Why the Doctor Shortage Continues in Hawai‘i

Class of 2022 members learn to intubate a patient (insert a breathing tube) at JABSOM. PC: JABSOM

Although seven new physicians—Hawai‘i Island natives—received their MD degrees from the University of Hawai‘i John A. Burns School of Medicine on May 11, 2019, the Big Island continues to suffer from the most severe doctor shortage in the Hawaiian Islands.

Comparing the number of physicians that the Big Island has to the average utilization of physicians across the United States, Hawai‘i Island comes up short with 41% fewer physicians than the island should have, making it commonplace to wait four to five months for a primary care or specialist physician.

Statewide, Hawai‘i is short approximately 800 doctors.

The problem is expected to escalate because many of the state’s doctors now are near retirement and there aren’t enough incoming doctors to take their places. The State of Hawai‘i currently has 600 physicians 65 or older.

In addition, many doctors are leaving the islands. From 2017 to 2018, the state lost 51 full-time-equivalent doctors. In fact, Hawai‘i was found to be the third worst state in which to practice medicine due to low wages and a high cost of living. Experts say a net gain of 650 doctors is needed in the state by 2020.

East Hawai‘i has a projected population of around 117,000 by 2020. To serve that population, there are four general surgeons (one of whom is near retirement), three orthopedic surgeons, three gastroeanterologists (two of whom are past retirement age) two cardiologists and two nephrologists.

The entire island has a projected population of around 217,718 by 2020. Serving the entire island are one urologist, one neurologist and one permanent ear, nose and throat specialist.

In 2015, the school graduated 64 doctors, but 24 residency positions were available. In 2016, there were 64 graduates and 15 residency positions; 2017 saw 55 graduates and 18 residency positions.

Over 80% of those who graduate from JABSOM and attend a residency program in-state remain local physicians.

Only two of the seven new physicians from the Big Island are proceeding with residency programs in-state.

Charles Peebles receives a lei from his wife at the JABSOM Convocation Ceremony. PC: DMD

But Charles Peebles, one of the graduates, is going into his residency program at the University of North Dakota.

“Many people are unaware that graduating medical students do not directly choose their residency program. but go through a process called ‘the match,’” said Dr. Peebles. “Applicants—of which there are tens of thousands every year—typically apply to dozens of programs, if not more, and then they are respectively sorted into a single residency based on their preferences and the preferences of the programs. This is done by computer algorithm and the results are binding. ”

Michael Brigoli. PC: Amanda Shell

Another one of those graduates, Mike Brigoli, will enter his residency program at the University of Arizona.

“Regarding how the state can get more medical graduates to practice locally, that data has been proven through research by Dr. Kelley Withy: increasing the number of people training here will increase the number of physician working here,” said Dr. Brigoli. “Whether that’s increasing the number of students in medical school or increasing the number of post-graduation residency positions, both will lead to more physician staying in Hawai‘i.”

Dr. Brigoli felt where graduates took there residency was a primary determinant in where they would end up practicing.

“People develop relationships, bonds while training,” said Dr. Brigoli. “They get married, have children and learn culture or our society. It’s a unique time. There are medical specialties that we still do not have residencies for in Hawai‘i, like emergency medicine for example.”

JABSOM Dean Jerris Hedges in the Hawaiian medicinal plant garden on campus. PC: Deborah Manog Dimaya, JABSOM

JABSOM Dean Jerris Hedges responded, “We have been advocating for increasing the number of students admitted to JABSOM for over a decade. Through medical school restructuring, growth of an affiliated practice plan and partnering with local healthcare systems, JABSOM has gradually increased the number of students, from 62 to 77 [this July], in the entering [matriculating] student cohort. This growth has occurred in the setting of an essentially flat UH base budget for JABSOM.

“Additional state support is greatly needed to increase the number of UH teaching faculty and staff [and to expand teaching facilities] essential for an even larger class size,” said the dean. “Additional support could be used to extend more medical education to the Neighbor Islands. With this limited state support, JABSOM post-graduate residency positions have remained largely flat. Although many factors contribute to limited expansion of the medical school class and residency positions in Hawai‘i, the primary factor is a limited number of compensated clinical faculty. Support for clinical faculty could not only help expand class size, but also help bring needed practitioners to Hawai‘i.”

Also, Hawaii Pacific University has a relationship with Lake Erie College of Medicine in which, starting their third year, students use their facility as a rotation site to train. In the future, rotating LECOM students at Hawai‘i hospitals may help facilitate keeping more doctors in the state.

Learn about more proposed solutions in Big Island Now’s followup story, to be published later this week.