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If Maui County residents think it’s tough to get a doctor appointment now, then just wait – a statewide physician’s shortage will worsen as nearly a third of Hawaii’s practicing doctors have reached retirement age, according to a University of Hawaii study submitted to state lawmakers this week.
Based on population of about 160,000, Maui County residents need the equivalent of 385.7 full-time doctors, but they have only 305.98, leaving a shortfall of 79.72, or 26 percent, of what it would take to meet the demand.
(Full-time equivalent figures are given as fractions in the study because many doctors have multiple specialties or may serve patients on multiple islands, among other reasons.)
No area in Hawaii has enough doctors, the study shows. The Big Island has a shortage of 36.1 percent. Kauai’s demand for doctors is 38 percent off from its supply, and Oahu is short by 17.6 percent, the study reports.
Statewide, there’s a shortage of 890 full-time doctors, with that number expected to grow to 1,500 within five years.
“If we all get the flu at once we’re going to overburden our physicians’ offices, so we will probably have to go to our emergency rooms and get treated there, overburdening the emergency rooms and costing more,” said UH medical professor Dr. Kelley Withy, the primary investigator for the physician workforce assessment. “But the bottom line is maybe we won’t get treated. Maybe we will get sicker. Some people who get sick could die. So without enough providers and physicians we are all at risk.”
The study shows that Maui County has no neonatal-perinatal physicians, although its population needs 2.4. There’s a shortage of 11.02 doctors in general internal medicine. The county has 11.17 psychiatrists, but it has a demand for 19. There are 5.25 general surgeons working in the county, but 13 are needed. The county has 8.13 orthopedic surgeons, but there’s demand for 12.
Statewide, the most dire shortages are in family medicine (174 more doctors needed statewide, 6.56 more in Maui County), general surgery (57 more statewide, 7.75 more in the county) and pathology (44 more statewide, 6.2 in the county).
The doctor shortage is apparent at Maui Memorial Medical Center, where the hospital recently has struggled to provide services in certain specialties, said Wes Lo, Maui region chief of Hawaii Health Systems Corp., of which Maui Memorial, Kula Hospital and Lanai Community Hospital are a part.
“It’s really close,” he said Wednesday. “It’s kind of scary right now,” especially as older physicians are retiring.
About a year ago, two gastroenterologists retired within a short period of each other, he said. And, more recently, two urologists retired, leaving patients not covered by Kaiser Permanente (which has its own staff of doctors) without treatment options at the hospital’s emergency room.
Other doctors have been hired to replace the specialists, but there have been dicey times when “basically the community is not having (full physician ) call coverage,” Lo said.
One of the replacement doctors was on call 24/7 for 20 to 23 days a month, he said. “That’s a lot for anybody.”
If there were no urologists or gastroenterologists on Maui, patients would need to fly to Oahu hospitals for treatment by specialists.
“That’s crazy,” Lo said. “That’s not what we want for Maui.”
But “that’s what’s starting to happen in a lot of specialties,” he said.
Aside from retirements, doctors are also choosing not to open their own offices and go into business independently, Lo said.
“The world has changed,” he said. “The newer doctors are looking for salaried work. They’re looking for regular hours.”
State Senate Health Committee Chairman Josh Green, a Big Island physician, said the physician shortage is a “crisis.”
“The solution is clear and just a matter of political will to provide for loan repayment programs for physicians, expand the residency training slots in Hawaii, grow the medical school graduating classes and improve reimbursements for primary and essential care in Hawaii to attract physicians . . . People will die or suffer unnecessarily if we don’t act.”
Dr. William Mitchell, president and chief executive officer of Maui Medical Group, said the medical partnership has aggressively recruited doctors, especially in specialties such as urology.
After the two Maui urologists retired recently, “we went from a shortage to a crisis pretty quick,” Mitchell said.
Since then, one new urologist has started working at Maui Medical Group, and another will join the staff next month, he said. “We’re feeling good about supplying that need on Maui,” Mitchell added.
In another speciality area, gastroenterology, Maui Medical has been “recruiting like crazy,” he said, and it will have three on staff shortly.
“If there’s enough of them, they cover for each other,” he said.
When there aren’t enough doctors, Maui Medical is forced to bring in temporary doctors from the Mainland, Mitchell said. Those doctors get a car, lodging and a phone. “It’s very expensive. We lose money pretty quickly, but we have to do it.”
Mitchell estimated that about 10 percent of Maui Medical’s staff of 55 doctors are expected to retire in the next five to 10 years, although he has no plans to do so.
“I’m no spring chicken myself,” the 68-year-old pulmonary physician said. “I love what I like what I do . . . My wife wouldn’t let me retire.”
Mitchell said it’s necessary to recruit doctors from Hawaii residency programs, the Mainland and internationally. “You need to bring in new blood to fill the gaps.
“We hope we can cover Maui’s needs for the foreseeable future, but it’s a challenge,” he said. “As long as Maui Medical Group is strong, we’re going to keep recruiting physicians. That’s our job here.”
Kaiser Permanente spokeswoman Laura Lott said Kaiser has 103 medical providers (including physicians, nurse midwives, optometrists and physician’s assistants) and 17 visiting specialists on Maui.
Kaiser has an “integrated model” of care that allows doctors and other providers to support each other while providing care to patients, she said.
Kaiser specialists visit Maui regularly for things such as cosmetic plastic surgery, she said. If patients need a higher level of care, they are transferred to Kaiser’s Moanalua Medical Center on Oahu, she added.
Because they work for a large medical group, Kaiser doctors don’t need to worry about administrative duties such as payroll, accounts receivable, medical records and insurance reimbursements.
“Most doctors I know don’t like that side of the business,” she said. “Physicians want to work for us.”
And, as a result, “Kaiser is better situated to weather the challenges,” she said.
The doctor shortage is a national phenomenon, Lott said.
Kaiser has started its own residency program “because we do not see this as a trend that’s going to be reversed anytime soon,” she said.
* Brian Perry can be reached at bperry@mauinews.com.