Have you looked for a new primary care provider recently? It’s not easy, especially if you live on one of the neighbor islands. And if you do get an appointment, it’s often several weeks away.

Even if you are lucky enough to already have a primary doctor, that doesn’t mean you aren’t affected by the provider shortage. With increased paperwork, the high costs of running an office and our cost of living here in the islands, some providers are closing their practices, transitioning into just seeing patients in the hospital or just moving away.

The Legislature passed a bill, awaiting Gov. David Ige’s signature, that would help to provide loan repayment funding for those who work in underserved areas. Without this appropriation, matching federal funds would disappear. House Bill 916 is an effort to help, but does it go far enough?

doctor notes history of treatment patient and consulting

We all have good reasons to alleviate the shortage of primary care providers.

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Since 2012, 25 physicians, nurse practitioners and psychologists have benefited from this loan forgiveness/repayment model. Basically, by committing to working in an area of need for a certain number of years, the providers can have some of their school loans repaid through the fund, as managed by the John A. Burns School of Medicine at the University of Hawaii.

According to the dean, Dr. Jerris Hedges, in his testimony in support of the bill, the average debt for the residents and fellows graduating from the school is $235,000, with some having $300,000 to $600,000 in debt before they even start their first job. That’s a huge financial burden that can seem overwhelming to those who are thinking of going into the medical profession, and with the cost of living in Hawaii much higher than the mainland, it’s no wonder that we lose people each year. 

What else can be done to help?

There’s a place to donate money for political campaigns on the IRS tax forms. Why not a place to indicate sponsorship of medical providers?

Having a portion of our state or federal taxes go to making sure that there are enough providers is a place to start. An extra $1 to $2 per taxpayer could go a long way. Having this available in a fund to help recruit and retain PCPs in underserved areas should be something of interest to all of us.

There’s a place to donate money for political campaigns on the IRS tax forms. Why not a place to indicate sponsorship of medical providers?

Insurance companies may be another resource to help support providers. Many local insurers have contributed to the fund to help with loan repayment, but not enough. The potential for the major insurers to contribute should also be spread to specialists.

Employers are another potential source of assistance, since they want to keep current workers healthy. Some major companies, like Facebook and Google, hire their own doctors to work onsite. Not every company can do that, but it can contribute at least a modest amount to a fund that helps to attract providers to the area.

Hospitals and medical groups also have a vested interest in having enough providers to take care of the patients at their facilities. Although profit margins these days are slim, and many health systems are nonprofit, some type of financial assistance to help future providers should be an expected cost of doing business.

Recruitment often comes with bonuses for relocation, but if some of those funds could be allocated to repayment for loans for the neighboring medical school, or psychology department, it would boost the potential of more local students going into these professions.

Finally, doctors, nurse practitioners and behavioral health specialists who initially benefit from these funds should be contributing themselves later on. One day we are going to retire, and when we do, we want to make sure that the patients we’ve seen all these years have someone else to take care of them.

Either through a voluntary donation or a mandatory fee with licensure renewals, we need to help those who are just entering the profession find ways to make ends meet financially. Often, after a decade or more of practice, we have the resources to help the next generation.

Our legislators clearly recognize the need to help those who are entering the profession deal with the huge indebtedness that inevitably results from four years of medical school, and three to seven years of additional training.

The matching state funds will ensure that Hawaii can continue to receive the federal funds that are available. But helping 25 providers in five years is only the start.

The next steps are ours. As a tourist-driven economy, we can’t expect everyone else to pick up the tab.

This one is personal. It’s time for all of us to find more creative ways to make sure that we can have access to primary care providers throughout the state.

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