot Hilo. Come by and we can discuss your situation and possibly remedy it with a simple fix.

When you move to 3rd we'll be pretty close. I'm on Makuu and third right on the corner. Look for the painted water tanks of animals. That seems to be a landmark for people in this area so I never painted it over when I bought my place.

[Beachboy]

You probably have a pre-charged tank that your pump sits on. This tank has a bladder that is filled with air to a certain pressure. If the bladder is leaking then your pump will run for long periods.

If your catchment pump is cycling too long or way too early upon flushing it may need an overhaul of the system. I work from 8:30 am to 4:30pm Monday thru Thursday at Home Depot Hilo. Come by and we can discuss your situation and possibly remedy it with a simple fix.

When you move to 3rd we'll be pretty close. I'm on Makuu and third right on the corner. Look for the painted water tanks of animals. That seems to be a landmark for people in this area so I never painted it over when I bought my place.

it kicks in over forty time per flush of the toliet. Isn't that rather a lot for just flushing a toliet?? I'm trying to find out if this could also be the reason my electric bill jumped way up too in my last bill? My last electric bill was $286, the previous month was way less than that, and I ran a room heater most mornings too!

But understand, I'm no expert on this setup at all. I only moved over from Oahu in end of Jan. Plus anything to do on land is really "greek" to me.
I will try to stop by this week at Home Depot. Do you work in any special Dept., or area?

[manoageek]

hey ginabeena,

I joined the forum just to reply to your post. :)

I'm also an internet entrepreneur "working from wherever", and my wife and I moved to Hawaii a couple years ago. We initially lived pretty far from town, with city water and hydro but no cable or DSL.

Moving here is GREAT but make sure you have high-speed access (hopefully through redundant providers) wherever you look. Cheers!

- aaron

[craigwatanabe]

it kicks in over forty time per flush of the toliet. Isn't that rather a lot for just flushing a toliet?? I'm trying to find out if this could also be the reason my electric bill jumped way up too in my last bill? My last electric bill was $286, the previous month was way less than that, and I ran a room heater most mornings too!

But understand, I'm no expert on this setup at all. I only moved over from Oahu in end of Jan. Plus anything to do on land is really "greek" to me.
I will try to stop by this week at Home Depot. Do you work in any special Dept., or area?


If your pump is kicking in that many times you have a pressure problem. There is an air valve stem on your tank. Depress it a bit just to see if you have air or water pushing out. If air, stop immediately and then take a tire pressure gauge and read your tank pressure it should be just under 30 PSI or roughly 28-PSI if you have a 30-lb system. If it reads just under 40 PSI then you have a 40-lb system. 30-lb systems are more common.

If on a 30-lb system you have wayyy less than 28 PSI then take a small bicycle pump and pressurize to 28 PSI and try flushing.

If that doesn't work your pressure switch is probably bad and needs replacement (that black plastic box where the electrical feed is located and a small water sense tube connects to)

Now if water comes out of the air valve, then the air bladder has leaked and you have to either replace the bladder or replace the entire pre-charged tank.

This bladder is important as it maintains a 28-lb pressure within the tank when the tank is filled with water. As water is pumped into the tank it displaces the air bladder. When the tank is full the pressure switch senses 30-lbs of water pressure and shuts off the pump.

The tank provides a ballast or a buffer so the pump doesn't come on as soon as the pressure drops.

In your case when you flush, the pressure drops. The pump kicks in and repressurizes the system but the system is in use so the pressure keeps dropping as water is drained out. The pump turns on again and shuts off when the pressure is achieved. But the cycle happens (in your case) 40-times over until the toilet stops.

We sell all items needed to repair your system. I work Monday thru Thursday from 8:30 to 4:30 pm in the Hardware department although what you need is in the Plumbing department. But I can help you with your pump problem.

BTW, my electric bill for last month was $458. Get used to the high electrical costs here on the Big Island and it's going up again as the PUC just approved HELCO's rate increase.:(

[Beachboy]

If your pump is kicking in that many times you have a pressure problem. There is an air valve stem on your tank. Depress it a bit just to see if you have air or water pushing out. If air, stop immediately and then take a tire pressure gauge and read your tank pressure it should be just under 30 PSI or roughly 28-PSI if you have a 30-lb system. If it reads just under 40 PSI then you have a 40-lb system. 30-lb systems are more common.

