Big Island - Opinions

[craigwatanabe]

Re: Big Island - Opinions

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]

Re: Big Island - Opinions

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

[Miulang]

Re: Big Island - Opinions

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]

Re: Big Island - Opinions

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]

Re: Big Island - Opinions

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]

Re: Big Island - Opinions

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]

Re: Big Island - Opinions

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]

Re: Big Island - Opinions

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!

[craigwatanabe]

Re: Big Island - Opinions

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]

Re: Big Island - Opinions

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]

Re: Big Island - Opinions

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. 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]

Re: Big Island - Opinions

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]

Re: Big Island - Opinions

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]

Re: Big Island - Opinions

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" 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]

Re: Big Island - Opinions

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) 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