A crisis of care
Alongtime Maui resident we know has been trying to find a doctor for nearly two months. Her previous physician retired and the one before that moved away. Though she is hurting and needs help, she has been told time after time that the doctors she would like to see are too busy. The physicians are either not taking new patients or their earliest available appointment is deep into next year.
A Physician Workforce Assessment released a year ago by the University of Hawaii’s John A. Burns School of Medicine reported that Hawaii was short more than 1,000 doctors. Maui County was reportedly short 138 doctors at the end of 2019 and that number has likely increased.
Dr. Colleen Inouye, a Kahului gynecologist, who serves as state treasurer and Maui director of the Hawaii Independent Physicians Association, says access to care is “poor” on Maui.
“I’d say we are in a crisis,” Inouye said. “When a patient cannot get a family physician or a specialist in a timely manner, and then on top of that, be seen by that physician in a timely manner, that is definitely a crisis. It affects the health of our community.”
Inouye says the shortfall is caused by a variety of factors. Hawaii loses homegrown talent due the limited enrollment at the Burns School of Medicine, and also because of the lack of opportunities to do residencies in the state. She says those bright students often end up studying and locating elsewhere.
“First of all, there are plenty of well-qualified students from Maui who want to become physicians,” Inouye said. “There’s just not enough spots at the John A. Burns School.”
The high costs of living and practicing in Hawaii also play major roles. Inouye says professionals thinking about moving here used to be put off by our high real estate prices. Now they cannot even find housing.
Physicians in private practice must pay Hawaii state general excise tax on the medical services they render. They cannot, however, pass that cost onto Medicare and Medicaid patients due to the set amounts those programs pay providers. It hurts doubly that the Medicare reimbursements they receive are less than in other states like Alaska because of Hawaii’s low Medicare Geographic Practice Cost Index, or GPCI.
Inouye, who has delivered more than 7,000 babies during her 36 years practicing on Maui, says there are ways for our state and county legislators to attract new doctors and retain old ones. They include getting the GPCI raised, increasing housing and reducing the tax disadvantages that dissuade doctors from coming here.
Living on an island in the middle of the Pacific Ocean means we must sometimes make do without the things we want or need. That should not include access to health care.