The Hawai`i State Legislature voted May 3 to continue the Hawai`i Physician Workforce Assessment, which is studying the state’s doctor shortage and implementing ways to recruit and retain more medical providers. The bill authorizes a fee on physician licenses to fund the assessment, with the goal of attracting more doctors to practice in rural and underserved communities.
“We are grateful the Legislature continues to recognize the profound negative impact of the worsening physician shortage,” said Jerris R. Hedges, Dean of the University of Hawai`i’s John A. Burns School of Medicine (JABSOM). “Today’s vote makes it possible to continue important efforts to meet the health care needs of Hawai`i’s residents.”
Under the measure, JABSOM will administer a fee-generated fund of about $245,000 annually. The school will submit an annual report on its use of the fund to the legislature, the state health planning and development agency, and the Hawai`i medical board. The fee would expire after 2017.
The latest figures from the Hawai`i Physician Workforce Assessment show the state is about 600 physicians short of the number considered necessary for a population its size. The shortage is expected to grow to 1,200 physicians by 2020.
The updated results were presented at the 2nd Hawai`i Physician Workforce Summit at the Sheraton-Waikiki Resort.
Second Physician Workforce Summit
The summit served as more than just a venue to update the figures, however. Over 200 Hawai`i MDs registered to attend the gathering to learn about implementing a “patient-centered medical home”, which JABSOM leaders believe could provide relief from the worsening shortage. The summit organizers also presented an award to Dr. Calvin Sia, JABSOM faculty pediatrician, who coined the phrase and concept of a patient-centered medical home, also called PCMH. Hawai`i Governor Neil Abercrombie, who gave opening remarks at the summit, also congratulated Dr. Sia.
Background on the Workforce Survey
The 2009 Hawai`i State Legislature created the Hawai`i Physician Workforce Assessment to determine the number of licensed physicians in Hawai`i who are currently treating patients and to estimate the future needs statewide for physicians based on Hawai`i’s population and the availability of practitioners in certain medical specialties areas (i.e., cardiology, etc.). The physician license fee to fund the assessment was set to expire in June 2012.
The assessment, led by JABSOM, is funded by a $60 fee imposed on MD licenses (licenses are renewed every two years).
The workforce summit attracted a range of doctors from across the state. Of the 252 physicans registered, at least one-fourth practice medicine in the critical shortage areas of the neighbor islands or rural O`ahu.
The Patient-Centered Medical Home
The educational focus was on the PCMH, coined by Dr. Sia, which has taken hold in many communities nationwide. The medical home is a single location, usually a primary care provider’s office, where a patient’s medical history is held, and where a team of professionals works to meet both the immediate and long-term health care needs of patients. They do this by scheduling treatments or specialty appointments and by coordinating screenings that prevent illness– for example– tests like mammograms, and keeping track of the patient’s care. The concept is popular because it reduces the number of costly emergency room visits, eliminates duplication of medical tests and promotes wellness.
Dr. Kelley Withy, JABSOM physician and the lead researcher on the workforce assessment, notes that implementing a medical home can be a costly investment for a doctor. For example, launching an electronic medical record system at your practice can set a physician back $50,000. Adding team members (staff) to assist in tracking patient appointments is an up-front cost. The summit advised MDs about resources available to them to help offset some of those expenses, including partial reimbursements of investment costs.
“We are trying to let the doctors know about all the resources available to them so they can afford to make changes that make a big difference to their patients,” said Dr. Withy. “Implementing more PCMHs can actually be a win-win-win for the patient, physician and government,” said Withy. “The patient wins from less confusion about who to call when they need health care–they can call their ‘home’. The physicians are aided because creating a team helps them provide the most attentive care to their patients. And the government wins because there are fewer duplications in tests ordered and fewer visits to the emergency room.”
See a summary of the updated 2012 Physician Workforce Summit Figures in our brief YouTube report. Please note that results are still preliminary, as they will continue to come in as licenses are renewed throughout 2012. If you are are not able to watch the video right now, here are some of the key new findings:
Hawai`i lost 50 fewer physicians than anticipated in the past two years. However, demand increased, leaving the shortage at around 600 doctors. Eighty percent of practicing physicians in the state are accepting new patients (which means 20% are not). Seventy-three percent of doctors accept Medicare patients (which means nearly 1/4 of doctors do not). The survey also found that 65% of Hawai`i physicians are in solo practice or in a group practice with fewer than five doctors. That means the investment costs associated with implementing a PCMH can seem more daunting for those practitioners.
Photos are courtesy of the Governor’s office. Story by Tina Shelton.
To see results of the initial 2010 physician workforce study, see: www.ahec.hawaii.edu/workforce.html