Scarcity of specialists creating local crisis

[Miulang]

The problem of finding a medical specialist on a Neighbor Island is very vividly being played out in Kona. Like many other communities, it is virtually impossible to get specialized care if you have more than a common cold. Most of the time, Neighbor Island residents have to travel, at great expense, to Honolulu to get the specialized care they need.

This PBN story tells of the looming medical crisis that is occurring in Kona, which is growing rapidly and yet it finds it impossible to keep qualified pracitioners due to the high cost of living and malpractice insurance and the low amounts of reimbursement from insurance carriers.

The State should be working with HMSA and other health insurers to revise their rules for reimbursement so that doctors can afford to practice in the smaller towns in Hawai'i, and the Federal government can do more to force the malpractice insurers to either lower their rates or put caps on the amounts paid out to patients who win their malpractice suits.

Miulang

[cynsaligia]

Re: Scarcity of specialists creating local crisis

food for thot: scarcity of specialists is not merely a problem in small communities. hospitals in honolulu often have diffculty getting surgeries (both non-emergent and otherwise) set up because of the shortage of anesthesiologists, orthopedic surgeons, etc.

[tutusue]

Re: Scarcity of specialists creating local crisis

I have friends in Kona who are now looking for a new doctor...on Oahu. All of their previous physicians have left the islands. During the past 4 years my friend has been treated for a stroke (stayed in Kona) and skin cancer (had to be treated on Oahu last year). The Oahu doc recently left the state. This is, indeed, a scary situation for outer islanders.

[Jonah K]

Re: Scarcity of specialists creating local crisis

food for thot: scarcity of specialists is not merely a problem in small communities. hospitals in honolulu often have diffculty getting surgeries (both non-emergent and otherwise) set up because of the shortage of anesthesiologists, orthopedic surgeons, etc.

I agree. Oftentimes, it's more convenient to go someplace outside of Hawai'i for non-emergency surgeries.

[Miulang]

Re: Scarcity of specialists creating local crisis

Talk about politics in healthcare: while Maui Memorial Hospital and the Hawaii State Hospital system were adamantly hostile about allowing a new private critical care hospital to be built in South Maui, now Maui Memorial Hospital is apparently looking favorably upon a private group of hospital developers who are looking into the feasibility of building a small hospital in West Maui.

So what is the difference between the group supporting a new hospital in Lahaina as opposed to one built in Kihei? It's true that the people of Lahaina have advocated for a hospital on that side of the island for longer than the people of Kihei/Wailea have, but both the Malulani Hospital proposal and the Lahaina proposal would be using Mainland investors to build the hospital. Both would "rob" MMH of critical staff. If Malulani agreed to the same kind of triaging that the Lahaina hospital apparently is planning to use, would the State give Malulani the CON it needs to build its hospital?

Gov. Lingle was a proponent for the Kihei hospital. Will she also be in favor of a hospital in Lahaina? Both areas really do need critical care facilities (although the Lahaina hospital is probably a little more critical because of the Honoapiilani Hwy situation) because their populations would support having small facilities located in both communities, and more importantly, both communities have lots of old, rich retirees living in them.

Miulang

[SouthKona]

Re: Scarcity of specialists creating local crisis

I have friends in Kona who are now looking for a new doctor...on Oahu. All of their previous physicians have left the islands. During the past 4 years my friend has been treated for a stroke (stayed in Kona) and skin cancer (had to be treated on Oahu last year). The Oahu doc recently left the state. This is, indeed, a scary situation for outer islanders.

In Kona (and probably all the small communities that have a shortage of doctors), it is sometimes a case of "getting introduced" by a current patient. And, it is not only a shortage of doctors - there is a shortage of dentists and dental specialists. If you are a dental hygenist and want to work an 80 hour week, move to Kona!!

[tutusue]

Re: Scarcity of specialists creating local crisis

In Kona (and probably all the small communities that have a shortage of doctors), it is sometimes a case of "getting introduced" by a current patient.[...]

My friend is very well connected in Kona and has been for years. It wasn't until she told me she was looking for a doc on Oahu that I realized the magnitude of the problem in Kona.

I've always fantasized about living outer island but, at this stage of my life, wouldn't even consider it.