If on a 30-lb system you have wayyy less than 28 PSI then take a small bicycle pump and pressurize to 28 PSI and try flushing.

If that doesn't work your pressure switch is probably bad and needs replacement (that black plastic box where the electrical feed is located and a small water sense tube connects to)

Now if water comes out of the air valve, then the air bladder has leaked and you have to either replace the bladder or replace the entire pre-charged tank.

This bladder is important as it maintains a 28-lb pressure within the tank when the tank is filled with water. As water is pumped into the tank it displaces the air bladder. When the tank is full the pressure switch senses 30-lbs of water pressure and shuts off the pump.

The tank provides a ballast or a buffer so the pump doesn't come on as soon as the pressure drops.

In your case when you flush, the pressure drops. The pump kicks in and repressurizes the system but the system is in use so the pressure keeps dropping as water is drained out. The pump turns on again and shuts off when the pressure is achieved. But the cycle happens (in your case) 40-times over until the toilet stops.

We sell all items needed to repair your system. I work Monday thru Thursday from 8:30 to 4:30 pm in the Hardware department although what you need is in the Plumbing department. But I can help you with your pump problem.

BTW, my electric bill for last month was $458. Get used to the high electrical costs here on the Big Island and it's going up again as the PUC just approved HELCO's rate increase.:(

ended up getting a whole new system. 42 gallon Flotec setup. Craig, is Flotec a good brand?:confused:

[craigwatanabe]

Yes Flotec is a good brand and I do believe the 42-gallon is a 30-lb pre-charged tank. For that tank you should use the 3/4 HP or lower Shallow well pump (also manufactured by Flotec) as the 1-1/2 HP model will eventually rupture the air bladder inside the tank.

[Beachboy]

it has the 3/4 hp pump with it! Is it, or would it be better to have even larger tank, say the 82 gallon tank at my own house. Family of four with two boys who love to flush!

[hedkikr]

My 1st post...(no pump advise)

I'll be in Hilo May 18~22 on a fact-finding mission becuase I'm mostly familiar w/ Kona (diving). I plan to retire there in a couple of years - sell my Orange Co. home & buy a smaller place cash.

I don't want to be in Hilo town but a 15-20 min. drive isn't too bad. Don't know if HPP area is for me & I keep seeing "Kaumana City" and "Ainako Subdivisions" mentioned.

I want to bring my elderly mother along & set her up in an ohana next door/ in da back.

Any & all local insights/advice is sincerely appreciated.

BTW: I'm 1/2 Japanese & my wife's Filipina.

[craigwatanabe]

The areas you mention is good but the reasons why I'm deciding to move back to Oahu is the lack of decent medical support in Hilo. I've been here for almost 4-years now and just two months ago was I able to find a doctor.

Cold calling via the yellow pages will net you with, "I'm sorry Dr. So and So is not taking anymore patients at this time". I had to basically ask one of my co-workers that lives here in Hilo to ask his doctor if he would take me in.

Thru word of mouth I was able to find a good doctor. No don't get me wrong, there are a lot of doctors (okay a handful) that will take you in, but when your health is of your concern, you want a good doctor, not just anyone.

Since if you get a doctor on the first crack, then that doctor has openings for a reason...he's not that good.

For elderly care, the situation is even worse with specialists virtually non-existant here. Flights to Oahu and Maui are typical for most people living in East Hawaii.

My parents are reaching their ends of the lines soon. My dad is 90-years old and I want to make sure he has adequate health care in his golden years. Hilo just cannot offer it.

Kaumana town is above Hilo and close to medical facilities but there are differences of opinion there as to go with county water or remain on water catchment in the upper areas of Kaumana.

HPP is a nice area to build however the traffic is becoming a bit hectic around rush hour time (I actually found it easier to travel the zipper lane in Honolulu than Pahoa Highway in the mornings). Health care out in Puna/Pahoa is also a concern as you are about a half hour drive from HPP to Hilo Medical Center. The Keaau fire department is next door to Bay Clinic which offer urgent care but these facilities are limited to clinical needs only.

[Pua'i Mana'o]

I wonder how long before the DR residency program under Burns MS opens on the Big Isle.

