Scarcity of specialists creating local crisis

[helen]

Re: Scarcity of specialists creating local crisis

Primary care doctors are available on Kauai and I would assume Maui, Molokai and the Big Island. I am pretty much sure that the hospitals there have the typical things like X-ray, operating rooms to handle routine things like a factured limb, appendetices, colonsopy, and C-sections, I think some places can handle chemo treatment.

Even on Oahu certain hopsitals do certain things better than other places on the island. You get burned really badly you go to Straub, problem with the child birthing one gets routed to Kapiolani, transplants seem to be at St. Fransicis.

[WindwardOahuRN]

Re: Scarcity of specialists creating local crisis

:::Sadly disappointed with the attitude of many MD's here:::

You can pretty much insert a variety of words in the underlined part.

"students"
"parents"
"administrators"
"cops"
"politicians"

Seems to me that 'attitude' is THE NUMBER ONE PROBLEM in Hawaii. This is perpetuated by the ingrained defeatist mentality that permeates the islands at every level. This likely stems from the whole overthrow issue, but you would think that after 115 years, people would be sick of the crutches. It's always easier to bitch and complain than it is to DO something positive and constructive.

A good attitude will carry you further in life than just about anything else.

I wasn't referring to a "defeatist mentality"

I was referring more to an ELITIST mentality.

Nothing at all to do with the overthrow issue.

[Miulang]

Re: Scarcity of specialists creating local crisis

Pardon me for butting in here and asking a question whose answer is probably known to most people posting here anyway but are you guys saying that people who live on neighbor islands who have working and reasonable insurance are not able to get primary care doctors? And that things like stuff like broken bones you have to get flown to Honolulu? What about things like pre-natal care and other pregnancy related issues?

I know the previous posts talked a bit about this stuff but it is not totally obvious to me from reading them if the people in question were on medicare, didn't have insurance, or whatnot...

People on Medicare might have problems finding a primary care physician because I don't know if the State of Hawai'i mandates that all docs have to accept Medicare patients. Up here, some docs don't accept Medicare patients because of the reimbursement rates.

There is an issue on the Neighbor Islands of getting obstetric services and oncology services and neurosurgical treatment...if you develop any kind of weird disorder, more than likely you would have to go to Honolulu to be diagnosed and treated. If a woman is experiencing a high risk pregnancy on Maui, more than likely the docs on the island would refer the patient to Kapiolani Hospital. Oncology patients covered by HMSA generally get referred to Straub, I think.

Miulang

[Miulang]

Re: Scarcity of specialists creating local crisis

And rather serendipitously, there is a story in today's SB that talks about how many Hawai'i families are struggling to pay their rising health insurance rates, and how many of them are forced to drop coverage, which means that Quest (the State-funded program) will have to pick up more insureds, which means the taxpayers have to subsidize more peoples' healthcare...viscious cycle.

Health insurance costs have far outpaced average earnings for Hawaii workers, causing many to lose coverage and go into debt, Families USA reported today.

More than half of bankruptcies are due at least partly to problems with medical costs, the nonprofit health consumer organization said.

From 2000 to 2006 in Hawaii, it said:

» Health care premiums rose 4.2 times faster than average wages.

» Annual premiums went from $6,047 to $9,952 in the six years, an increase of $3,906 or 64.6 percent.

» Median earnings went from $26,180 to $30,205 in the six-year period, or 15.4 percent.

Miulang

[Bard]

Re: Scarcity of specialists creating local crisis

And that sort of thing is happening all over the US. The US healthcare system is slowly imploding but no one seems to be able to stop it.

I know that year after year I've had to pay more and more insurance premiums and get less and less coverage.

[Miulang]

Re: Scarcity of specialists creating local crisis

This Maui News story reiterates the critical need for healthcare reform in the State and the country.

six reasons why a young doctor might reject Maui:

High cost of housing.

Low reputation of public schools.

Reluctance to pile a big mortgage on top of a big debt left over from medical school.

Dissatisfaction with Maui Memorial Medical Center.

High cost of medical malpractice insurance.

Low rates of reimbursement from Medicare and QUEST insurance.

This other Maui News story highlights why it might make more sense to try to get the UH Medical School to recruit and train doctors who commit to staying in Hawai'i once their training is over. I think the reason why some docs stay in Hawai'i is because their extended families live there, even though they could be making way more living and practicing on CONUS. The State should also look at its QUEST reimbursement rates and make them more comparable to Medicare reimbursement rates, even though Medicare doesn't reimburse enough either.

Miulang

[joshuatree]

Re: Scarcity of specialists creating local crisis

This other Maui News story highlights why it might make more sense to try to get the UH Medical School to recruit and train doctors who commit to staying in Hawai'i once their training is over. I think the reason why some docs stay in Hawai'i is because their extended families live there, even though they could be making way more living and practicing on CONUS. The State should also look at its QUEST reimbursement rates and make them more comparable to Medicare reimbursement rates, even though Medicare doesn't reimburse enough either.

I'm not sure raising QUEST reimbursement rates is such a great idea. All you are doing is fueling the spiraling upward costs of healthcare. QUEST is publicly funded so you're just raising the expenditure of public dollars.

Maybe a creative way would be to waive or reduce the cost of UH med school for those entering candidates willing to sign a commitment of X years to service to the islands, knowing the lower pay and high cost of living ahead of time.

[WindwardOahuRN]

Re: Scarcity of specialists creating local crisis

I worked with a doc in NY who moved to Maui to fulfill his grant debt. Seems Maui is considered an underserved area, or at least it was eight years ago.

