Issues Re Big Island Medical Care

[Kenney]

Sorry you’re having such a hard time securing a Dr. Mearth11. Too many of us are having similar problems.

The Doctor shortage in the State is really critical. I think I read that on the B.I. we are 200 Doctors short. That’s a lot.
I worked for a Dr. in Hilo who had over 5000 patients. If even one Dr. retires, that’s a lot of people who have no Physician and most here are at Retirement age as are Nurses.. The difference in the Nursing shortage is that we are Graduating Nurses yearly both from the ADN Program at HCC and the BSN Program at UH. here in Hilo as well as on other islands.

In my experience, the Loan programs which offer 20% repayment for every year worked in Hawaii after graduation are a winner. In my class only one person who received the DOH loan moved out of state (and had to repay loan immediately). All the rest of us stayed here and worked off our loans.
I think this kind of incentive to stay in Hawaii really works, but is definitely best for people who already live here. It’s hard for anybody new to acclimate to Hawaii and many come and go pretty fast.

Fortunately for us, we do have the John A. Burns School of Medicine, and I hope to see many more Physicians from Hawaii taking advantage of an education there. I would love to see lots more Hawaiian Drs. here who understand the local culture and people.

Lastly, I’d like to say that Doctors are just people, some committed and compassionate and others neither committed nor compassionate. They don’t have to seek patients and can afford to pick and chose who they want to serve. This past Nov. I called one Dr. to ask if they were taking new patients and they never called back. I called them again and was told I “was on the list” of people who’d called and they would contact me later. Apparently, sight unseen, they decided I wasn’t the optimal patient and I never heard from them again. There were no red flags. I am healthy, not on Quest, no pain meds, yet still I did not even get a call back. (stuck with Kaiser for yet another year)

As a Health Care Professional, I always had good Insurance and Medical Care, until I retired. Now, I’m in the same leaky boat as everybody else, hoping the Dr. shortage is rectified before more people come to unnecessary harm or have to leave Hawaii.

[mearth11]

Thanks so much, everybody, for your responses. This is such a big problem with so many facets that deeply affects most of us. I don't have a clue what to do about it. So, at least we can commiserate a bit on Punaweb. Aloha.

[Amrita]

Have the same PCP since 2002 but concerned if he retires I'll be left in the lurch. Can switch to Kaiser during open enrollment but would that entail flying to HNL for other than routine health care? Anyone care to comment on pros and cons of Kaiser.

[Chunkster]

I have been with Kaiser for about 13 years, initially on an individual plan and more recently on their Medicare Advantage plan. I'll start with the good parts:

You are guaranteed a primary care physician, and they are generally competent. (More about that in the cons section, though.) Those flights to Honolulu are fully paid by Kaiser and they are changeable with no fees. If needed, they will pay for an air ambulance. (I was sent by air ambulance to HNL for emergency surgery, and they paid the entire cost of it, including the ground ambulances at both ends.) Kaiser's hospital in HNL is rated as one of the better ones in the city, and I received excellent care there in a private room with unbelievably good food. At Kaiser, all your records are in one consolidated system since virtually everything, including lab work and specialty treatment, is done in-house. Those records are tied into a pretty decent website where you can email your doctor, view test results, pay your bill, get general information, and order prescription refills. Speaking of drugs, they have a crackerjack mail order pharmacy which is quick and very reasonably priced as long as your meds are in their formulary. (One of my old meds was not in the formulary and I grudgingly changed to save money. I got better results with their choice.) Kaiser offers free telephone consultations with both doctors and nurses, and this has saved me a lot of trips to Hilo, particularly for follow-up care. And finally, the staff consistently show a lot of Aloha.

Now the cons:

That guaranteed primary care physician is likely to be young and not too experienced, and she/he will probably not be around long. After having one Big Island native PCP, Dr. Hu, for my first six years with Kaiser, I have been through three more in the past seven . . . and that does not count two rent-a-docs who were very clear about being temps. Specialty care available at Hilo has been cut back. Other than dermatology and psychiatry, I'm not aware of any specialists who practice at Kaiser Hilo on a regular basis any more. I had to drive to Kona to see a urologist, and other matters require that flight to HNL. Speaking of which, although free, those flights can be a hassle, what with the usual airport grind and having to take a shuttle to Kaiser HNL. And one last big con for you Medicare Advantage folks is the cost. In 2017 Kaiser went from $69 to $200 per month on top of what the government charges. That was an unconscionable single jump, and Kaiser's only excuse for doing it all at once was that the Feds approved it. And what were their Medicare customers going to do? As we all know, there are very few alternatives.