[Miulang]

I wonder how long before the DR residency program under Burns MS opens on the Big Isle.
Even if the program started today, it would be years before the infrastructure to create the facilities required could be built, given the current CON situation in the State. The medical residents would need to have places to practice, and with the exodus of so many doctors from the Neighbor Islands, I fear that access to even basic healthcare on the neighbor islands is going to be critically lacking for quite a few more years unless the State's healthcare system is completely overhauled, particularly in the area of reimbursement and malpractice insurance.

Miulang

[Beachboy]

The areas you mention is good but the reasons why I'm deciding to move back to Oahu is the lack of decent medical support in Hilo. I've been here for almost 4-years now and just two months ago was I able to find a doctor.Craig, wow when are you moving back to Oahu? Have you been planning this for awhile or is it all of the sudden I tired of this lack of infrastructor that has finally taken it's toll on you?

As I read your post I'm getting a bit nervous. I haven't had health care since we moved here. A family of four with no health care. Am I playing with fire or what? But I figure no need rushing into anything. If there are no doctors what's the hurry?

One of the fastest growing island, but none of the people moving here are doctors!? What gives Craig, what is the problem here money,malpractise insurance, what's keeping the doctors away?

[Miulang]

One of the fastest growing island, but none of the people moving here are doctors!? What gives Craig, what is the problem here money,malpractise insurance, what's keeping the doctors away?
Yes, Beachboy, money (in the form of reimbursement from the feds, state and private health insurers), the high cost of malpractice insurance, lack of a backup system (many docs are on call 24x7x365 because they don't have other practitioners to share that duty with them, which causes practitioner burnout) and the higher cost of living on the Neighbor Islands all play a role in the lack of adequate healthcare on the Neighbor Islands.

As long as you and your family are young and reasonably healthy (and you don't plan on having any more kids or have any chronic or weird diseases), you will probably do OK. But you'd better know where the nearest hospital or clinic is anyway because the Puna area is still considered "the wild west", and if you do have something weird, expect to have to fly to Honolulu for treatment.:(

Miulang

P.S. You may want to see if you can find a practitioner of lomi lomi nearby or think about learning more about the kanaka maoli way of healing with native plants so at least you have something you can do if someone in your family gets sick.

[Keanu]

I fear that access to even basic healthcare on the neighbor islands is going to be critically lacking for quite a few more years unless the State's healthcare system is completely overhauled, particularly in the area of reimbursement and malpractice insurance.

Miulang

I wouldn't hold my breath. ;)

[WindwardOahuRN]

The lack of advanced health care on the neighbor islands is a very scary thing. Working in the critical care area, I get to see just how little the neighbor islands have to offer in the way of anything more than basic care.

Complicated cases come to Oahu. There are no ifs, ands, or buts. Some diagnostics are done on neighbor islands but once the need for more complex care is identified patients are moved on over to Oahu. There simply are no comparable resources available on any other island. I have stopped being surprised at just how much is NOT available on our neighbor islands.

Very taxing to the families of those patients. My heart goes out to them. :(

[tutusue]

The areas you mention is good but the reasons why I'm deciding to move back to Oahu is the lack of decent medical support in Hilo. I've been here for almost 4-years now and just two months ago was I able to find a doctor. [...]
Was son #6 who, iirc, is under 4, born on the BI or in Honolulu?

I have friends who live in Koloko. She's had some health challenges and has had to fly to Honolulu. All of her docs over the years have moved. Now that I'm finally at a point in my life where I could experience outer island living, I'm also at the point when medical care is more important than ever. I just keep telling myself the Makaha IS outer island living! :D

[craigwatanabe]

I wouldn't hold my breath. ;)


I was hoping with the movement of people here to the Big Island, a decent health care infrastructure would soon follow. Hmmm seems it's getting worse as more people move in but not enough medical doctors to fill the need.

I talked to some of those on the county council four years ago that Hawaii County had better get on the ball and begin to prep for this influx of people. They relished in their increased tax revenue but failed to utilize it early enough, hence basic infrastructures such as electricity, water, and medical facilities have become inadequate to deal with the sudden growth spurt.

Meanwhile I told some that with big business coming in they had better be prepared to deal with their presence. Hilo isn't the small town anymore and if the County Council isn't prepared with a long term managed growth solution, havoc will prevail.

Look at WalMart now. Imagine that Hilo getting a Super Center! How in the world did that happen? When the County Council tried to ban supercenters it came too little too late and even if it did get it approved, it didn't matter because Walmart's supercenter is slated to be built on private lands.