ITA with Miulang's quoted assessment of why docs do not move or stay in the Islands. I've seen it up close and personal, over and over again. Good docs with great potential, heading for the mainland after residency.

[Miulang]

Re: Scarcity of specialists creating local crisis

The trend continues, and is stated very simply:

"Doctors here make half of what they make anywhere else on the Mainland."

...Despite the public perception that doctors are affluent, many private-practice physicians are earning only $50,000 to $60,000 a year after costs, she said.

...It's not just high business expenses and malpractice premiums that are keeping Hawai'i from retaining doctors and recruiting new ones, Berry said, it's also quality-of-life issues such as housing and public schools, and on the Neighbor Islands, inadequate medical facilities.

...Hawai'i has seen the greatest exodus among obstetricians/gynecologists and orthopedic surgeons, who run the highest risk of malpractice lawsuits. A recent survey by the Hawai'i chapter of the American College of Obstetricians and Gynecologists found that 42 percent of ob/gyns in the state plan to stop providing pregnancy care for women, largely because of malpractice issues.

For Neighbor Island women who are planning to have children, it's going to get even more dicey as OB/GYN docs give up the obstetric part of their practice, and for the retired people who generally tend to have more chronic diseases as the number of internal medicine and family practitioners erodes even as the populations continue to increase. Gov. Lingle, in her State of the State address, talked about the need for healthcare reform; the question is, how important is this to the average Nani and Kawika as they find their options for doctors dwindling?

Miulang

[timkona]

Re: Scarcity of specialists creating local crisis

Going to the doctor is a CHOICE.

Therefore, medical malpractice lawsuits should be illegal. Imagine the savings on Insurance Premiums alone.

How about deregulating the industry. "Oh dear, say the lefties, WE CAN'T DO THAAAAAT !!!"

It's time for a good doctor to start taking CASH. COD. Pay as You Play. Installment's available for high priced procedures. Betcha that would change people's living and eating habits. Or weed out the idiots.

Most of the reasons that Americans head to a doctor could be prevented with some life management skills, and a touch of self control.

Got Diabetes? Maybe you should have skipped desert - your entire life??
Cholesterol ?? Imagine a salad for dinner. (Ewwww, veggies, no way!!)
How's that liver? Need another drink?
Lung Cancer? Should trade the cigs for running shoes.
Try 1 scoop rice. Or perhaps you weigh 280 because "It's in the genes."

Tell you what - If it's in your jeans, you certainly ate too much. Get ye to a toilet.

Sounds harsh. But the ball's truth is that life is full of choices. Some choose wrong.

Right now, I choose to go for a nice 2 mile walk, with a little running. (I'm gettin older and slower ya know)

[tutusue]

Re: Scarcity of specialists creating local crisis

Timkona...my almost 8 year old nephew was born with Angelman's Syndrome. Yes, my family has had a CHOICE, since his first symptom at 3 weeks old, whether or not to take him to a doctor. Had they made the CHOICE not to, he'd be dead by now. Food, lifestyle changes, running shoes and blanket statements don't always work. Spencer has a beautiful spirit and I strongly believe he was put on this earth for a reason...possibly to teach others about love, acceptance and living life outside the box with severe limitations.

Be thankful for that beautiful, bright, sweet daughter of yours. She's a winner. Other parents aren't so lucky. They have to make extremely difficult CHOICES that involve illnesses not treatable by lifestyle changes.

[WindwardOahuRN]

Re: Scarcity of specialists creating local crisis

Timkona...my almost 8 year old nephew was born with Angelman's Syndrome. Yes, my family has had a CHOICE, since his first symptom at 3 weeks old, whether or not to take him to a doctor. Had they made the CHOICE not to, he'd be dead by now. Food, lifestyle changes, running shoes and blanket statements don't always work. Spencer has a beautiful spirit and I strongly believe he was put on this earth for a reason...possibly to teach others about love, acceptance and living life outside the box with severe limitations.

Be thankful for that beautiful, bright, sweet daughter of yours. She's a winner. Other parents aren't so lucky. They have to make extremely difficult CHOICES that involve illnesses not treatable by lifestyle changes.

Beautifully said, Tutu.

If life were so simple there would be a succint manual of instructions by which we could make decisions. It just ain't that easy.

I have no doubt that the very young woman who I cared for last night, ravaged by ICE and also terribly ill due to disease totally unrelated to ICE, was the apple of her mother's eye. Judging by Mom's grief, she was.

Life deals ugly hands, sometimes. It's all too often the luck of the draw.

Compassion goes a long way. It might be nice to remember these words: "There but for the grace of God go I."

[WindwardOahuRN]

Re: Scarcity of specialists creating local crisis

The trend continues, and is stated very simply:

HOLY CRAP!!!! My GYN bolted and left for the mainland! What an exquisitely crapass way to find out!!!

I have to get my prescriptions refilled, pronto. G-Dammit!!!

I love my life.

[CranBeree]

Re: Scarcity of specialists creating local crisis

My primary doc (rheumatologist) is in town. But, it's a long drive from Makaha to town if I feel junk. I know you're not a fan of Waianae Comp, RN, but it has a wonderful NP on staff and that's who I see. She gave me her home phone, cell phone and email address! She treats the person, not the bank account! Great lady.

tutu would the first name of your rheumatologist be Panu?? if soo...umm hmmm he's a difficult person (er maybe i was a difficult patient! )

[tutusue]

Re: Scarcity of specialists creating local crisis

tutu would the first name of your rheumatologist be Panu?? if soo...umm hmmm he's a difficult person (er maybe i was a difficult patient! )

Nope...his name is Ken!