Report: More doctors needed to treat Maui County patients

Gastroenterologist Dr. Rory O’Connor and endoscopy nurse manager Michelle Domingo talk Friday afternoon at Maui Memorial Medical Center. According to a University of Hawaii study, Maui County needed 402 full-time doctors last year, but with only 300 available there was a shortage of about 25 percent. -- The Maui News / MATTHEW THAYER photo

While the shortage of doctors statewide has improved, it grew worse on the Neighbor Islands in 2016, including Maui County, according to a University of Hawaii report to the state Legislature.

And the lack of experienced medical care is not expected to improve anytime soon with retirement age approaching for 31 percent of Hawaii’s physician workforce, the Hawai’i Physician Workforce Assessment says. Within 10 years, 52 percent of doctors in the islands will be 65 years old or older.

In a similar report issued in January 2015, Maui County patients needed the equivalent of 385.7 full-time doctors, based on a census population of about 160,000. At that time, there were 305.98 physicians treating patients, leaving a shortage of 79.72, or 21 percent.

Late last year, that shortage was reported to have grown to 101.71 full-time doctors, or 25.3 percent. Maui County’s estimated population was increased to 165,386, generating a demand for 401.9 full-time doctors, but with only 300.19 available.

(Full-time equivalent figures for physician supply and demand are often fractions in the study because many doctors have multiple specialties or may serve patients on multiple islands, among other reasons.)

The overall statewide shortage was 500 doctors, according to the report.

The highest demand in Maui County last year was for primary care physicians, with the need put at 146.7 doctors. The report says there were only 112.32 doctors available at the time of the study, leaving a shortage of 34.38 physicians, or 23.4 percent.

The second-highest demand was for doctors practicing emergency medicine. The county’s need was put at 26.3 doctors, but only 14.9 were available, a shortfall of 11.4, or 43.3 percent.

In the specialty of psychiatry, there was a countywide demand for 22.9 physicians, but there were only 12.59 doctors treating mental health, leaving a deficit of 10.31, or 45 percent.

The university’s John A. Burns School of Medicine Area Health Center prepares the physician workforce assessment annually for lawmakers. The center looks at newly issued physician licenses and the number of doctors retiring as a way to quantify the ongoing doctor shortage in the state.

The recruitment and retention of doctors is the “single biggest challenge in our medical group operations,” said Dr. William Mitchell, president and chief executive officer of Maui Medical Group.

“It’s an ongoing issue,” which is made more difficult by the fierce competition for available doctors nationally, he said.

Many doctors are reluctant to come to Hawaii because of its distance from family on the Mainland and because of the high cost of living in the islands, he said. Some physicians try to relocate to Hawaii but, after a couple of years, decide “they cannot stay,” Mitchell said.

The medical group has 55 physicians and 20 mid-level advanced nurse practitioners or physician’s assistants, he said.

Mitchell said that the group has been successful lately in attracting younger physicians.

“You’ve got to keep the new blood coming or you’re going to be short,” he said.

Last year, the group’s two full-time obstetrics-gynecology physicians departed, leaving a part-time physician and one nurse practitioner.

The group discontinued obstetrics services, but continues providing gynecological care to nonpregnant women and pregnant women through their first trimester, when patients are referred to an obstetrician, Mitchell said.

It was impossible to recruit enough obstetricians to reliably offer services, he said.

The UH study shows Maui had a demand for 21.4 OB-GYN doctors, but there were only 16.1, leaving a shortage of 5.3, or 24.8 percent.

Hale Makua Chief Executive Officer Wesley Lo saw problems with doctor shortages when he served a dozen years as chief executive officer of Maui Memorial Medical Center and later as head of the Maui Region of Hawaii Health Systems Corp. before taking his current job Oct. 31.

“In many instances, physicians will be overworked, or faced with schedules that require them to be ‘on-call’ 24 hours a day, seven days a week,” he said. “When this occurs, it is not sustainable, and things will unravel quickly, and more doctors leave because the burden is too much. You can’t expect anybody to be overworked for an extended period of time without some consequences.”

Lo led efforts to privatize hospitals in the Maui Region, and they will be taken over by Kaiser Permanente on July 1.

Longtime Maui psychiatrist Dr. Al Arensdorf said he’s aware of doctors who left Maui because of uncertainty over management at MMMC.

But now, with the transition about three months away, “I think the hospital situation sounds like it’s going to get better,” he said.

Kaiser spokeswoman Laura Lott said: “No one’s immune to the physician shortage. It’s a reality in Hawaii and the rest of the country.”

But, she said, at Kaiser, with its physician-employee system, “it probably affects us less.”

As employees, Kaiser doctors concentrate on medicine, not the business of managing employees, payroll, legal matters or billing, she said.

There are multiple applicants for physician openings at Kaiser, where physicians receive support from colleagues with consultations on medical issues and coverage of patient care, Lott said.

“Kaiser’s a good place to work,” she said.

Arensdorf said that the shortage of psychiatrists in Maui County has meant that all children or adolescents who need psychiatric care involving hospitalization and medication are being sent to Oahu for treatment.

The shortage affects patients when they suffer a crisis and there’s no psychiatrist at the hospital, “there’s nobody to respond,” he said.

The medical school’s assessment also aims to find ways to address the shortage of doctors in the islands.

It reports that the medical school has increased its class sizes and has stepped up long-term ways to attract new health workers. The school has produced a directory of health professions and resources, which has been provided to all school counselors. The directory features information about various jobs and realistic salary ranges in the medical fields. (It may be downloaded at www.ahec.hawaii.edu/resources/health-career-navigator.)

Meanwhile, the personal finance website WalletHub ranked Hawaii 43rd overall among the states and the District of Columbia to practice medicine. The state was 41st in the “opportunity and competition” ranking and 31st in the “medical environment” category.

Hawaii was 50th in average annual wages of physicians and 51st in average monthly starting salary of physicians (both adjusted for the cost of living). The state ranked 34th in the punitiveness of the state medical board. It was 22nd in malpractice award payout per capita. It was 18th in two categories — hospitals per capita and current competition (number of physicians per capita).

* Brian Perry can be reached at bperry@mauinews.com.