Isle doc­tors pro­pose new way to at­tract more physi­cians

Hawaii Tribune Herald - - NEWS - By JEFF HANSEL Email Jeff Hansel at jhansel@hawai­itri­bune-her­ald.com.

Big Is­land physi­cians are start­ing a non­profit de­signed to en­cour­age doc­tors-in-train­ing to pick the Big Is­land as a place to live and prac­tice medicine.

Physi­cian-ad­vo­cates ad­dress­ing the county’s wor­ri­some doc­tor short­age met Satur­day to re­view by­laws, draft ar­ti­cles of in­cor­po­ra­tion and pre­pare to file an ap­pli­ca­tion for non­profit sta­tus.

It is to be called Hui Kahu Malama (“care­tak­ers group”).

Flights, rent and trans­porta­tion are costs that could be cov­ered by the non­profit, help­ing doc­tors in spe­cialty train­ing come to the Big Is­land.

The doc­tors who are form­ing the non­profit want to cre­ate a pipeline of new physi­cians who like Hawaii County and its peo­ple so much that they’ll stick around once med­i­cal res­i­dency train­ing is com­plete. Of­ten, physi­cians end up prac­tic­ing near the lo­ca­tion they last trained, which is why county of­fi­cials con­sider res­i­dency pro­grams es­sen­tial.

Med­i­cal res­i­dents are physi­cians who fin­ished med­i­cal school. They train at least three years after med­i­cal school to spe­cial­ize, on the Big Is­land, in dis­ci­plines such as fam­ily medicine and ob­stet­rics.

In­ter­nal medicine, psy­chi­a­try and sur­gi­cal res­i­den­cies are now at var­i­ous stages of plan­ning and im­ple­men­ta­tion.

Dr. Syd­ney Tat­suno prac­tices in­ter­nal medicine in Hilo. He’s one of five doc­tors who de­vel­oped Hui Kahu Malama, hop­ing to mit­i­gate the physi­cian short­age.

Al­ready, two med­i­cal res­i­dents have done ro­ta­tions on the Big Is­land, Tat­suno said.

But it be­came clear to Hui Kahu Malama that it’s a hard sell to con­vince med­i­cal res­i­dents to do a ro­ta­tion in elec­tive ru­ral medicine with­out fi­nan­cial as­sis­tance.

Med­i­cal res­i­dents look through their elec­tives hand­book “and they say, ‘This looks in­ter­est­ing,’” Tat­suno said. But the Big Is­land’s high cost of liv­ing com­pared to the main­land is a bar­rier.

In July, Mayor Harry Kim wrote to the Uni­ver­sity of Hawaii’s John A. Burns School of Medicine in Honolulu in sup­port of cre­at­ing the non­profit.

“Please know that the County of Hawaii stands ready to sup­port this ini­tia­tive with fund­ing, and any other means ap­pro­pri­ate to mit­i­gate this doc­tor-short­age cri­sis,” Kim said in the let­ter to Dr. El­iz­a­beth Tam, chair­per­son of the UH-Manoa Depart­ment of Medicine.

The county has $20,000 of grant fund­ing avail­able to kick-start the non­profit.

Dr. Mark Hi­raoka, who over­sees the JABSOM ob­stet­rics res­i­dency pro­gram now of­fered in Hilo, said the Big Is­land-fo­cused non­profit will be broad enough to ac­com­mo­date var­i­ous spe­cial­ties.

But, he said, an ini­tial top pri­or­ity will be in­ter­nal medicine res­i­dency.

Typ­i­cally, in­ter­nal medicine res­i­dents get hos­pi­tal-fo­cused train­ing. Hi­raoka said the pro­gram will help in­ter­nal medicine res­i­dents also get com­mu­nity-based ex­pe­ri­ence dur­ing the pro­gram’s third year.

In­ternists fo­cus on chronic dis­ease man­age­ment in adults, whereas fam­ily prac­tice physi­cians treat all ages, and of­ten prac­tice pri­mar­ily in hospi­tals.

“We want more in­ter­nal medicine physi­cians as pri­mary care physi­cians de­liv­er­ing care in Hilo,” Hi­raoka said.

Tat­suno said med­i­cal res­i­dents will ap­ply for the elec­tive ru­ral medicine ro­ta­tion on the Big Is­land through JABSOM.

One doc­tor cur­rently com­plet­ing in­ter­nal medicine res­i­dency on the main­land, Hi­raoka said, is from Keaau and wants a ro­ta­tion in a ru­ral care re­gion such as Hilo.

The non­profit could help physi­cians like that one come to a com­mu­nity clinic on Hawaii Is­land for a ro­ta­tion and, Hi­raoka hopes, make it more likely they’ll stay on the Big Is­land to prac­tice medicine when train­ing is com­plete.

Tat­suno said the ru­ral medicine elec­tive isn’t only to teach physi­cians the spe­cialty of in­ter­nal medicine. It also will teach them how to sus­tain­ably op­er­ate a ru­ral medicine prac­tice, he said.

Hawaii County Man­ag­ing Director Wil Ok­abe said the county wants to get the non­profit started “as soon as pos­si­ble.”

It’s an un­usual ef­fort “for county gov­ern­ment to get in­volved in,” he said.

But be­cause many physi­cians in Hawaii County are al­ready in their 60s and 70s, he said the doc­tor short­age cri­sis re­quires county at­ten­tion.

“We need to reach out and try to get these young doc­tors to come,” Ok­abe said.

“The bot­tom line,” Hi­raoka said, “is we want more physi­cians in Hilo, and we will use all av­enues to at­tract them.”

Board mem­bers of the new non­profit in­clude Tat­suno and Dr. John Uo­hara, Dr. Cur­tis Lee, Dr. Henry Lee Loy and Dr. Rod­ney Ono, who all prac­tice in Hilo.

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