Funding for student loan repayment program advances in state Legislature

Effort aims to make a dent in Hawaii doctor shortage

A state House-Senate conference committee has recommended final passage of a bill that would budget $250,000 in state money to help fund a physician student loan repayment program for doctors who practice in underserved areas in Hawaii, Big Island Sen. Josh Green said Friday.

Calling House Bill 916 a “bellwether piece of legislation” of “major significance,” Green said it would get matching federal money for two years, making it $500,000 a year, or $1 million over two years.

Green, the former chairman of the Senate Health Committee, has called Hawaii’s doctor shortage, especially on the Neighbor Islands, a “crisis,” and he estimated that the funding would help pay student loans for 20 primary care doctors, those most in need in the islands.

“I’m really happy that this is happening,” he said. On the Neighbor Islands, the shortage of doctors is “very, very bad.”

A University of Hawaii report submitted late last year to state lawmakers said that while the shortage of doctors statewide had improved, it had worsened on the Neighbor Islands.

Green said that the Big Island shortage of doctors is 30 percent worse than Maui’s and 50 percent worse than the state’s.

“Maui’s shortage is bad, and the Big Island’s is really bad,” he said.

Patients on the Big Island often need to wait two or three months just to get an appointment to see a doctor, Green said.

The UH report said Maui County, with its estimated population of 165,386, needs nearly 402 doctors but has only 300, a shortage of 102, or 25.4 percent. Two years earlier, Maui’s physician shortage was at 21 percent.

And, what’s even more worrisome is that retirement age is approaching for 31 percent of Hawaii’s physician workforce, who are now between 55 and 65 years old, according to the Hawai’i Physician Workforce Assessment. Within 10 years, 52 percent of doctors in the islands will be 65 years old or older, it says.

Dr. Kelley Withy, director of the John A. Burns School of Medicine Area Health Education Center, leads the school’s annual effort to assess Hawaii’s doctor workforce.

On Friday, she said she was “excited” about the passage of House Bill 916, although it still needs to pass floor votes of both chambers and get signed into law by Gov. David Ige.

“It’s taken five years to pass,” she said.

State funding would allow the continuation of the Hawai’i State Loan Repayment plan, which was established and funded through a grant from the federal government and from other sources in Hawaii, including Hawaii Medical Service Association, The Queen’s Medical Center, Maui Memorial Medical Center and the Lanai Community Hospital.

In testimony to lawmakers, Withy and Dr. Jerris Hedges, dean of the UH medical school, warned that the repayment program started in 2012 would end without state funding because Hawaii would not be able to reapply for a federal grant.

Currently, the program pays for educational debt for primary care and behavioral health physicians, nurse practitioners, physician assistants, psychologists, social workers, licensed professional counselors, marriage and family therapists and certified nurse midwives who work for nonprofit organizations in areas with doctor shortages in Hawaii. (A Senate version of the bill renamed the program to the Hawai’i Rural Health Care Provider Loan Repayment program and deleted references to psychologists, social workers, licensed professional counselors and marriage and family therapists.)

The repayment program has helped 25 health care providers since it was launched five years ago, with two-thirds of recipients remaining to practice in Hawaii underserved areas, Withy and Hedges said.

Sixty-four percent of UH medical school residents and fellows have student loan burdens, they said. The average student indebtedness is $235,000, with some residents having debt from $300,000 to $600,000.

“These loans, with average minimum monthly payments of $500, begin repayment while in residency training, in addition to the high cost of living, rent and other expenses,” they said. “The high cost of college and medical education results in large student loan debt, which detracts from physicians choosing primary care specialties and choosing to practice in underserved rural communities.”

Program participants receive at least $25,000 a year in loan repayment funding for practicing at least two years in a needy area, they said.

In written testimony, Maui psychiatrist Dr. Sarah Feenstra said: “Loan repayment works. It attracts providers, like myself.”

Now, she works with the state correctional system and a community clinic on Maui, and she said she moved to Maui in 2015 for her first job out of residency.

“In my career search, it was important to find a job that offered loan repayment, as I came out of residency with a daunting $280,000 in debt,” she said. “I thoroughly enjoy my work with the underserved mentally ill population, seeing people that are often overlooked but have significant needs. I have learned firsthand that there are not enough providers on this island, and we desperately need to improve this situation.”

As amended and recommended for approval by members of the conference committee, the bill calls for spending $250,000 in fiscal 2017-18 and 2018-19 for the Hawaii rural health care provider loan repayment program. The measure only allows state funding to be used if it’s matched dollar-for-dollar with private or other public funding.

The loan repayment program would be administered through the John A. Burns School of Medicine and help pay loans for physicians, physician assistants and nurse practitioners who agree to work in a federally designated health professional area or an area in Hawaii that is underserved.

Green estimated that the state money with federal matching funding would cover student loan repayments for 20 or more primary care providers.

Maui’s shortage of primary care physicians is 23.4 percent.

Green said he came to Hawaii to practice medicine after completing his residency training in family medicine and accepting a position in the National Health Corps to be a doctor in underserved areas of Hawaii. He settled in Kau and is an emergency room physician on the Big Island.

By working with the program, he was able to pay off a $130,000 student loan in exchange for working in a rural area, he said.

Doctors in rural settings earn less than those in urban areas, he said, but doctors also carry student loans now of up to $150,000 to $200,000, Green said.

Getting and retaining primary care doctors is important because they can manage most health problems or catch them before they get worse, he said.

“There’s no way to replace a good primary care base,” he said.

Many Hawaii doctors are tired and overworked because of the shortage, he said.

“It’s very difficult,” said Green, who estimated that in his 17 years of practice in Hawaii he’s worked about 30 years of hours as a doctor.

“My professional age is 60 instead of 47, my actual age,” he said. “There’s a question of how long you can practice at that pace.”

* Brian Perry can be reached at