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Like many others before me, I just got fired by my primary care physician (PCP). The reasons this time are for being selective about what specialists I am willing to see, and for “using” her “just to get meds” that I have been on for years (not opioids). Who, pray tell, am I supposed to use?
I was fired twenty years ago in Honolulu because the MD “wanted to take his practice in a different direction.” He was later put on trial for Medicare fraud. Next came the PCP who I watched deteriorate into mental illness. My medical records from those years are under a court-ordered seal. The next doctor lost her license due to poor record-keeping. The next committed suicide. I stopped going to doctors for quite a while. Seeking medical care in Hawai`i is not for the faint of heart.
And now, new problems: The whole “my body, my choice” thing has apparently been rendered obsolete by Big Island PCPs. We can no longer safely and freely choose what treatments we are willing to undergo without fear of some unforeseen reprisal in the future. A PCP now thinks if a patient is recalcitrant and refuses certain treatments, deny that person all treatment. Be done with them. This attitude illuminates the second problem: by denying treatment, MDs are demonstrating their power over our well-being. And, in my current situation where there is obviously an ego involved, that denied treatment feels like bullying. Which leads to the third problem: since we face a horrendous MD-shortage, throwing someone out of a medical practice these days is equivalent to denying them all non-urgent medical care for an extended period of time. This does not, apparently, disturb the consciences of Big Island doctors, people who have sworn to never do harm, to treat their patients with respect and compassion.
Doctors and lawyers used to be the same kind of service providers. People were patients/clients who paid them for their services to manage our health or defend our rights. Once “hired,” they stuck with you, protected you, defended you. They were supposed to be on your side, despite the often-poor choices you may make.
This may still happen in the world of cash retainer fees that the wealthy can afford to pay. For the rest of us, however — maybe each of us should make these docs swear the Hippocratic Oath to each and every one of us, orally, in person, with hand raised. Let’s see if they remember what it says.
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I really appreciate all the retired nurses that live in my neighborhood, since they can usually advise me (as a friend) and save me a long wait for 5 minutes with an overworked doctor. I only go now for checkups and referrals.
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" . . . since we face a horrendous MD-shortage, throwing someone out of a medical practice these days is equivalent to denying them all non-urgent medical care . . ."
While I sympathize with all your points, I would not have put this one in third place. It really makes the other ones serious issues because it enables them. The shortage of physicians on this island routinely gets mentioned in the press, but nothing of real consequence is being done about it. Yes, we have a residency program at Hilo Medical Center, but it has yet to put the least dent in the lack of MD options. As doctors retire, this will only get worse. Kaiser offers good pay and benefits, but can't get doctors to stay here very long.
This problem has the potential to wreck the whole local economy because a large part of it depends on retirees coming here and bringing their own money along. (Career minded young people have to go elsewhere to find professional development, so the retirees make up the slack.) I already know more than a few who have left for good due to lack of health care and taken their money with them. At some point, the word will get out, and replacement retirees will stop moving here. Of course, by that point, it will be everyone's problem, not just the old folks'.
There are solutions that have worked for other isolated rural communities with aging populations. These usually involve recruiting young physicians who agree to stay for a set number of years in return for having their student loans paid by the community. This does, however, require forward thinking and engaged local governments willing to spend money on attracting and keeping doctors. Can you imagine our corrupt and inefficient county (or state) government diverting money from union dictated pay raises or shady contracting procedures to pay for viable health care?
So you do indeed have a problem mearth11, only it's a lot bigger than just you.
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Why don't more kids want to go to medical school? What's not attractive about starting to earn money in a career in your early 30's with a half million dollars of debt?
"Added to the lost potential income above, and assuming a modest 10% increase in debt burden through interest during school, doctors are routinely $416,216 more in the hole when compared to the average college graduate. In other words, comparing doctors to average college graduates, doctors are half a million dollars behind in real and potential losses, all by their early thirties."
https://www.bestmedicaldegrees.com/is-me...nancially/
Our daughter had grand ideas about becoming a doctor. Unless you are the child of millionaires... good luck.
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Liability is another reason for the doctor shortage. And in sue happy Hawaii if a patient is not following an approved course of treatment they are a red flag of trouble.
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Another Hawaii issue is insurance compensation to doctors. Stefan Harmeling and his Aloha Nui Family Practice began a new business model on January 1: they accept no insurance and require all patients to sign an annual contract and pay up to $250 every month just for the privilege of being seen by his practice. All office visits and treatments are covered, but lab fees, x-rays and anything outside his office must be paid out of pocket or with medical insurance. I'm sure this action has released hundreds of patients back into the pool of folks looking for a new doc. My partner and I are health individuals who have good employer-provided insurance, but ti took us several weeks and lots of calls to get accepted by a new doc. Many are retiring or not accepting any new patients. Once my partner is retirement eligible from his current job, we'll be heading back to the mainland (with its better medical facilities and providers) taking our pensions and 401 (k) savings with us. Oh, and BTW, a recent study quoted in the New York Times lists Hawaii as one of the 5 worst states for retirees. Chunkster is exactly right - Hawaii better act now to improve its medical care, or it risks losing lots of retiree and tourist revenues.
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This issue is a repeating pattern on the Big Island.
People move here from the mainland while both partners of the couple are healthy, and enjoy their version of 'living in Paradise'. But as we all age into retirement, the housing markets become distorted. Retirees pay minimal property taxes ( now up to $200 / year if over 65! ), and very little state income tax
( pensions are not taxed ) to support the services used. Yes, all retirees absolutely do contribute to the local economy in very many important ways, but they also the change the finances for the services supported by taxes ( roads and schools first come to mind ).
When one of the couple starts needing more medical care than is available here on the far side of the last island on the most remote archipelago on the planet , the tendency has been to move back to the mainland, or to Oahu, where they hope such services are available. This starts repeating the pattern of selling homes ,
taking pressure off the housing market, dropping prices, and making more rentals available. From what I have seen, this pattern tends to have a 10 year ebb and flow. It was somewhat distorted by the natural disasters of 2014 ( lava flow and Iselle ), but there is little doubt that the lack of medical services is a driving factor in housing prices. The sell-off of properties is as inevitable as the tides.
As I wrote in another thread, you get what you pay for. There are many, many places on the mainland where rural areas have little or no health care options. This situation is not unique to Puna. There are larger issues to be dealt with before we can see needed services available no matter where in the US we chose to live.
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Punaperson said: "There are many, many places on the mainland where rural areas have little or no health care options."
Yes, there certainly are. Many are places just like Hawaii County where the elected officials and other community leaders do not have the vision and courage to reallocate financial resources from the traditional waste and graft to something more useful.
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I don't think this is an issue that can be fixed by local community leaders. As long as the 'health care industry' is profit driven, places like Oahu, with a population of over a million, will have a wider range of options available over a place like East Hawaii, with 'only' 50,000 people.
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many places on the mainland where rural areas have little or no health care
...but on the mainland, you can drive to the nearest city in search of better healthcare offerings.
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