Updated: 1/30/2020 10:45 a.m.
Hawaii is facing a major shortage of surgeons in the state, but it is especially acute in rural areas on Maui and Hawaii Island.
Dr. Whitney Limm, the governor of the Hawaii Chapter of American College of Surgeons, described the factors that are contributing to the shortage.
“A recent trend has been less general surgeons and more general surgeons who choose to specialize . . . It's hard to provide sub-specialty care in smaller communities and in rural communities," he said. "Rural communities, they need general surgeons.”
Dr. Kenric Murayama, head of the University of Hawaii’s John A. Burns School of Medicine surgery department, believes work-hour limits could be contributing to the lack of practicing general surgeons. That's because fewer hours also means less experience.
Work-hour limits were put in place to ensure surgeons were not overly fatigued and risking patient safety.
“I'm not advocating for us to go back to that kind of [grueling] work schedule, but it is part of the problem we face,” he said.
Murayama explained that not all trainees are comfortable with the more complex general surgical operations after five years of training. He said that is one of the reasons trained general surgeons chose to sub-specialize.
As for practicing in rural areas, surgeons do not want to practice where the hours are demanding and they are isolated from other doctors, Limm said.
“The isolation can contribute to burnout and to less professional satisfaction,” he said. “I think we need to have a system in place where in rural areas people don’t have to be on call every night."
His organization is looking into a rotation program that would allow rural surgeons to switch out with surgeons working in urban areas and get needed time off.
Limm and Murayama also suggest that exposing medical residents to rural areas could attract more surgeons to less populated communities.
They are collaborating on a program that allows residents to spend their fourth year training in Waimea on the Big Island instead of in Honolulu.
“It is helpful for residents to see for themselves the benefit of practicing in a smaller community,” he said. “You have an opportunity to integrate into a community and do a variety of procedures that other general surgeons cannot do.”
Murayama explained that in Hawaii, the surgeon shortage could be more of a distribution problem with many surgeons working in or near Honolulu. Oahu's surgeon shortage is about half that for Hawaii, Maui or Kauai.
Murayama and Dr. Kelley Withy, Hawaii Physician Workforce researcher at the University of Hawaii, both noted that general surgeons tend to have the lowest salaries among different categories of surgeons.
Withy said in the 1950s there weren’t many special surgical procedures. So as new ones emerged, Medicare paid surgeons more to do them.
“I don’t think it was designed that way, but I think that’s what happened,” she said. “In certain specialties, more procedures came out than in other specialties, and that’s my understanding of how the differentiation of pay came out to be what it is now.”
Withy is advocating for a bill in the state Legislature that would provide a tax exemption for doctors and nurses acting as a primary care provider.
Doctors in private practices serving Medicare and Medicaid patients absorb the cost of the taxes because it is against the law to pass additional expenses beyond that for treatment to patients. There are also several bills that would create a loan repayment program for medical professionals.
Hawaii Sen. Brian Schatz has also introduced legislation that would study the general surgeon shortage occurring across the country.
Hawaii needs as many as 206 more surgeons to meet the current demand, according to a University of Hawaii study.
Murayma clarified a quote that was in a previous version of this article.
