State needs to cope with a growing doctor shortage

THE ISSUE A national shortage of physicians in rural areas is being felt on Hawaii's neighbor islands.

PHYSICIANS are in short supply in rural areas across the country, and the shortage is felt in Hawaii's neighbor islands. Combined with a nursing shortage that is projected to worsen, Hawaii could face a health care crisis that will require action to produce and retain more medical workers in the islands.

Hawaii has about three physicians for every thousand residents, ranking it 11th among states in doctors per capita. Still, the state has a shortage of specialists such as orthopedic surgeons, anesthesiologists, gynecologists and general family doctors, who are especially scarce on neighbor islands.

John Bellatti, a Kona orthopedic surgeon, predicted to the Star-Bulletin's Nina Wu that "the all-out shutdown of private medical doctors is on the horizon. There will still be a very few maintaining their existing practices and large parts of the population will have no doctor."

More than 35 million Americans live in areas that are underserved in health care, and the American Medical Association estimates that it would take 16,000 doctors to fill the need. That need is expected to rise to 24,000 doctors by 2020, according to a government estimate, and as many as 200,000, according to an alarming 2005 study in the journal Health Affairs, based on a rising population and an aging workforce.

At the same time, the American Hospital Association reported last year that the nation's hospitals have 118,000 vacancies for registered nurses, and that shortage could grow to more than 800,000 by 2020. Hawaii's shortage of nurses was 1,041 in 2000 and is expected to reach 2,267 by 2010 and nearly 4,600 by 2020.

Gov. Linda Lingle turned to the Philippines last year to cope with the nursing shortage, creating a college exchange program that prepares participating Philippine faculty to learn how to better prepare nursing students for Hawaii's nursing exams. More than 1,000 graduates of Philippine nursing schools work in Hawaii.

Other states are similarly looking abroad for doctors, but the federal government has made it more difficult since 9/11 to obtain special J-1 visa waivers, which allow foreign doctors to work in underserved areas for three to five years to qualify for permanent U.S. residency. The number of physicians training with such waivers has fallen by almost half in the past decade, according to the Government Accountability Office.

Some Hawaii doctors also point to the rising cost of medical malpractice insurance as a reason for them to move to the mainland, pointing to California's malpractice economic cap as a cure-all. Actually, California's malpractice insurance premiums rose sixfold in the 13 years following the cap's enactment before being brought under control after voters required state approval of premium increases and other insurance regulation. A bill similar to California's law was rejected this year by the Hawaii Legislature.