Cardiac care

[Lee DeJongh]

I can't make the blanket statement of 50% across the board and I suspect Family Practice are close to what they get on the mainland but subspecialists are less. Part of it is Kaisers philosophy and part is Hawaii itself. it is seen as a prime place to be. But like other occupations, it attracts a type of person who might be just a little laid back and not like, for example the Mass General Docs. Some people I know have liked working for Kaiser because it is Factory or shift work in a sense. Defined hours. This is not bad and is the way of the future in my opinion.
And, as an aside, sometimes the care that people want is not the care they really need. Needs and Wants are not the same.
Most of the Residents and Students I work with have debts of 250,000 or more. Add in the cost of living and it's is hard to imagine any new doc being able to afford Hawaii.

[Kapohocat]

After speaking extensively with John, the Communications manager for the Bay Clinic, and trying to figure just what is wrong with our system for attracting good docs here and how to fix it - the problem seemed simple - docs coming here deal with the same issues us regular folks did - complete change in culture from the mainland, lack of good schools & programs for their kids, no support network for their SO's (kinda like the family support groups in the military), far away from their older parents who may require care.

His take on it was this is the big reasons for docs coming here and leaving soon, or not coming. I understand wages are fairly competitive to small towns of the same size, although some of the docs trained in big cities are not used to/familar with rural/non-affluent care and there are some issues. Also not having access to specialists is as hard for them as it is for all of us. Maybe even more disheartening.

My thought would be to attract younger docs or single docs who had experience in 3rd countries. Have a welcoming committee that helped the newbies through their first year, helped them get acquainted with the social life. That kind of thing.

Any thoughts?

[JerryCarr]

Small and/or isolated communities on the mainland have used a number of strategies to attract doctors. Some small towns on the Great Plains offer scholarships and grants for medical students or residents on the condition that they practice in their community for a minimum number of years. These programs started back in the 70's and 80's and resulted in many of the docs staying on long after their obligations were completed. Others have taken over paying off student loans to various degrees in return for a commitment to serve a community.

One possible solution for Hawaii might be to use some of the state and local budget surplusses to fund scholarships, to enlarge the UH medical school (they do have one, don't they,) or to outright bribe doctors with cash incentives to practice here.

Kapohocat makes a very good point about the lack of support networks and amenities for families. The public schools have come up time and again when discussing reasons for lack of progress in a number of areas, and would be a good topic for a separate thread.

Aloha,
Jerry

[Lee DeJongh]

okay....to be blunt. This is what you are competing against. In my community of 60,000, our local HMO health system pays Family Practice a starting salary of 175,000 plus benefits, health, retirement, etc totaling 75,000 a year plus a loan forgiveness program which pays back their student loans over 5 years. A wonderful house with an acre of land like all the docs want costs 275,000. That's 3000 plus square feet. Our schools are top notch and we are 35 miles from a world class university. We are 100 miles from Chicago and all its culture. The docs are supported by a network of top specialists both here and at the University 35 miles away. State of the Art diagnostics. This is your competition.

I do not believe FPs on Hawawii are making 200,000 a year but I could be wrong. You know yourself what 275K buys in Hilo or Kona. And as you say, you do not have the specialist network to back these docs up. Yet they are held to the same standard of care as anyone else. It is tough to practice good medicine under those conditions to the standard the public demands. (It is not tough to practice appropriate medicine, just that the public expectations are sometimes not realistic)

I think the solution for Hawaii is what they have done. Start a school. Grow your own. Local homegrown docs. Support them with incentives.

Alaska has even a worse problem than Hawaii and it doesn't yet have a school. One of my acquaintances is a rad tech in an Alaskan village north of the arctic circle. He is paid 50/hr 24/7. Works one month. Then they fly him home to Chicago for one month, then they fly him back. He shares the job with one other person. Makes lots of money. Absolutely nothing to do up there.

[Lee DeJongh]

Forgive me for getting on my high horse, but what I am trying to say is that:

I am sure you have good docs in Hawaii. I am sure they are trying their best. And I am sure they are stresed. There really is nothing wrong with using a popsicle stick as a splint. There really is nothing wrong with not immediately treating a fracture. When I was a kid, it was standard practice to ice and elevate for 4 or 5 days until the swelling went down before casting. There are life threatening things and then there is everything else. And something one just has to accept some delays. Because there is no choice to do otherwise. and you really need to support the docs you have.

End of rant.

[JerryCarr]

Lee, you are not on a high horse. Sometimes the truth is not entirely pleasant or what we want to hear, but we need to deal with it anyway.

Aloha,
Jerry

[Punamom]

I love all my doctors it is not the docs that are the problem.But isn't that always the case I don't want to go into a major rant about this. I just want to let astridf know about our health care.

[Kapohocat]

I think Lee & Jerry's ideas on homegrown docs are a great idea!! Set up scholarship/grant funds for graduating HS seniors that are going to go into medicine and also medical students from Hilo/Keaau/Pahoa areas - student loan payment incentives.

My mom was an Rad Tech - HMC offered her $3000 to move, much bigger salary than Cali, and just swapping her license from Cali here for $20 Lic Fee.

And yes we do have a medical school in HNL - the John Burns School of Medicine I think it is.

[Carey]

to Jerry, Cat & all, Manoa does have the John A Burns College of Medicine, website:
<http://jabsom.hawaii.edu/jabsom/>
At the Shipman meeting lastnight, Kimo Lee from Shipman has related how they have tried to interest a med facility into some of their Puna property, but met with no interest form the medical community, not enough finacial incentive.
Hopefully Puna will have enough incentive soon.
Aloha, Carey

[medic]

As a RN in an Emergency Department in Atlanta who has an interveiw next week at a Big Island hospital, I have to agree with the two freacture incidents sited above as standard practice. Emergency room physicians are not orthopedists. The set fractures to maintain circulatory and neurological function and package the affected area (read splint) for the ortho docs.

Malama pono,

Al Braun, RN,BSN EMT-P