The County Council acted too late and as a result managed growth is going beyond what East Hawaii's legislators could have imagined. If there's anyone to blame for this growth, don't blame it on Walmart, blame it on our elected officials who let this big fish slip by.

As for medical facilities, yeah Hilo Medical Center did a big make over, big deal. There's still not enough doctors here to fill a growing need and because of our isolation, critical care units are needed out here where a medivac flight can be too late.

There is a huge population of elderly men and women here in the Hilo area and their health is waning. We simply do not have what it takes to keep our seniors healthy out here. With a growing middle class entering the housing population, doctors are seeing a greater amount of people with better health coverage than Med Quest patients they are accustomed to so they can pick and choose.

I had a doctor simply tell me that they screen their patients. If you have Quest they will back burner you because if you incorrectly input reimbursement information on a Quest application, there are serious fraud charges levied against you. Doctors don't need that kind of harrassment so they are gun shy of accepting Quest patients.

Don't get me wrong, I love the Big Island but I'm concerned about the health of my family including my aging parents who simply are not getting adequate health care. They complain about not getting their problems resolved. I tell them they need a second opinion...yeah right, from who? You're lucky if you can get ANY opinion.

If there was any reason to move back to Oahu this is high on the list of them. Adequate child care was the other and with my wife working back on Oahu she took my three year old to go to a decent pre-school there. He's flourishing in Honolulu with proper early childhood guidance at his pre school where as one of the more decent ones here in East Hawaii failed him miserably. Elementary, middle and high schools here are doing fine if not excellent, but it's my three year old and my elderly parents that concern me the most and I'm sorry but the Big Island is simply lacking on those two ends.

This is why my family has decided to make the move back to Oahu where facilities are better served. It will be an expensive move but you cannot put a price on a solid educational foundation as well as adequate health care. You simply cannot skimp on either.

[Konaguy]

blame it on our elected officials who let this big fish slip by.


From my view, there is practically nothing Hawaii County can do to help mitigate this doctor crisis. Hawaii County doesn't manage the hospitals or can exert any control over HMSA etc. The entities at fault here for this mess is the federal government, HMSA,the state of hawaii and all those money grubbing malpractice lawyers.

[Miulang]

From my view, there is practically nothing Hawaii County can do to help mitigate this doctor crisis. Hawaii County doesn't manage the hospitals or can exert any control over HMSA etc. The entities at fault here for this mess is the federal government, HMSA,the state of hawaii and all those money grubbing malpractice lawyers.
If this crisis doesn't prod the Legislature (which has a couple of bills pending) to overhaul oversight of the healthcare facilities on the Neighbor Islands to allow those County governments to have more control over what goes on on each island, there is NO hope.:mad: This is the most blatant case of "big city-ism" I can see, where the decisions are all made by people who live and work in Honolulu, even after the residents in each County---who know what is needed and who have to directly suffer the consequences of those decisions---are consulted and their opinions totally rejected. If you're not going to listen to the people who are most aware of what's needed, why perpetuate the SHAM of allowing them to provide feedback???

Miulang

[WindwardOahuRN]

I still have to wonder just how you can legislate doctors into moving to and living in areas in which they don't want to live. Perhaps incentives can attract them initially but when the negatives of living in a place outweigh the positives they will move on.
As far as the JBMS MD residency program on the BI goes? Trust me on this one---residents need experienced oversight, big time. A residency program is not, IMHO, the answer to any health care crisis. Maybe for clinics or regular floors in a hospital but certainly not for complicated cases. So if staffing clinics is the goal it might be a stopgap solution. At least those sore throats and minor issues could be taken care of.
And would these be third or fourth year residents or newbies? I deal with residents on a daily basis. There are very very few that I would trust to take care of me. VERY few (counting fingers and not getting past one hand). I can't begin to tell you how many times we have to question or downright refuse orders from residents. If I ever do have to be admitted I will stipulate "NO RESIDENTS" on my chart. I'm totally serious about that.
I don't have any solutions. Does anyone? Indentured servitude? Free oceanfront lodging, free tuition to private schools for kids of docs, matching Mercedes(es) for doc and wife/husband/SO?

[timkona]

Seems to me that the price of doctoring should rise if there is a shortage. Doctors should adjust their billing accordingly. You work in a short industry, you get to charge premium dollars.

