Doctors Agonistes: Paradise Lost
by Edward Gutteling, M.D.
My friend Frank died Friday night. Our Big Island doctor shortage is now 231. He came here straight from the army, 1976. Two years ago, age 70, anesthesiologist Dr Hammer got the power lifting championship Masters Division World Record dead lift and 2nd in bench-press. He said ”I was thinking I’d just grab the bar and push my f*&king feet through the floor!”. And man-o-man, did he ever.
His heart attack started during a surgicenter case. “I didn’t feel quite well” he told me later.
OBGYN surgeon Dr Nitta (no spring chicken himself) told him to get subbed out. ”No way!” Frank said, finishing the operation before Dr Nitta could get an EKG on him. “No Frank, you’re not driving yourself to the ER”. He went by ambulance, bypassed the ER and straight into the Hilo Med Center cardiac cath lab. They saved his life that day. “Maybe I’ll quit hospital call, staying up all night, when they let me back next month” he said. “Good idea, Frank. Rest up.” But it wasn't enough. A week later he was gone.
A few years ago, after 40 years in Hilo, my friend Djon died. The Queens Med Center program director said Dr. Lim was “the best cardiologist the Fellowship program ever had”. He was from Medan, Sumatra, near Banda Ache where my grandmother was born.
He and my Dad, his patient, chatted about old Indonesia days, very cool.
I remember once him crawling off his sick bed, coming in coughing, looking like crap to help my ER fracture patient, dead of a Sunday night. Then one day Djon said “Ed, I can’t continue losing money every year. I’m closing my practice, changing to hospital employee”. Even a fully-booked world-class cardiologist couldn't make money practicing in Hilo.
They’ve been through about 6+ cardiologists since then, they come and go, none in private practice.
My friend Ben quit last year. Dr Ono was my personal doc, the only fellowship trained pulmonologist on the Big Island. Superb. Busy. He said insurance company constraints, “payment transformation program”, forced computerized scrutiny, extra requirements all resulted in losing money. He wanted to keep going, tried, but he quit.
After two of his kids were born here, my neighbor, anesthesiologist Dr Steve Lazaro took his family and moved away. “It’s never going to change, and it’s getting worse.” Anesthesia Dr Danny Chaung left last year too, with wife and newborn kid. The Hilo Surgicenter started cutting back on my OR time, short on anesthesia docs. Now it completely shuts an OR some days.
The Hilo Endoscopy Center went from 3 to 1 ½ gastroenterologists, soon 1, and has been unable to recruit anyone in 6 years of trying.
No one wants to come here.
Why is that? Very simple: our docs get worked way too hard, get paid way too little. As in any abusive relationship, eventually one leaves.
Medicare pays Hawaii docs near the bottom of the scale despite our highest cost of living in the nation. Alaska docs get 50% more, even New York and California get more. Then Hawaii State takes GET 4.2 % of that, which we are forbidden to charge the patients. So Hawaii docs actually get paid net the lowest rates in the nation. Ditto for Medicaid, Quest. No other state taxes medical care. None. The counties voted an extra .5% to pay for the Honolulu train-to-nowhere, so 4.7% hit coming atcha, docs!
CMS(Centers for Medicare & Medicaid Services), began penalizing us an additional 4% “negative adjustment” for not meeting “Meaningful Use Stage II” electronic heath record requirements. (Meaningful Abuse?) In 2 years this becomes a 9% hit. Many practices, including urgent care, can in no way meet those extra requirements without losing money.
They’re already penalizing 8 of our hospitals 0.3% for having too many re-admissions, due to collapse of primary care provider back-up in the community.
The Big Island is experiencing a critical physician shortage currently at 44%, worsening with demand climbing and our docs leaving, getting old, quitting, retiring and dying. Last year 152 docs left Hawaii.
Docs are channeling their inner Rambo: “I love my country! I just want it to love us back.”
Dr. Gutteling is team orthopedic surgeon for the UH-Hilo Vulcan Athletes, one of the last endangered free-range orthopedic surgeons on the Big Island.