So there you have my opinion. I'm sure there are others with differing experiences, and I hope they post here to give you a broader perspective.

[kalakoa]

Those flights to Honolulu are fully paid by Kaiser and they are changeable with no fees.

...

In 2017 Kaiser went from $69 to $200 per month

1. Those flights aren't exactly "fully paid by Kaiser";

2. I don't have all day to fly to Oahu for a 15-minute doctor visit.

[Kenney]

Kaiser wasn’t happy when I stood up at the Medicare Informational Meeting and said “what you’re saying, is that the fragile population in this room must fly 500 miles one way for care?”.
Their reply, “we will talk to you after the meeting.” I left but really had no choice but to stick with Kaiser for another year.
Kaiser knows they’ve got us as there just isn’t another choice.
What really chaps my hide is that they have a “special plan”for the BI and Maui that costs the same as O’ahu but you must fly for everything beyond PCP Office calls.

[DTisme]

I've had very good treatment since I've been with Kaiser. This was after a number of years with two local doctors I was NOT happy with. (Don't get me going) Of course I'm NOT happy that individual rates have more than doubled since joining, but treatment is good, everyone is nice and helpful, and you can get an appointment even same day sometimes. Might not be with your PCP, but there's a doctor there to see you. You can change PCP's on the fly, btw, once you're in. Just go to website to change. I have done this a few times in last few years. You don't need to wait to open enrollment like you do if you're JOINING Kaiser.

Just to clarify what kinds of things as Kaiser patients my friends and I have have either had to fly to Oahu for, or have had handled here inside and outside of Kaiser Hilo clinic:

Things requiring flight to Oahu: Diagnostic mammogram (could also be done in Hilo, but if can't be done quickly enough, they'll fly you to Oahu); breast biopsy; MRI; CT scan; neurologist specialist visit (this could have been done in Hilo with neurologist who comes here once a month, but since I needed MRI, I saw him there); scheduled surgery; hospital stay after scheduled surgery; colonoscopy; etc.

Things treated here by local doctors or services who contract with Kaiser: specialized physical therapy; sleep study; xrays; emergency room visits; emergency surgery; radiology for cancer; hospital stays; cardiology tests [<<most at Hilo Medical Ctr]; etc.

Things done at Kaiser Hilo: routine doctor visits; specialist visits with specialists who come to Hilo once a month such as podiatrists, neurologists, etc.; mammograms; lab work; asthma treatments, etc.

I have a sister who lives on the east coast. She can't imagine taking a flight to see a doctor. I ask her how long it takes her to see her doctor. She drives an hour into Boston and an hour home, plus parking and doctor visit. I get to fly into Honolulu and see Diamond Head in same time frame! Just sayin'.

So far, it hasn't bothered me, and the Kaiser travel office is super efficient. i.e., you don't make our flight plans, they do it for you. All you have to do is show up with your driver's license at the airport and your reservation code.

Bottom line is that if treatment or diagnosis requires specialized equipment and can wait a few days, they'll fly you to Oahu. If it requires specialized equipment and/or you are unable to fly, they'll send you to Hilo Medical Center.

[Obie]

I lost my retiree medical years ago in a cost cutting measure.This was before I retired.
Later the company filed for bankruptcy and people who had already retired lost their insurance.

We formed a group and this is what we have now.

http://www.itdr.com/

I don't have a problem seeing a doctor because I can see anyone I want.

[Amrita]

Mahalo everyone for the Kaiser info.

[BillyB]

More than a few years ago a man went into Hilo emergency room with a cut on his leg, they sewed him up and told him to change the bandages every day. A week or so later he returned with the same bandage still on, and an infection so bad they had to amputate his leg. Well he sued the doctor and got a big payoff because he lost his leg. I cannot blame a doctor at some point for not wanting a patient who refuses advice if the doctor is liable for the patient's actions, and even inactions.

A quick look shows our medical school has 250 students and the law school has 270 students. In my whole life I have never heard anyone complain there is a shortage of lawyers, it's always doctors. Why not close the law school and double the size of the Med School?
Twice as many new doctors, lower insurance costs, less MD paranoia motivated prescriptions and tests.