That would then be the incentive for more doctors to move here.

But in Hawaii, free market enterprise is condemned and villified. So insurance companies set rates that are not realistic, and doctors flee to greener pastures. A complicit legislature that shares a disdain for the notion of free market enterprise is essential to the destruction of the health care process.

[Miulang]

Seems to me that the price of doctoring should rise if there is a shortage. Doctors should adjust their billing accordingly. You work in a short industry, you get to charge premium dollars.

That would then be the incentive for more doctors to move here.

But in Hawaii, free market enterprise is condemned and villified. So insurance companies set rates that are not realistic, and doctors flee to greener pastures. A complicit legislature that shares a disdain for the notion of free market enterprise is essential to the destruction of the health care process.
Doctors can raise their prices through the roof if they wanted to, but they only get reimbursed based on what payors (the feds, state or private health insurers) are willing to pay. Healthcare is a highly regulated industry, even in those so-called "for profit" institutions, because there's an industry rule of thumb called "UCR" (usual, customary and reasonable, which are the prevailing rates in any community).

There's a new practice model that's sort of taking hold up here called "concierge (http://www.acponline.org/journals/news/oct01/new_model.htm)" or "boutique" medicine, where for a set fee, you get, as a private patient, 24x7 coverage with no waits for visits. The problem is the service is very pricey and only those with enough income can afford it. So the disparity between being rich vs. being poor and having access to healthcare becomes even greater. If this trend takes hold, then some doctors in the larger towns and cities in Hawai'i might also adopt this model. But how severely would that impact access for people with limited incomes on Quest?

Miulang

[Miulang]

I still have to wonder just how you can legislate doctors into moving to and living in areas in which they don't want to live. Perhaps incentives can attract them initially but when the negatives of living in a place outweigh the positives they will move on.
As far as the JBMS MD residency program on the BI goes? Trust me on this one---residents need experienced oversight, big time. A residency program is not, IMHO, the answer to any health care crisis. Maybe for clinics or regular floors in a hospital but certainly not for complicated cases. So if staffing clinics is the goal it might be a stopgap solution. At least those sore throats and minor issues could be taken care of.
And would these be third or fourth year residents or newbies? I deal with residents on a daily basis. There are very very few that I would trust to take care of me. VERY few (counting fingers and not getting past one hand). I can't begin to tell you how many times we have to question or downright refuse orders from residents. If I ever do have to be admitted I will stipulate "NO RESIDENTS" on my chart. I'm totally serious about that.
I don't have any solutions. Does anyone? Indentured servitude? Free oceanfront lodging, free tuition to private schools for kids of docs, matching Mercedes(es) for doc and wife/husband/SO?
It's true that the so-called "teaching hospitals" (where residents tend to practice) tend to be regarded as less desirable sometimes because of all those "docs in training" running around. But there's a plus side to teaching hospitals, too: that's where the docs are exposed to the latest leading edge technologies.

The Pacific NW has a regional rural healthcare medical education system (WAMI (http://www.washington.edu/research/pathbreakers/1971a.html)) that trains GPs and internists to work in rural communities. The UW School of Medicine is consistently recognized as the best medical school for primary care in the country. What this program does is it recruits candidates with an interest in rural medicine; many are people who come from the communities they go back to serve. If you have ties (and family) to a certain community, as a doc, I think you would be more likely to want to go back to be with your relatives and people you know than to start out someplace where you don't know anyone. Pay for rural docs isn't as high obviously as for those who go into specialties or who practice in large cities, but sometimes it's not all about the money.

Miulang

[timkona]

Ahh yess.....indications of a free market in the doctoring biz.

Plenty rich folks in Kona to pay doctors for whatever. While the legislature and the Insurance Companies screw the po'folks. Nobody ever gets tired of watching the po'folks get burned in the State of Hawaii.

I was always under the impression that it was conservatism that normally keeps the po'folks down. But in Hawaii, we have had liberal political control for decades, and the po'folks is sufferin mightily.

Methinks a rat, or several, may be lurking in the dark, hallowed halls of Honolulu politics. A rat protected by the biggest dogma in the yard.

[WindwardOahuRN]

It's true that the so-called "teaching hospitals" (where residents tend to practice) tend to be regarded as less desirable sometimes because of all those "docs in training" running around. But there's a plus side to teaching hospitals, too: that's where the docs are exposed to the latest leading edge technologies.

