Putting a human face on Hawaii's doctor shortage

by Keli'i Akina, Ph.D., President / CEO, Grassroot Institute of Hawaii

The greatest takeaway from three forums last week about Hawaii’s doctor shortage was the realization that we are dealing with an undeniable human tragedy.

Sponsored by the Grassroot Institute of Hawaii, the forums on Maui, Oahu and Hawaii island made it clear that the state’s acute shortage of physicians — estimated at more than 1,000 — is not just about doctors, but also our families, friends and neighbors throughout the islands who are desperate for affordable and easily accessible healthcare. 

How bad is it?

At the Oahu event, James Winkler, a physician associate who is president and CEO of the Kauai Community Health Alliance, described the situation in rural Kauai:

“We have no endocrinologist, we have no outpatient neurologist, we have no oncologist. We don't have a psychiatrist on our island. We have no geriatrics. We have no palliative care medicine. Our ophthalmologist won't see Quest patients. I just had a patient with senile macular degeneration and diabetes. I tried to get them into an ophthalmologist, and they told me, ‘Send this person to Costco.’”

Winkler said recruiting and retaining doctors is extremely difficult, and those who are practicing here are “exhausted” from working long hours and “broke,” trying to cope with “our high cost of living [and] our high cost of housing.”

He continued: “I haven’t taken a salary in four months just to keep the [KCHA] facility going. … In a way, our facility is a canary in the coal mine, but we’re one of many canaries. There are canaries dropping out every day. We’ve lost 25% of our private practices in Hawaii in the last two years. I mean, just think about that for a second: 25% of private practices have disappeared in the last two years.”

As for Hawaii’s residents who need healthcare, “It’s heartbreaking to not be able to take care of the patients we take care of,” Winkler said. “So the human face of this is profound. These are patients who are depressed, suicidal, have breast cancer, ovarian cancer, diabetes, hypertension. These are our aunties and uncles. These are our children. … So anyway, I just wanted to set the record straight, [that] it’s really not about us.”

Winkler’s story has garnered nearly 640,000 views on TikTok, and comments from other healthcare professionals express similar struggles:

>> “I am a physician planning to move back home to Hawaii. … I will be taking a 50% pay cut, increased taxes/cost of living.”

>> “I looked at becoming licensed there and providing therapy via telehealth, but the process is cumbersome in HI. They need to offer reciprocity.”

>> “As a case-management nurse in Hawaii that has patients statewide, this is a huge problem we deal with everyday; we have to send people to Oahu.”

>> “I am closing my Oahu clinic in primary care. I don’t get paid for a year. I fight to get services. Cannot afford to live in HI.”

>> “My husband and I are both from Honolulu and in the health field. We want to return home, but we would both be taking significant pay cuts.”

If there is one message you can take from these comments — which are just the tip of the iceberg — it is that there are medical professionals who are willing to work in Hawaii. What they aren’t willing to do is barely scrape by because of our high cost of living. The inevitable result is that we can neither hold onto nor attract medical professionals. 

There is no quick, miracle fix for Hawaii’s doctor shortage, but one obvious first step would be to relieve private and group practice physicians from having to pay the state’s 4.7% general excise tax — especially since they are not allowed to pass that expense onto their Medicare, Medicaid and TRICARE patients. 

In another viral video from the Oahu event, Dr. Scott Grosskreutz, a diagnostic radiology specialist from the Big Island and founder of the Hawaii Physician Shortage Crisis Task Force, says that more than half of patients in Hawaii are covered by these three government-funded insurance programs. 

And because of their exceptionally low reimbursement rates, Hawaii doctors are “basically breaking even, losing money. And then they’re being taxed on top of that, driving them into the red,” he said.

Grosskreutz mentioned one more bad omen for the future of healthcare in Hawaii: 

"We … have the second oldest cohort of healthcare workers in the country. … We have 37% of our providers over age 60. Statewide, 25% of us, including myself, are over age 65, and [on] the Big Island, a third of us are over age 65. A lot of these providers are working 60-70 hours a week. And at some point, we’re going to be gone, and we desperately need to bring in new and younger providers to replace us."

Fortunately, some Hawaii policymakers are waking up to the need for change.

In an effort to heighten awareness of this problem, the Grassroot Institute launched a petition this week urging the Legislature to create a GET exemption for medical services.

If enacted, it would be a small, but vital, step toward making our state more attractive to doctors — and making healthcare more available to all who are in need.

Together we can make Hawaii a better place to practice medicine. Send a message to our lawmakers by signing and sharing our petition to exempt medical services from the GET.

E hana kākou! (Let’s work together!)