[damontucker]

Re: Scarcity of specialists creating local crisis

The lucky thing for many people including my mom...

Is that insurance does cover for flight expense as well as taxi expense!

Which can add up to a lot.

For me... I look at the positives of it... I get to see my mom more on the Insurances pocketbooks...

I just wish they were under better circumstances!

The unlucky thing, is many people do not have insurance or the same insurance as my mom and travel costs often are not covered by certain insurance companies!

There are really many things that are contributing to this crisis!

[brianca]

Re: Scarcity of specialists creating local crisis

It seems like it would probably fall to a subsidy issue rather than an insurance issue. If the community isn't large enough to support the specialist, and it happens to be an isolated community that can't easily travel to a bigger one, it would seem that the state has to decide if it wants the specialist there enough to subsidize their income enough to make it worth while.

[Miulang]

Re: Scarcity of specialists creating local crisis

It seems like it would probably fall to a subsidy issue rather than an insurance issue. If the community isn't large enough to support the specialist, and it happens to be an isolated community that can't easily travel to a bigger one, it would seem that the state has to decide if it wants the specialist there enough to subsidize their income enough to make it worth while.

The residents of the smaller communities in Hawai'i should be writing to your Congressional delegation to ask them to support the Health Care Access and Rural Equity Act of 2006 (it was introduced in the last session in the House Energy and Commerce and House Ways and Means Committee but has not been voted upon yet either in the House or the US Senate). If this bill could be turned into law, hospitals like Kahuku on the North Shore might not have to convert to an outpatient clinic or go under completely, and communities on the Neighbor Islands might be helped, too.

With the Democrats in power, this bill or one similar to it will probably stand a good chance of passing because the Democrats realize that access to healthcare is a critical need of many citizens in this country.

Miulang

[helen]

Re: Scarcity of specialists creating local crisis

The lack of doctors is one problem, the other problem would be the facilities and personel to staff treatment centers.

[Miulang]

Re: Scarcity of specialists creating local crisis

The lack of doctors is one problem, the other problem would be the facilities and personel to staff treatment centers.

The bill, if enacted, does create some financial incentives both for building or upgrading facilities and payment of providers. The State could also work with UH Medical School to create a rural health program and get some assistance in setting up its program from the University of Washington WWAMI program which serves 5 states. Having a training program like this might entice more local kids to stay in Hawai'i to practice medicine. It would be way cool if more local kids could be inspired to become doctors so they could practice medicine in the communities they grew up in.

Miulang

[cynsaligia]

Re: Scarcity of specialists creating local crisis

If the community isn't large enough to support the specialist, and it happens to be an isolated community that can't easily travel to a bigger one, it would seem that the state has to decide if it wants the specialist there enough to subsidize their income enough to make it worth while.

I seems to me that a lot of the reason for scarcity of MDs is that Medicare/Medicaid does not reimburse enough. And it's not merely that we're losing docs to the Mainland (my own, beloved PCP being one of them--earlier this year, he told me he was leaving Honolulu Medical Group to move to California. This was more devastating to me than if my hairstylist were to move from Honolulu). Those hospitals--and not just those in rural areas--but even those hospitals who do not have an endowment upon which to fall back and whose patient population is mostly poor or depend mostly on Medicare/Medicaid are struggling to make it. Mind you, all the hospitals in Hawaii are non-profit--at least until January 1, 2007.

[WindwardOahuRN]

Re: Scarcity of specialists creating local crisis

I seems to me that a lot of the reason for scarcity of MDs is that Medicare/Medicaid does not reimburse enough. And it's not merely that we're losing docs to the Mainland (my own, beloved PCP being one of them--earlier this year, he told me he was leaving Honolulu Medical Group to move to California. This was more devastating to me than if my hairstylist were to move from Honolulu). Those hospitals--and not just those in rural areas--but even those hospitals who do not have an endowment upon which to fall back and whose patient population is mostly poor or depend mostly on Medicare/Medicaid are struggling to make it. Mind you, all the hospitals in Hawaii are non-profit--at least until January 1, 2007.

Non-profit? Technically, maybe. I'd love to take a look at the books at Queens.

[brianca]

Re: Scarcity of specialists creating local crisis

Does medicaid/medicare reimburse differently in hawaii than on the mainland?