Doctor shortage belies top ranking
A physicians group says insurance is no good without enough doctors in the state
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Many islanders can't find a doctor, especially on the neighbor islands and in rural Oahu areas, despite the state's top ranking nationally for access to health care, says the Hawaii Medical Association, a local physicians association.
A Commonwealth Fund survey said Hawaii has the best access to health care in the country, primarily because of a high number of residents with health insurance. But the study didn't consider availability of doctors, Hawaii Medical Association members say.
"If we don't have doctors available to see them, what good does insurance do you?" said HMA President Linda Rasmussen, a Kailua orthopedic surgeon. High malpractice premiums and low insurance reimbursements have created a "state of crisis" in Hawaii with physician shortages limiting access to health care, she said.
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Hawaii residents may have the best health insurance coverage in the nation but that doesn't mean they have access to doctors, says the Hawaii Medical Association.
"People have got insurance -- great," said HMA President LInda Rasmussen. "If we don't have doctors available to see them, what good does insurance do you?"
The Hawaii Medical Association's next public forums will be from 5:30 p.m. to 7:30 p.m. Aug. 16 at The Dunes at Maui Lani, Maui, and Aug. 22 at Wilcox Memorial Hospital, Kauai. A Honolulu forum will be held Nov. 13 at a location not yet named.
A survey done by the Commonwealth Fund's Commission on a High Performance Health System ranked Hawaii tops in the nation for access to health care. The findings, reported Wednesday in the Star-Bulletin, cited Hawaii's high rate of insured residents, largely because of the state's prepaid health care act and low unemployment.
But the national study didn't consider availability of doctors, Rasmussen, a Kailua orthopedic surgeon, and other doctors point out.
The ability to find a doctor "is dangerously limited due to Hawaii's lack of medical tort reform and low insurance reimbursements," Rasmussen said. "In fact, access to health care in Hawaii is in a state of crisis.
"If I have a patient who needs a total joint (replacement) and has an abnormal EKG (electrocardiogram) and needs to see a cardiologist, it's almost three months to get an appointment before he gets cleared," she said.
"If a person calls when they're 50 for a colonoscopy, they're almost 51 before they get in."
The medical association has been holding forums statewide to address patient access-to-care problems and drawing big crowds -- 175 people at one in April in Kona and 125 last month in Hilo.
"People are frustrated," said HMA Executive Director Paula Arcena. "They have insurance coverage but they can't find doctors." The neighbor islands and rural Oahu are affected the worst, especially in specialty and trauma care, she said.
"In Hilo, you can't get a primary care doctor. Everyone there is booked and not taking new patients," Rasmussen said.
She met last week with the Kauai Medical Society and found Wilcox Memorial Hospital is overloaded with patients being transferred from the Big Island and Maui.
Suffering a coughing spasm during a telephone interview, Dr. Barry Blum, Kona Community Hospital medical director and orthopedic surgeon, said, "My own doctor closed his practice, so I can't even go to a doctor."
He said his doctor, an internist, had 3,000 to 4,000 "very complex patients" when he closed his practice in January. Now, he's at Kona Community Hospital and Blum said he has to catch him in the hallway and ask what he suggests for his cold.
The hospital has about four or five internists but no new internists have joined the staff in the past 10 years, Blum said.
He said Kona Community Hospital is sending some stroke patients to Maui Memorial Hospital and considering it as an alternative for trauma patients.
One of the major solutions is an increase in federal reimbursements to doctors, he said. They have been going down every year, with HMSA reimbursements following the pattern, he said. "So, why bother being a doctor?"
The Legislature previously provided emergency funding to compensate Hawaii Health Systems Corp. hospitals for losses, he said. "This year they're telling us they're not going to do it. ... Our hospital lost $1.5 million with the (Oct. 15) earthquake and the state is unwilling to pay that back to us.
"The good news," Blum added, "is our little (93-bed) hospital is determined to provide what's needed for our community and we're going ahead and hiring physicians. ... We really lost a lot of doctors. I think we're finally turning around now. "
Dr. Joann Sarubbi, Hawaii County Medical Society president and a Hilo Medical Center emergency room physician, also stressed that high malpractice premiums and living costs, coupled with low reimbursements, are driving doctors out of Hawaii.
The Big Island has no neurosurgeon and its only neurologist is leaving this month because "he cannot afford to practice and live in Hawaii," she said.
The Hilo community hasn't had a new primary care physician for almost three years, she said. "Most physicians are ready to retire and all are at capacity, so unfortunately the emergency room bears a large brunt of primary care."
Hilo has three orthopedic surgeons but one is injured and another is often on military duty, leaving just one in active practice, Sarubbi said.
"We're transferring a large portion of patients to Queen's and we're starting to transfer them to Kauai, which has an orthopedic group now willing to take outside transfers."
The Queen's Medical Center, the state's designated trauma hospital, has only two on-call orthopedic surgeons and is often inundated with cases from across the state, Sarubbi said.
She said there have been quite a few patients with multiple traumas who could not be transferred right away and for whom a delay could cause "a life-and-death situation."