Year after year, Hawai‘i’s physician shortage continues to grow. A 2017 report on the state’s physician workforce shows a shortage of more than 400 doctors, and the largest shortfall on all islands is in primary care. The good news is there is a health care model rising in popularity across the country, and it may be just what Hawai‘i needs to help meet its primary care needs. HPR’s Ku‘uwehi Hiraishi reports.
After more than a dozen years working in the traditional health care system here in Hawai’i, Dr. Melissa Bloom was craving a closer relationship with her patients.
“You know doctors are significantly burdened with the regulations and measures that insurance companies and regulatory agencies put on them,” says Dr. Melissa Bloom, “That leaves very little time is devoted to the patients at this point.”
She says the nationwide average for facetime with patients is 7.5 minutes. And that’s not enough time to get to know your patients, their medical history, or listen to any of their concerns.
“This new practice, direct care practice, really has allowed me to connect with my patients,” says Dr. Bloom.
She opened her direct primary care practice in Haleʻiwa a year ago. She charges patients as low as $60 a month for unlimited primary care. Direct primary care or DPC is a fee-for-service model that eliminates the insurance company by having the patient pay the doctor directly.
“I use the gym as sort of an analogy,” says Dr. Brian Forrest, CEO and founder of Access Healthcare. He established the first DPC practice in the country 17 years ago.
“If they were to have someone follow you around in the gym with a clipboard and every time you got on a treadmill, they wrote a price. And every time you lifted a dumbbell, they wrote down a price,” says Dr. Forrest, “You know by the time they wrote all those things on a clipboard and followed you around the gym, they would have had to pay that person more to do that than the membership for the entire month. That’s the kind of insanity we’ve got into in primary care.”
The DPC model was designed to serve the uninsured and streamline the health care process. His latest estimates indicate there are as many as 8,000 DPC practices in the United States. While the model eliminates the middle man, it doesn’t eliminate insurance altogether.
“People typically will still use their insurance in the hospital or for specialist coverage or for surgery or things like that,” says Dr. Forrest, “All this does is just changes the way that the primary care piece is paid for.”
Dr. Kelley Withy is a primary care physician on O’ahu and a big proponent of DPC. But she says in Hawai’i, the economic model just isn’t there.
“In Hawai’i, we have such excellent medical coverage that it’s unlikely that direct primary care will take off,” says Dr. Withy, “It’s unlikely someone is going to want to pay an additional $30 a month to see a doctor when they have to pay $500 for their family anyway.”
Dr. Bloom is one of three DPC doctors in the state. She says most of her 40 patients already have primary health care coverage. But she questions the need for it.
“Why do we even have insurance? It should be for accidents* but it shouldn’t be there for routine care,” says Dr. Bloom.
Dr. Withy sees the direct primary care model as a game changer in Hawai’i, especially since the largest physician shortage statewide is in primary care.
“I think it would help the doctor shortage because it would have the primary care doctors be happier,” says Dr. Withy, “Because it’s back to the basics.”
Back to the doctor treating the patient and the patient paying the doctor.
*NOTE: When an accident happens or the unthinkable occurs, catastrophic health insurance provides for costs associated with hospitalization, trauma, or a sudden illness.