A cure for what ails

KAILUA-KONA — Hawaii faces a stark reality when it comes to the number of health care professionals in the state as well as access to that care for Hawaii’s residents, especially in the state’s many rural communities.

A November 2016 report to the state Legislature from the Hawaii Medical Education Council said the state was short about 500 physicians at the time of the report — a situation only expected to get worse as an aging population increases the demand for medical care.

But a dedicated team is promoting an opportunity to partner with an accomplished University of Washington physician assistant program that would increase Hawaii residents’ access to care, give aspiring health care professionals more opportunities to train and practice in their home communities, and offer clinics and hospitals a wide pool of locally grown talent.

“It’s a win-win for everyone involved,” said Terry Scott, program director/section head for the MEDEX Northwest PA Section under the University of Washington School of Medicine’s Department of Family Medicine.

A local advisory committee leading the charge hopes to partner with the MEDEX Northwest Physician Assistant Program at the University of Washington with a goal of training health care workers from throughout the state to become physician assistants, which practice medicine under a physician’s direction, and return to practice in their communities.

Representatives from the University of Washington, local medical professionals and others promoting the program’s establishment in Kona came together Saturday at the Friends of NELHA Gateway Visitor Center to share information about the proposal and discuss ways to make the program a reality here.

Sen. Josh Green, who spoke at Saturday’s event and is among the program’s proponents, cited the statewide shortage of health care professionals and noted it’s even more severe on this island. Hawaii Island, he said, needs about 40 percent more health care professionals.

The MEDEX physician assistant program is an opportunity to address the shortage and cultivate talent that can support the health care needs of communities throughout the state.

“When we combine the shortage of professionals and the opportunity to build something in Kona, it really was very attractive to me,” Green said.

The program would also be the only physician assistant program in the state, Green added, meaning it could also attract students from the other islands who are interested in the program.

MEDEX Northwest currently has four classroom sites, three in Washington and one in Anchorage, Alaska, with 2,400 graduates over 49 years.

Among its graduates is Nhumey Tropp, a physician assistant who graduated from the Seattle campus in 1981 and now lives part-time there and in Waikoloa Village.

“It’s a great field,” Tropp said at Saturday’s event. “You can go into any aspect of medicine that appeals to you.”

And developing a program here, she said, would also mean a lot for access to care in the area.

“There’s a huge need,” she said. “Even my neighbors, they’ll say to me, ‘Yeah, we have to fly back to the mainland, because we can’t get the health care we need here.’”

The program is a 27-month master’s degree program, with one year in the classroom — Scott said the Gateway Center where Saturday’s event took place would be “a great and ideal location for us” — and a second year when students would return back to their home communities for clinical rotations.

Those rotations include family medicine, emergency medicine, behavioral medicine, general surgery and others. Scott said during their preliminary work for the local program, they’ve already received interest from potential local preceptors, which would host the students during their rotations. Scott added the hope is to have the Kona campus’ first class of 23 students in 2021.

Scott Miscovich, an Oahu-based physician among those spearheading the effort to bring the program here, knows the impact physician assistants can have on improving quality of care, having integrated several into his own practice.

“And what we’re able to do when we’ve integrated physician assistants with physicians in practice has been tremendous,” he said, saying the quality of care and outcomes they’ve seen have been greatly enhanced with the physician assistants’ involvement.

One of the biggest advantages many proponents raised for establishing a local physician assistant program is the relationship between where professionals train and where they end up practicing.

Green said 85 percent of people who go through medical school or a residency in Hawaii stay in the state, compared to just 15-20 percent of those who come to Hawaii after training elsewhere.

And Terry Scott said where people pursue their medical education is generally where they’re going to stay, so those who have left Hawaii for physician assistant programs around the country generally ended up settling elsewhere rather than returning.

“What we see is there’s a lot of qualified candidates coming from the islands having to go to the mainland and often times never coming back or coming back late in their career,” Scott said. “What we are trying to do is say, ‘OK let’s train them here locally. Let’s recruit locally, let’s train them here locally and see if they don’t stay in the state.”

The program’s models in Alaska, he said, show that’s not a bad strategy, leading to a retention rate of 80-90 percent remaining in that state.

“To me and for us, that’s an indicator that we’re providing better access to care for the local population by training folks in the state where they are likely going to stay when they’re done,” Scott added.

More information about the program and how to support it or get involved is available at https://hawaiipaprogram.org.