East Hawaii Hospitals Face Layoffs

[dakine]

After that, they get to pay off those medical school bills...

Is that any different than the expense of a post-graduate degree in any discipline? I do not think so. Even though for doctors considering the 12 - 13 years of post-graduate education they must finance the numbers are higher than most. Conversely the salary that can then be expected is equivalent with the debt load. Otherwise the system would be untenable. So holding out that line as HOTPE did is nonsense.

I have a couple of close friends that just got done with their residency and are making greater than 500k the first year, and have no problem with paying off their loans. Though they choose to stay on the mainland where their earning power is greater until their loans are paid off instead of returning to Hawaii where they grew up and hope to practice in the long run.

There is also a program that funds a lot of doctors that come here (the Bay Clinic is very adept at taking advantage of it) that pay off a young doctors tuition expenses in exchange for a three year commitment to work in rural America, which the entire Big Island is considered. It is called the National Health Service Corps (NHSC)

http://nhsc.hrsa.gov

and has been instrumental in bringing many doctors to the island that aren't ready to be more aggressive about their finances as yet and still want to develop a relationship with a community etc. and get their loans paid off. Unfortunately the Bay Clinic has taken serious criminal advantage of this program and many doctors have left to go back to the mainland after their three year commitment is over because of their mismanagement.

The real problem in Hawaii is the absence of serious tort reform. For that we have our state congressional body to thank. They're gutless methinks. Nationally, I believe, it is the continued profit based model of healthcare in general. As long as there are insurance companies involved the entire population is being held hostage to the greed of a few. Obamacare would have been great had the Republicans not screwed it up by insisting on the retention of the insurance industry. Why we would allow others to make a profit on our healthcare needs is absolutely mind boggling. And, a good example of what I mean when I say our society is unhealthy.

[HereOnThePrimalEdge]

$500,000?
Here are average doctor salaries for 2014 starting at $174,000., This includes doctors who have been in the profession for 30 years. A new doctor makes nowhere near the average, unless they work in the emergency room, the most stressful position available to a doctor. Most would not choose ER work, which is why the pay is about triple the average.

http://www.medscape.com/features/slidesh...overview#2

The NHSC does offer a 3 year program to pay their student loans, but they need to be willing to spend another 3 years working in a place where most doctors do not want to live.

[Punatic007]

quote:

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Originally posted by Peter Easterling

Punatic007, you are always a troll who is good for a laugh. But I am a sucker too, so I'll go for your bait. 1. You know an "incredible" amount of people who move here for our health benefits? Hawaii, and the east side of our island in particular, are not known for high quality health care. The opposite is the truth. 2."Lots of families move here..." You claim to know all of two. And a doubtful story of wealth forever." In fact it is a lie or a fabrication. 3. You notice an "inordinate amount of locals and transplants...who abuse their bodies," etc. You are extraordinarily perceptive. I cannot tell if somebody is local or a transplant by their looks. And again, you are either mistaken or lying. Hawaii is #1 amongst states in longevity and second to the last in obesity. Our tobacco use is in the lower 25% of the nation. We are in the top 5 for exercise (darn Colorado is #1 for exercise and last for obesity). Perhaps a return visit to your neurologist is in order. The topic is layoffs at our hospitals, not our lack of self-control or prescription drugs. I thank and appreciate those physicians who choose to serve our communities. The lay-offs are very bad news.

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Hon, just so you know, it's obvious when someone has a strong reaction to another opinion, a nerve was struck. You don't need to agree with me but you don't need to freak out over a post either. Hopefully my post got you to thinking about taking better care of your health. Aloha.

[PunaMauka2]

http://en.wikipedia.org/wiki/Edgar_Cayce

wowzers.

According to Cayce, five human races (white, black, red, brown and yellow) had been created separately but simultaneously on different parts of the Earth. Cayce also accepted the existence of aliens and Atlantis and claimed that "the red race developed in Atlantis and its development was rapid". Another claim by Cayce was that "soul-entities" on Earth intermingled with animals to produce "things," giants that were as much as twelve feet tall.[28][29]

Cayce said the destruction of Atlantis was the result of the central power crystal being tuned too high. It was too unstable to safely power the remote crafts under the sea, on the land and in the air. The strong vibrations of the crystal resonated the earth in a way that eventually caused earthquakes and this was hidden from the population. Cayce said many of the people that came to him for life readings were actually in Atlantis at the time of the destruction, had contributed to the destruction and have reincarnated at this time to try to right the wrongs and not allow a similar event to occur. Cayce foresaw a future where man's present technological achievements could eventually lead the world to a similar fate.

healthcare related...

He is credited as being the father of holistic medicine[citation needed] and the most documented psychic of the 20th century. Hundreds of books have been written about him and his life readings for individuals. Though Cayce himself was a member of the Disciples of Christ and lived before the emergence of the New Age Movement, some consider him the true founder and a principal source of its most characteristic beliefs.[2]

[TomK]

Opihikao,

"Aloha, mmbvd7, continued prayers and positive thoughts for healing. You will return to your home here, even if for a moment (ie. 3 weeks, or months, years...positive thoughts create positive results). Also thinking of Pam ("beepbeep", aloha Pam!) as I write."

Pam's not in top form right now, but she wanted me to pass on her thanks to you for thinking about her. (And my thanks as well). Thank you again!