The Pacific NW has a regional rural healthcare medical education system (WAMI (http://www.washington.edu/research/pathbreakers/1971a.html)) that trains GPs and internists to work in rural communities. The UW School of Medicine is consistently recognized as the best medical school for primary care in the country. What this program does is it recruits candidates with an interest in rural medicine; many are people who come from the communities they go back to serve. If you have ties (and family) to a certain community, as a doc, I think you would be more likely to want to go back to be with your relatives and people you know than to start out someplace where you don't know anyone. Pay for rural docs isn't as high obviously as for those who go into specialties or who practice in large cities, but sometimes it's not all about the money.

Miulang

I have pretty much worked in teaching hospitals for most of my life. I prefer working in them over private-doc hospitals, for lots of reasons. They tend to be a lot more fun, you learn more, you do more, you see the latest innovations. Sorry if I gave the impression that I thought they were inferior---I don't.

My intention was to convey to people who think this JBMS residency program on the neighbor islands is somehow going to improve health care to any great extent that I really don't think it will make a helluva big difference. I think what you will see is residents who are there because they have to be, not because they want to be.

After working with residents for decades I can say that, as stressful as the programs are, most residents understandably are just trying to make it through, learn their craft, and get on with their lives once they are finished. They have plans. Their plans often involve paying back their loans, getting great positions in the specialty of their choice, and living great lives. Sorry to say but many I have seen are not all that concerned with making the world better. Not to say that they are not conscientious but they are far from altruistic, with few exceptions. Most are young, have started or are planning on starting families, and want all the good things that go with attaining their credentials and snagging that lucrative position.

The PNW program is notable in that it actively seeks recruits who are already interested in rural medicine. Perhaps that would be something the JBMS could look into but they'd have to get over their preference for admitting rather well-off private-school grads and wealthy foreign students first.

When you see a resident who truly personifies what we all would love to see in a physician it sticks in your mind forever. I have seen them and they are among the most brilliant shining stars you could ever imagine. True gifts from God, IMHO. They are few and far between but incredibly memorable.

Here is one. I worked with him only briefly and he probably wouldn't remember me if he fell over me but he left quite an impression:

http://www.kaleimailealii.net/kawika.htm

Read the article that's linked in the site. It doesn't surprise me at all that he is travelling this road.

You'e absolutely right, Miulang---sometimes it isn't all about the money. But unfortunately, in the world of medicine, it far too often is.

[hedkikr]

I'm not exactly sure what kind of senior plan my mother has but it's been good for her (here in So. Cal.) I have Kaiser & will probably continue w/ them following retirement (maybe @ 55). I know that there's a Kaiser facility in Kona. How about Hilo?

BTW: What is Quest? Sorry, having been w/ Kaiser for so long, I understand very little about med insurance.

Thanks

[Miulang]

I'm not exactly sure what kind of senior plan my mother has but it's been good for her (here in So. Cal.) I have Kaiser & will probably continue w/ them following retirement (maybe @ 55). I know that there's a Kaiser facility in Kona. How about Hilo?

BTW: What is Quest? Sorry, having been w/ Kaiser for so long, I understand very little about med insurance.

Thanks
There's a Kaiser Permanente (http://www.kaiserpermanentejobs.org/regions.asp?id=5)clinic (but no hospital) in Hilo, Kona and Waimea on the Big Island. For inpatient care, more than likely you'd either be flown to Honolulu for care at the Kaiser hospital there, or end up in Hilo Hospital.

Quest is the state-mandated healthplan for uninsured patients.

Miulang

[ginabeena]

Wow. I revisted the forum again to see what was happening and this is a very interesting thread regarding healthcare. I am lucky to have my health!!!!

I am going over week after next week as I sold my house in Atlanta very quickly and now am ready to start looking. Poor husband stays here while I go looking. I need a buyer's agent---does anyone have a good person in their address books? I really like to work with someone who is low-key and would understand the needs of a childless set of internet businesspeople....(to reduce myself down to a stereotype!).

Also, any ideas on a good vacation rental while I look?

Mahalo everyone!

