When Stephen Kemble closed his Honolulu psychiatry practice last August, he tried to match 500 patients with a new psychiatrist.
It was an impossible task — especially for recipients of Med-QUEST, Hawaii’s version of Medicaid.
Kemble found only two psychiatrists in private practice on Oahu who were willing to treat new patients covered by the state’s public health insurance for low-income people. A few of Kemble’s patients got in with these two psychiatrists — but they had to wait up to three months for an appointment, he said.
“The willingness of psychiatrists to take in new Medicaid patients has dwindled to almost nothing,” Kemble said. “Even if you do get in with someone, the doctor has five minutes to renew your prescription and that’s it. I mean, they’re trying, but the psychiatrists don’t even have time to talk to you — they’re totally overwhelmed.”
New data from the University of Hawaii reveals a health system in crisis. In 2017, Hawaii was short more than 750 physicians across the medical field, according to University of Hawaii professor Kelley Withy, who conducts an annual workforce survey. This calculation accounts for differing needs on neighbor islands and the unique demand for medical specialties like psychiatry.
Experts say filling the void is practically impossible, as it would require that the state increase its physician workforce by about 25 percent. Luring new doctors to Hawaii is complicated by myriad factors, not the least of which is the state’s high cost of living coupled with its relatively low rates for insurance reimbursement.
When it comes to psychiatrists, the UH data reveals a 10 percent statewide shortage. The gravest scarcity is on Kauai and Hawaii islands, which are tied with a whopping 33 percent shortage. But surprisingly, the Oahu data shows a slight surplus equivalent to one full-time position.
Withy acknowledges the Oahu numbers, which are based on the national statistics, fly in the face of what she sees first hand: a severe need for psychiatric services that’s not being met — on any island.
“I don’t think our model adequately represents the demand in Hawaii,” Withy said. “Perhaps people in Hawaii are more open to using behavioral health or need more services, but the model does not correspond to the anecdotal need we hear about. Also, many psychiatrists don’t take our public insurance programs, making it extra hard for those individuals, who usually need the services even more due to poverty or disability, to find services.”
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