Ka Wai Ola - Office of Hawaiian Affairs, Volume 31, Number 11, 1 November 2014 — Hawaiʻi's health worker shortage expected to worsen [ARTICLE]

Hawaiʻi's health worker shortage expected to worsen

By Mary Aliee Ka'iulani Milham Hawai'i's worsening health-care worker shortage is expected to hit the Native Hawaiian community hard. According to research by the Area Heahh Education Center (AHEC) at the University of Hawai'i John A. Burns School of Medicine, the current shortage of about 700 physicians statewide will be twice as bad in five years if drastic changes are not made. "If we keep going the way we're going, in 2020 we'll be 1,500 physicians short," says AHEC Director Kelley Withy, a family physician whose doctoral work focused on elinieal research. "We don't train enough. We don't keep enough. We don't recruit enough."

Mueh ot the increased eoneem over Hawai'i's health-care worker shortage comes from the state's aging population. According to the Hawai'i State Plan on Aging for fiscal years 2012 to 2015-29.7 percent of Hawai'iresidents willhe 60 or older by 2035, compared to 11.9 percent in 1980. Withy, who has been collecting data on Hawai'i's health-care worker shortage since 2010, says that unlike on the continent, where the health-care worker shortage has been hard hit by a flood of newly insured patients under the Affordable Care Act - in Hawai'i, the shortage is due to an unhealthy loeal mix of high cost of living, low pay and laek of employers that's been brewing for years. Stir in other reasons - sick family members on the continent, high mortgages, school system limitations and spouses who either dislike Hawai'i or can't find a job - and the combined effect drives nearly 100 physicians out of the state every eouple of years. Over the same period, she says, an equal number of Hawai'i's physicians are lost due to retirement and death. The worsening shortage in Hawai'i is especially bad news for low-ineome groups and Native Hawaiians and others in rural areas where health-care needs are great. "Rural areas are suffering terribly right now," says Withy. "Because we train people on O'ahu, and most of them stay on O'ahu." About half the shortage statewide, she says, is on the neighbor islands where only one-fourth of the population resides. Increasing the number of Native Hawaiians going into medicine could significantly improve the situation. ' 'We have very few Native Hawaiian physicians, so as far as cultural competency, we significantly need to expand training for Native Hawaiians," says Withy. Annual Ananeial support for training Native Hawaiian physicians and other health-care workers, through the federal Native Hawaiian Heahh Care Improvement Act, is helping to address this issue. The most recent allocation of $12.3 million will support Papa Ola Lōkahi and the five Native Hawaiian Health Care Systems. According to Kim Ku'ulei Birnie, Papa Ola Lōkahi community relations specialist, the funds POL receives will be used for its Native Hawaiian Health Scholarship Program and to create jobs within the Native Hawaiian Health Care Systems for scholarship graduates. Since 1991, the Native Hawaiian Heahh Care Systems has made 345 awards within 15 heahh professions, including doctors, physician assistants

and nurse practitioners, 49 of whieh were for medical school. Telemedicine - video conferencing with a specialist, phone calls, emailing whh a doctor - may also offer some relief, particularly whh regard to specialists on the more rural neighbor islands. For example, Withy says, a dermatologist who might not have enough patients to maintain a practice on the Hawai'i Island could treat patients on more populous O'ahu. Withy says her research indicates private insurance payments are in the bottom one-third for U.S . states and that Medicare payments do not adequately account for the high cost of living in Hawai'i. Hawai'i's poor retention rate also has to do with professional and personal isolation and older facilities. JABSOM, the UH medical school, whieh trains 66 physicians a year, has plans to increase its class size to 75. About 10 doctors are also trained annually through the AT Still School of Medicine at the Wai'anae Coast Comprehensive Health Center. But given loeal needs, the combined output is a drop in the petri dish. By comparison, Withy says, the shortage of nurse practitioners and physieian assistants, or PAs, is not nearly as severe, yet it is concerning, especially given there are no schools training PAs in the state. Currently there are about 200 nurse practitioners and 100 PAs working in Hawai'i. "We have about half of what a community our size on the mainland has," says Withy. ■ Marv Ali.ce Ka 'iulani Milham is afreelance kanaka writer. Aformer newspaper reporter and eohumūM from California's Central Coast, she lives in Mākaha, O'ahu.

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HEALĪH

Job fair Hawai'i's growing health-care workershortage prompted a Healthcare WorkerJob Fairatthe Sept. 6 Hawai'i Health Workforce Summit at the Hilton Hawaiian Village Waikiki Beach Resort. The job fair sought to connect health-care job seekers with employers from Kaiser Permanente, Hawai'i Pacific Health, UCERA, AlohaCare, 'Ohana Health Plan, Rehabilitation Hospital of the Pacific, The Queen's Health Systems, Clinical Labs, Hawai'i Advanced lmaging and others. The job fair, whieh included 23 vendors representing 10 health-care job specialties, was attended by about 300 people.