SB977 SD1

SECTION 1. The legislature recognizes that to protect the health of Hawaii's citizens and control future healthcare costs, action must be taken to address the severe primary care health workforce shortage in the rural areas of our State. With the exception of a few areas on the island of Oahu, the counties of our state are either designated by the federal government as medically underserved areas, health professional shortage areas, or as having medically underserved populations.

Family physicians are well suited to rural health care because of the broad scope of their practice that encompasses inpatient, outpatient, and nursing home settings, and addresses acute, chronic, and preventive health across the lifecycle. Many family physicians include in their practices, maternity care, family planning, and mental health services. However, of the approximately three thousand five hundred licensed physicians in Hawaii, there are only one hundred ten family physicians practicing on the neighbor islands.

As Hawaii’s population ages, increasing demands will be placed on our already fragile, rural healthcare system. The "graying" of the patient population will also be accompanied by the aging of the existing healthcare workforce and the retirement of our rural physicians.

This Act addresses the rural primary health care shortage by creating a pipeline that places primary care physicians who are in the final years of their training, in the underserved areas of our State. This approach is predicated on the fact that physicians tend to remain and practice where they train. The Act expands the family medicine residency program sponsored by the John A. Burns school of medicine and Wahiawa general hospital, by adding two new rural training sites and doubling from eighteen to thirty-six, the number of family medicine resident physicians being trained. The final two years of clinical training in this program will be completed at rural training sites in Hilo, Hawaii Island and Lihue, Kauai, providing an expanded and ongoing primary care physician supply to the State.

The partial costs of starting the two new academic clinical practices on the neighbor islands total $870,000 in fiscal year 2008 and $1,890,000 in fiscal year 2009. They include the costs of eight faculty physician salaries, clinic infrastructure improvements, transportation, and electronic health records. These components are the minimum critical elements necessary for American college of graduate medical education accreditation. Once the new academic clinical practices are accredited, the federal centers for medicare and medicaid services (CMS) will establish a resident allotment or “cap” for each hospital site and federal graduate medical education funds will become available to cover residents' salaries and training expenses.

The sustainability of this model will be accomplished through a combination of CMS funding, clinical revenue, and support from rural hospital and community health center partners similar to programs adopted successfully in other rural states such as Washington and Wisconsin. To guarantee a primary care physician workforce, states such as Texas and Washington presently fund portions of their family medicine residency programs through legislative line items.

The purpose of this Act is to improve healthcare access for the people of Hawaii by establishing a statewide rural training model that produces a robust, well trained primary healthcare workforce, and places family physicians in rural areas.

SECTION 2. 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 2007-2008 and $ , or so much thereof as may be necessary for fiscal year 2008-2009 to develop a statewide rural training model to provide a pipeline of well trained family physicians to rural areas, and improve healthcare access for the people of Hawaii.

The sums appropriated shall be expended by the John A. Burns school of medicine, University of Hawaii at Manoa for the purposes of this Act.

SECTION 3. This Act shall take effect on July 1, 2007.

THE SENATE	S.B. NO.	977
TWENTY-FOURTH LEGISLATURE, 2007		S.D. 1
STATE OF HAWAII