Is there a doctor in the house on Maui?

County is 141 doctors short, UH study shows

MIKE REMBIS – Doctor recruitment a top priority

Maui County currently has a shortage of 141 doctors, up slightly from the 139 in 2017, according to a recent Hawaii physician workforce survey by the University of Hawaii.

At the moment, the county has no colon surgeon, no neurological surgeon, and no rheumatologist to handle arthritis, said Kelley Withy, a UH professor who conducted the survey.

With the shortage of doctors, Withy said Monday that there are longer wait times for doctors, and “without enough providers, you might fly to Oahu to get care.”

She hoped that Maui County residents would not have to fly to Oahu for primary care, “but it is possible.” Maui County is short 44 primary care doctors.

Maui County also needs more neonatal-perinatal doctors and physicians who specialize in pathology and infectious diseases, the workforce statistics show.

Overall, the state has a shortage of 797 doctors with the shortages skewed to the Neighbor Islands.

The survey is based on a micro-simulation model that provides the numbers of doctors an average American community would use based on comparable populations.

Hawaii island has the largest shortage in the state by percentage, 41 percent, followed by Maui County, 34 percent; Kauai. 33 percent; and Oahu, 17 percent.

The reasons for the shortage of physicians include low pay, Hawaii’s high cost of living, spouses having a difficult time finding jobs and schooling for children, Withy said.

She said doctors prefer modern medical facilities and an active medical community, which means being able to connect with other doctors and to conduct studies. These are things that some places in Hawaii may not offer, Withy said.

New doctors often carry a half-million dollar student debt, and there are higher salary opportunities on the Mainland, she said.

Withy also pointed out an interesting characteristic with doctors who move to Hawaii from the Mainland. Some move back to the Mainland to take care of aging parents but return after their parents have passed or when they are no longer needed.

Cliff Alakai, administrator at Maui Medical Group, which has five clinics on Maui, said overall “we are doing OK.”

“We are trying to fill the gaps,” he said. “There are less physicians available to be hired. It’s more challenging to find candidates.”

During recruitment, Maui Medical Group is finding that “not enough physicians are being turned out by the programs,” he said.

Currently, Maui Medical Group is seeking a gastroenterologist and is always looking for adult primary care physicians, he said.

Maui Medical Group loses two to three physicians or other care providers every year for various reasons, including leaving to care for an aging parent outside of Hawaii, he said.

In 2016, Maui Medical Group dropped its obstetrics care when two full-time OB-GYN doctors departed. Obstetrics is a difficult field of practice because doctors must be on call for deliveries whenever they occur 24/7. The practice becomes more difficult with a small pool of doctors, Maui Medical Group officials have said.

Maui Medical Group continues to offer gynecological care and is beefing up staff, including the addition of a woman’s health nurse practitioner who joined the health care group in March.

Over the years, Maui Medical Group has been able to hire doctors and other health care providers, such as certified physician assistants and advanced practice registered nurses.

In 2016, Maui Medical Group hired 12 health care providers. In 2017, 17 providers were hired, and this year so far 10 providers have joined the health care group, Alakai said.

An advantage Maui Medical Group has is its health care/economic infrastructure. New doctors prefer to join a group or a larger medical entity, such as Maui Medical Group, rather than starting their own private practice because of the cost, he said.

Maui’s other major health provider, Kaiser Permanente Hawaii, attracts doctors because it is a large, established entity, said Kaiser spokeswoman Laura Lott. The health care provider has an “integrated model,” which provides support for doctors and mentoring opportunities and has attracted independent physicians, she said.

Kaiser also has its own residency program with primary care rotations on the Neighbor Islands.

“Our hope is they love Waimea, or love Wailuku, or love Lihue and want to go back and practice there,” Lott said.

Physician numbers have been “pretty stable,” said Lott, noting increases in physician recruitment for specialties and primary medicine. She could not give a number for doctors who left Kaiser on Maui last year.

“We’re not as affected by the physician shortage as private practices or smaller medical groups,” she added.

In fact, Kaiser added four doctors and one certified nurse midwife on Maui this month. Lott did note a shortage, though, of licensed practical nurses and social workers.

“We still use resources from Oahu,” she said. That means patients flying to Kaiser Permanente Moanalua Medical Center for major surgeries, such as heart bypasses, and other procedures, and Kaiser flying specialists to Maui for dermatology and sports medicine appointments.

Kaiser is able to use its resources on Oahu to fill in spots for doctors as needed, she said.

In the survey, Withy said Maui could support 2¢ neurosurgeons, though the island currently doesn’t have one. Maui’s only neurosurgeon, Dr. Thomas Rogers, has been dealing with his own health-related issues and has been unavailable this year. He has been on-call 24/7 for 20 years.

But help appears to be on the way. Maui Health System Chief Executive Officer Mike Rembis said Monday that the Kaiser subsidiary that manages Maui County public hospitals has recruited one neurosurgeon, who will be on Maui by the end of this year, and is finalizing an agreement with a second neurosurgeon with hopes of having that specialist on island beginning of next year.

Maui Health System took over management of Maui Memorial Medical Center, Kula Hospital and Lanai Community Hosptial in 2017.

“We are working closely with the medical leadership at Maui Health System to determine where the needs are for physicians in Maui County,” Rembis said. “We’re committed to meeting and exceeding the health care needs of our community and are aggressively recruiting physicians.”

Other recruitments include an oncological surgeon, who will begin in December, he said. Maui Health System also is working with two trauma surgeons to finalize agreements and is hopeful they will begin at the end of the year.

Recuitment continues in neurosurgery, trauma, oncology, gastroenterology, internal medicine, pulmonology, psychology/psychiatry and nephrology, he said.

Physician recruitment is of the “utmost importance and highest priority” for the next three years, Rembis said.

The final report on the 2018 demand and supply of physicians for the state will be completed in October and will be submitted to the state Legislature, Withy said.

* Melissa Tanji can be reached at mtanji@mauinews.com.

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