Bills help address the physician workforce shortage, especially on the neighbor islands

Governor David Ige signed two bills to help combat the state’s increasing physician shortage and support the University of Hawaiʻi at Mānoa John A. Burns School of Medicine’s mission to retain more of its graduates to practice medicine in Hawaiʻi.

Ige signed Senate Bill 2657 and Senate Bill 2597 into law on July 7 at JABSOM.

The Hawaiʻi Physician Workforce Assessment Project Report indicates that Hawaiʻi is in need of at least 750 doctors, with the greatest statewide shortage being in primary care specialties. The proportional need is greatest on the neighbor islands, with both Maui and Hawaiʻi County experiencing a physician shortage of 40%. 

In addition to the bills introduced by the legislature, Ige identified the physician shortage as a priority at the start of the 2022 legislative session by including funding to expand JABSOM’s residency program in his proposed budget.

“My administration is committed to supporting the development and expansion of high-quality educational and training sites, especially on the neighbor islands where we face the greatest challenge,” said Gov. Ige. “Mahalo to our lawmakers for also making this a priority and to JABSOM and our local medical partners for their dedication to ensure our local residents can access the healthcare they need now and in the future.”

Senate Bill 2657 funds JABSOM’s expansion of medical residency and medical student training opportunities on the neighbor islands, and with the U.S. Veteran Affairs (VA) Pacific Islands Healthcare System sites across the state––specifically in areas where healthcare is most needed. The VA is a valuable partner in JABSOM’s academic programs. Internal Medicine, Family Medicine, Psychiatry, Geriatrics, and Addiction Medicine residents or fellows have part of their curriculum based at VA sites. 

Currently, some medical students complete pre-clinical rotations for up to three months on the neighbor islands of Hawaiʻi Island, Lanaʻi, and starting this academic year, Kauaʻi. Third-year students participate in a longitudinal clerkship program where groups of students train in the same location for a five-month long rotation in rural communities. Third year students presently train at several locations on Hawaiʻi Island, Maui and Kauaʻi.

“Data show that more than 80% of physicians who graduate from both JABSOM and its residency programs tend to stay in Hawaiʻi to practice—that is one of the highest retention rates in the country,” said JABSOM Dean Jerris Hedges.“We know that physicians who train in rural areas on our neighbor islands are also more likely to put down roots and nurture the communities that they’re in. We look forward to expanding our medical training opportunities to these underserved areas and to stay true to JABSOM’s vision of ALOHA: Attain Lasting Optimal Health for All.”

To alleviate the shortage of physicians in the state, more than 225 physicians participate in JABSOM’s Accreditation Council of Graduate Medical Education (ACGME)-accredited residency and fellowship programs. Kaiser Permanente Hawaiʻi also has a primary care internal medicine residency program and the Hilo Medical Center is the sponsor of the Hawaiʻi Island Family Medicine Residency Program. With the exception of the Hilo-based program, the remainder of these civilian residency programs are on Oʻahu, with some having clinical rotations on the neighbor islands. The neighbor island rotations – through the VA clinics or in partnership with other neighbor island physicians and health systems – gives residents and fellows the opportunity to train and eventually practice in rural areas. 

“Hawaiʻi Residency Programs, as the employer of the JABSOM residents and most fellows, is committed to our rural and at-risk communities by training our future physician workforce,” said Natalie Talamoa, executive director of Hawaiʻi Residency Programs. “We are excited that the State of Hawaiʻi shares our goal and look forward to working together on this initiative to invest in our neighbor island communities that have been hardest hit by the physician shortage. This funding will increase access to training opportunities for our residents and fellows, and provide them exposure and understanding of our most vulnerable populations so that they want to return to serve these communities.”

“The VA’s ability to expand Graduate Medical Education can help reduce the effects of a forecasted physician shortage here in the Pacific Islands, especially in Hawaiʻi, thanks to the partnership we have with the John A. Burns School of Medicine,” said Adam Robinson, Jr., director of the Veteran Affairs Pacific Islands Health Care System. “We take pride in providing the largest education and training enterprise for health professionals in the nation, but we can’t do it without the relationships we share with our valued academic affiliate residency sponsors.” 

Senate Bill 2597 allows for more loans to be given in the Hawaiʻi State Loan Repayment Program, which helps graduates of JABSOM and other health professions reduce their educational debt in exchange for remaining in Hawaiʻi to practice. Loan repayment programs are a critical part of addressing the health professional workforce shortage, and Hawaiʻi’s program has proven to be highly successful. 

According to JABSOM’s Hawaiʻi and Pacific Basin Area Health Education Center Director Kelley Withy, “83% of loan repayers have remained in Hawai‘i to practice, and 70% have remained at the site where they performed their service. Currently, there are 25 active providers in the program with another seven waiting for funding. We are very thankful to the legislature for the matching funds so that we can provide more opportunities to those interested in caring for communities where there is a dire shortage of healthcare providers.” 

Health care professionals who have benefited from the loan repayment program serve on all islands and in the communities of Waimea, Kihei, Waiʻanae, Hilo and Wailuku; at Federally Qualified Health Centers in Kalihi-Palama and Kokua Kalihi Valley; and in public institutional settings at the federal detention center in Honolulu, the Halawa correctional facility and the Maui County correctional center. Health care professionals who are eligible to participate in the program include physicians, nurse practitioners, psychologists, social workers and many others.

Those present at the bill signing ceremony included state lawmakers Rep. Gregg Takayama, Rep. Ryan Yamane, Sen. Donna Mercado Kim and Sen. Jarrett Keohokalole, UH President David Lassner, JABSOM Dean Jerris Hedges, JABSOM Associate Dean for Academic Affairs Lee Buenconsejo-Lum, JABSOM Associate Dean for Administration and Finance Nancy Foster, as well as leadership from affiliated hospitals, the Hawaiʻi Residency Programs, Inc., the VA Pacific Islands Health Care System, and leaders from several of JABSOM’s clinical departments and the Office of Medical Education that oversees the MD Program curriculum.