2 doctors’ departure
leaves Hawaii short
of rheumatologists

Regs anger doctors

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By Helen Altonn
haltonn@starbulletin.com

Two Honolulu rheumatologists are moving to the mainland, leaving fewer than a dozen specialists in the state to treat an estimated 60,000 to 100,000 residents with rheumatic diseases.

Dr. Jeffrey Fong, in private practice, and Dr. Lawrence Levin of Straub Clinic & Hospital cite personal reasons for leaving, but acknowledge reimbursement and regulatory issues.

Fong, who has practiced here since 1985, said he is leaving for "personal fulfillment issues." He and his wife are going to San Francisco, where he will join Kaiser Permanente.

He said he's closing his practice here because he can't find anyone to buy or take it over. "No one wants to go into rheumatology or endocrinology because of reimbursement issues and extra training and patients are more difficult ... They are people with a lot of pain."

He has an active file of about 1,500 patients, many of whom will have trouble finding another rheumatologist, he said. "For Medicare patients," Fong said, "it's almost impossible to find somebody a doctor because of reimbursement issues and administrative and bureaucratic hassles dealing with Medicare, government laws and regulations."

Levin, who has lived here 37 years, said his departure "is a personal lifestyle decision," mainly because he and his wife want to live in Oregon. They are leaving Aug. 17 for Ashland.

With a shortage of rheumatologists, Levin said, "Everybody's working as hard as we can. We cover outer islands, too." He said Maui "is in desperate need of a full-time rheumatologist."

Rheumatic diseases include arthritis and lupus.

Being at Straub the past 12 years has been "a pretty great thing," Levin said, praising the medical staff.

But he said he is "somewhat dissatisfied" with these issues: "Medicare reimbursements are pathetically low and patients don't realize it. They don't understand what it costs to run an office ... And Medicare regulations are absurdly burdensome ...

"You'd see people going to jail right and left in the next few months if they were monitoring big business the way they monitor medicine, and applying breaking rules and regulations as stringently, as obnoxiously, as they do in our field.

"But again, that's not why I'm leaving Hawaii. That applies around the country," Levin added.

He said HMSA is difficult to deal with at times but is "very good at making sure there is accessibility (to care) and trying to spread the risk fairly among the community ... "

Fong pointed out that the health care system is changing "because of the force of government to decrease the inflationary costs of medical care, government decrees and the public policy deciding how health care is being delivered."

Under increasing pressure, doctors will change the way they practice, shifting from private offices to groups, clinics or somewhere with a protected position and salary, he said.

"Before, we all wanted to go into private practice. In the last 10 years, the whole thing has shifted."