[mmbvd7]

[/quote]Aloha, mmbvd7, continued prayers and positive thoughts for healing. You will return to your home here, even if for a moment (ie. 3 weeks, or months, years...positive thoughts create positive results)[]. Also thinking of Pam ("beepbeep", aloha Pam!) as I write.

Edgar Cayce had a wonderful "outlook" on life as a whole (My Papa quoted him when I was a child; a "prophet" of sorts. Sorry O/T). In your copius free time, reading his literature may provide solace, and peace until your return. Just a thought. Best wishes, and fond aloha.

As to our dilemma with local health care facilties, our State of Hawai'i must make some drastic changes. Sooner than later, please.

Be well. Look forward to your return home.

JMO.

ETA: State hospital is in Honolulu.
[/quote]

Big mahalo! Sorry in advance for any & all typos, using my cell phone (not large enough print!)

Next week have a marathon of sorts with various appointments. Unfortunately, these are located approximately 100 miles apart of one another. I feel a bit like a long distance ping pong ball....in between the appointments are family and friends that want to get together.

I can say, without hesitation, I do not miss congested interstate driving, or being in a metro downtown area. Just saying...

One oncologist left the BI recently. He had stated that the state ran management practices were a deciding factor in his leaving. I have worked in health care for over 30 years, and could relate to administrative practices that can drive a saint to drinking in this *industry*.

I was also surprised when another provider on the island told me they did good just to be able to pay their mortgage there!

I try to remain hopeful that perhaps one day I will have the health to return to practice. As a nurse practitioner, so far what I have seen in opportunities is greatly limited on the BI. Most positions are "physician only". Mid-level practitioners can help fill gaps in care, even in specialty areas. I know in my previous state of residence, there is a nurse practitioner legislation group that has worked on changing laws so we can help fill the voids, especially in shortage ares.

When hospital close programs, it is usually because they do not make money, or the program requires specialty staff which are not available. In rural areas, I have seen multiple psych units shut down because there was not a psychiatrist on staff. I know in home health, it is VERY hard to "prove" patients require the services. One nursing assessment form was called an Oasis, required by Medicare. It was over 40 pages and had to be done routinely. Also, nursing services are not a billable service. Otherwise, they can bill insurance when the doc comes by to see a patient, but the 24 hour nursing care and nurse aids are billed in with things like housekeeping, or the cost of room per day. Now my knowledge of this is decades old when I did floor/hospital nursing. Same with medication charges...pharmacist and pharmacy technicians have to get paid somehow. Then add on the cost of the electronic medical record...these costs are real, people and technology has to be paid for to keep, and the results are hospitals and clinics run out of money. When I was in practice, a simple med check would receive $28 reimbursement from medicaid, $33 from medicare, & $48 and up from private insurance. Out of that money I got paid, but also the office staff, all employees benefits, the reimbursable expenses, electric, water, gas for the office, and other supportive services to keep the place up and running (Not to mentio all the insurances needed for malpractice to protect the agency) is indeed a production based industry. I had no clue about it when I wanted to become a nurse. I just wanted to help others.

Sorry if on a tangent. There doesn't seem to be a simple solution to the problem. It is part of the situation that all health care agencies go through, but the smaller clinics and hospitals cannot absorb the overhead like the larger corporations. Many individuals who would like to go into practice cannot afford the electronic medical record keeping. Medicare and medicaid (in some states) will not reimburse providers for services (or will only reimburse part payment) unless the EMR is used. Seems like more barriers are put into plac.

Best wishes

[kalakoa]

smaller clinics and hospitals cannot absorb the overhead

There is a trend towards "cash-only" clinics: paperwork for insurance reimbursement is simply too much overhead.

cannot afford the electronic medical record keeping

EMR as legislated is worse than useless. Biggest problem: no interoperability requirement.

[pahoated]

Uninsured inpatient psychiatric care is mostly covered by Medicare. The Republican platform is they would like to see Medicare totally eliminated. Not being able to do that, they are slashing coverage as much as they can.

http://www.cbsnews.com/news/gop-cuts-med...blueprint/
GOP cuts Medicare, food stamps in new budget blueprint

Inpatient psychiatric care isn't just crazy people. A lot of elderly develop dementia and alzheimers, also strokes, that damage the brain. They no longer have the mental capacity to take care of themselves, sometimes become violent or harmful to themselves. They tend to not have support services, most get abandoned towards the end of life, usually without finances. One thing that is going on around here is the hippies from the 70's that moved here have grown old, developed mental problems, kids or family move over, then proceed to drain any money they have left in their accounts. Seen this a few times now, sometimes emptying houses while the mentally ill person is still living there.
Since Ronald Reagan terminated federal mental health hospitals, the states have had to pick up the responsibility and state hospitals are overloaded with huge costs and little reimbursement. Same goes for private hospitals. There is no money in taking care of the mentally ill, except for those that take advantage of what little they have left.

"Aloha also means goodbye. Aloha!"

[PaulW]

I believe in miracles too. I believe one day rationality will be the norm instead of the exception and people will stop listening to nutcases like Cayce. You may say I'm a dreamer, but I'm not the only one.

[leilanidude]

pahoated - Medicare is a joke. Many doctors are now refusing to accept it as it pays them less than their own costs. Stop blaming it on the Republicans - your buddies, the Democrats, had been in charge for a long time. What did they do?