SB2589

SECTION 1. The legislature finds that there is a critical shortage of licensed physicians on the neighbor islands and that access to health care in these medically underserved areas will only deteriorate as the population ages. While it is reported that Hawaii ranks eleventh in the nation for physicians per capita, neighbor island residents have limited or no access to physicians, including primary care physicians. According to the state board of medical examiners, of the 4,009 licensed physicians practicing in Hawaii, seventy‑five per cent are practicing on Oahu. Immediate action is necessary to retain and attract licensed physicians to practice medicine in rural areas on the neighbor islands.

A physician's residency generally consists of two to three years of on‑the‑job training and continuing education after graduation from medical school. Research indicates that physicians tend to establish a practice in the geographic area in which they receive their residency training. The family medicine residency program at the University of Hawaii John A. Burns school of medicine, department of family medicine and community health has graduated six board‑certified physicians each year since 1994. Sixty per cent of these graduates are practicing in rural, underserved, or academic family medicine.

Act 277, Session Laws of Hawaii 2007, appropriated funds to expand the family medicine residency program to create residency opportunities in rural areas on the neighbor islands. A rural family medicine training site was developed on the Big Island last year to rotate medical school graduates specializing in family medicine through Hilo medical center. The goal is to further expand the family medicine residency program to include rural areas on Maui, Kauai, and Molokai in the future.

By participating in the family medicine residency program, these physicians have already expressed a willingness to serve rural areas and are acquainted with neighbor island residents and facilities. A rural medical practice loan repayment program would encourage physicians to participate in the family medicine residency program in the first instance and, upon completion, to establish their practices on the neighbor islands where they received their residency training.

The purpose of this Act is to establish and appropriate funds for a rural medical practice loan repayment program for licensed physicians who participate in the family practice residency program and who, upon completion of the family practice residency program, commit to practice medicine for five years in rural areas on the neighbor islands.

SECTION 2. Chapter 304A, Hawaii Revised Statutes, is amended by adding a new subpart to part II to be appropriately designated and to read as follows:

. Loan Repayment Program

"§304A‑ Rural medical practice loan repayment program; special fund. (a) There is established the rural medical practice loan repayment program. The rural medical practice loan repayment program shall be administered by the University of Hawaii John A. Burns school of medicine and shall provide eligible loan repayment assistance to qualifying physicians.

(b) In order to qualify for eligible loan repayment assistance under the rural medical practice loan repayment program, a physician shall:

(1) Be licensed to practice medicine under chapter 453 or 460;

(2) Complete the family practice residency program at the University of Hawaii John A. Burns school of medicine, department of family medicine and community health;

(3) Have an outstanding eligible loan;

(4) Commit to practice medicine for a minimum of five years in a rural area of a county in this State with a population of 500,000 or less; and

(5) Meet any additional requirements determined by the administrator.

(1) The maximum number of annual qualifying physicians;

(2) The annual eligible loan repayment assistance amount to be awarded to each qualifying physician; provided that a qualifying physician shall not receive more than five years of eligible loan repayment assistance; and

(3) Any additional requirements for a physician to qualify pursuant to section (b).

(d) Nothing in this section shall be construed to create in any physician a right to any eligible loan repayment assistance or any specific amount of eligible loan repayment assistance under the rural medical practice loan repayment program.

(e) There is established a special fund to be known as the rural medical practice loan repayment program special fund into which all appropriations, donations, and gifts shall be deposited. The administrator may use any amount of the moneys in the special fund to provide qualifying physicians with eligible loan repayment assistance under the rural medical practice loan repayment program. Upon determination by the administrator, the fiscal officer of the University of Hawaii John A. Burns school of medicine shall disburse payments to qualifying physicians. The administrator shall submit an annual report, including an accounting, to the legislature no later than twenty days prior to the convening of each regular session.

(f) For purposes of this subpart:

"Administrator" means the dean of the University of Hawaii John A. Burns school of medicine.

"Eligible loan" means any need‑based federal, university, or educational loan directly related to obtaining a medical degree as determined by the administrator, except for loans that are eligible for forgiveness or repayment assistance through other sources and loans extended by a private individual or family member.

(g) The administrator shall adopt rules pursuant to chapter 91 as necessary to implement this section."

SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2008-2009 for deposit in the rural medical practice loan repayment program special fund.

SECTION 4. There is appropriated out of the rural medical practice loan repayment program special fund the sum of $ or so much thereof as may be necessary for fiscal year 2008-2009 for the rural medical practice loan repayment program pursuant to section 2 of this Act.

The sum appropriated shall be expended by the university of Hawaii for the purposes of this Act.

SECTION 5. This Act shall take effect upon its approval; provided that sections 3 and 4 shall take effect on July 1, 2008.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2589
TWENTY-FOURTH LEGISLATURE, 2008
STATE OF HAWAII