The doctor shortage on the Big Island has grown nearly 40 percent since 2007. That’s according to research on Hawaiʻi Island’s health workforce over the years. Big Island doctors say the high cost of living, heavy tax burden, and low reimbursements have created a bad situation that’s likely to only get worse amid a global pandemic.
Hawaiʻi County has the largest doctor shortage in the state with fewer than half of the physicians needed to properly serve the island’s population. Hilo radiologist Scott Grosskreutz says most people know somebody affected by the shortage.
“It might be a friend or a neighbor or a family member that hasn't been able to find a health care provider for their family,” says Dr. Grosskreutz, “Sometimes people are suffering from diseases that go undiagnosed, like hypertension or diabetes and end up having secondary heart attacks and strokes.”
He says the state’s high cost of living and heavy tax burden make doing business in Hawaiʻi for any doctor an unattractive option. Especially for those in private practice.
“One of the real challenges we have here is the state of Hawaii uniquely taxes health care and Medicare benefits, which no other state in the country does,” says Dr. Grosskreutz.
He’s referring to the state general excise tax or GET, a 4-percent tax levied on all Hawaiʻi businesses. Unlike most businesses, however, doctors serving the state’s most vulnerable populations through Medicaid and Medicare are not able to pass on the tax to their patients.
Lisa Rantz, head of the Hawaiʻi State Rural Health Association, says legislation is set to be introduced this session that would give doctors a GET exemption for serving these patients.
“I mean, it's not a great time to talk about, you know, relief from the GET tax for our physicians,” says Rantz, “But that would allow them to continue to practice and to be more in line with what's happening on the mainland.”
Hilo radiologist John Lauris Wade has analyzed the data on the Big Island’s doctor shortage over the past decade. He says issues like the GET tax, the high cost of living, and the low insurance reimbursements have laid the financial groundwork for what he terms the perfect storm.
“Each of these things might be fine in and of itself but in combination has created an environment where Hawaiʻi is 1,000 physicians short,” says Dr. Wade, who also serves as the legislative liaison for the Hawaiʻi Physician Shortage Crisis Task Force.
He says the economic toll brought on by the COVID-19 pandemic will likely prevent state lawmakers from acting on any legislation this session to help rebuild the health workforce.
“When the community starts to ask why, that's where I think we'll start seeing our state government respond,” says Dr. Wade.
But he says if the issue continues to be ignored, the Big Island doctor shortage could grow to 72 percent by 2030.