[craigwatanabe]

There are a ton of realtors servicing the Big Island. One I highly recommend is Mary Begier. She has offices on both Oahu and the Big Island and knows both markets very well. Here is a write up from the Star Bulletin:
http://starbulletin.com/2003/11/30/business/story2.html

One thing about the Big Island, is you want someone who is well-versed in the communities of East Hawaii (if that's the side you're thinking of). The realtor I was working with knew the Hilo market very well but wasn't too knowledgable about the Puna district other than calling it the Wild wild west. For most Hiloans that monicker resides in their minds. But upon doing my own research, I notice that Hilo isn't as innocent as Puna. As far as property crimes go, Kaimuki in Honolulu experiences more property crimes per week than all of Puna does in an entire month. So for me coming from East Honolulu that was acceptable enough.

There are neighborhoods in the Pahoa area that can be crime-ridden so you don't want a realtor selling you a Great Deal then finding out the house has been vandalized several times since being put on the market.

For excellent web-based real estate searches check out these web sites:

Hilo Brokers at: http://www.hilo-brokers.com/ and,

Hawaii Information Service at: http://www.hawaiiinformation.com/REsearch/

I used both in looking for my dreamhome here on the Big Island while living on Oahu. Both websites have information regarding the properties for sale and HIS has property tax map key information to help you decide if the property is up to date on taxes and permits, even who owns the property you are interested in and who owns the property next to you.
Both also have photos of the properties interested.

Either site has search engines that allow you to input the MLS listing of a particular property you may know of.

Both are excellent tools when trying to find that home here on the Big Island. It makes it easy to search from the comforts of your own home instead of having to drive to each location. You get to preview the property without having to set foot in it so you save time in eliminating properties you'd have wasted time on trying to get there. Trust me it was invaluable for me and I looked at a ton of properties flying back and forth from Honolulu to the Big Island almost weekly until I found these resources. Saved me Bookoo Bucks in the process.

[alohabear]

A BIG reminder too about realtors on the Big Island .Most only work a 5 day week and are open 8:00am -5:00pm. My Cousin found this out when he moved from Oahu.

[hedkikr]

Since I'll be on a scouting trip (getting to know Hilo & the surrounding area) w/o plans to buy immediately, what's my best course of action?

Thanks

[hedkikr]

I returned from Hilo (May 18-23) w/ some good neighborhood viewing. I was impressed w/ Ainako due to its distance from town, medical center, standard of living & easy access to the PKP. Kaumana was OK too.

Someone posted that the HPP area traffic was bad & I'd have to agree. My buddy lives in H.Beaches & the access road (Kahakai off the 130) had a car going by every 5-10 seconds. Last time I visited him, a car might go by every few minutes.

All in all it was a good 1st trip. I worked w/ a realtor referred by my buddy (Denise Nakanishi of Prudential) who took 2 hrs off on a Saturday to drive me around. I made it clear that the purpose of my visit was exploratory w/ no moves for @ least 2-3 yrs yet she was very accomodating w/ NO pressure.

I noted that Hilo Hospital was undergoing an ER expansion...that was good. Let's just hope other improvments to the health care system will follow during the next 2-3 yrs. I love east HI.

[Beachboy]

I live in HPP by way of Honolulu. I find the morning commute traffic in Honolulu far worse than the morning work traffic along Hwy 130(Pahoa Town to Kea'au). As far as living on the Big Island, Puna District is the most affordable, or Ka'u District. Puna is a better situation between the two district in my opinion.
After living in a rental "dump" in Kapahulu for $1500.00 a month +utilities, and being told how lucky I was....I finally wised up! Yeah, lucky if I wanted to spend the rest of my life paying for someone else mortgage?!?!:mad: Sure the house was a cute little thing,(less than 700 sq ft.),good location and all. But I felt like a hamster in a cage. I was only surviving there, and nothing else.

ENTER PUNA:

Making the move to Puna made sense(cents) in so many ways. The housing market was turning soft in the islands, the time was right. So now I have a new home being built on 3rd Ave. in HPP. I can hear the ocean from my house there. I'm not calling it my dream home, because in reality my dream home can only be in one place/area on the Big Island and Puna is not it! Waimea, is where I want to build my dream/retirement home one day.
It's totally awesome there!

[hedkikr]

Yes Waimea is nice & expensive, I understand. If I were younger & w/o family, Puna would certainly be an option (HPP or HI Beaches). Loved the coqui frogs too.