Hawaii Faces Urgent Need for Geriatric Care Specialists

Hawaii is witnessing a significant gap between its growing senior population and the availability of medical professionals specializing in geriatric care. The state boasts the highest life expectancy in the United States, but this achievement is overshadowed by a concerning shortage of physicians equipped to provide essential services for its aging residents. The need for more geriatric specialists is pressing, as healthcare practices struggle with tight budgets and fail to recruit adequate numbers of these professionals.

A significant portion of geriatric specialists in Hawaii also serve as primary care physicians (PCPs), contributing to another critical issue: the state is experiencing one of the most severe shortages of PCPs in the country. This situation is particularly alarming in rural areas, where access to healthcare is already limited. Many primary care providers express concern that the current physician deficit, compounded by restrictions imposed by insurance providers, threatens the quality of care available to patients.

Kamal Masaki, chair of the geriatric medicine department at the University of Hawaii’s John A. Burns School of Medicine, emphasized the need for healthcare systems employing geriatricians to recognize that these positions may not yield significant financial returns. As long as healthcare remains tied to a fragmented insurance system, with a focus on cost control and profit margins, attracting specialists to geriatric care will remain a formidable challenge.

Hawaii has a unique opportunity to enhance geriatric care through two federal programs initiated by the current administration: the Rural Health Transformation Program (RHTP) and the Achieving Healthcare Efficiency through Accountable Design (AHEAD). These programs aim to improve primary and rural healthcare delivery, offering incentives for participation while demanding substantial commitment from the state, healthcare providers, and both public and private insurers.

In January 2023, Gov. Josh Green announced an allocation of $189 million to implement the RHTP, which he stated would enhance “access to quality primary care, behavioral health services, emergency response, and modern technology.” Part of this funding will support rural providers in adopting innovative, value-based care models, incentivized by the AHEAD program, which aims to prioritize consistent patient care while stabilizing costs.

Insurance coverage trends currently favor compensation models that reward healthcare providers based on the number of patients treated rather than the specific services rendered. This shift often leads to capped services. Traditional Medicare remains less affected by these controls but is facing rapidly escalating costs. Geriatric specialists and hospitals frequently care for patients with complex needs that require longer consultations and comprehensive services, making the current insurance models ill-suited for geriatric care.

To meet the challenges posed by the RHTP and AHEAD, Hawaii must explore alternative cost-cutting measures. Strategies could include utilizing telehealth for routine consultations, a method supported by Governor Green, reducing prior authorizations and paperwork, and improving continuity of care to minimize unnecessary hospitalizations.

Geriatrics is one of the lowest-paid specialties nationally, which makes practicing in Hawaii particularly challenging given the state’s high cost of living. There is an urgent need for improved reimbursement rates for geriatric specialists and primary care physicians. Federal incentives will be crucial in achieving this goal and ensuring the success of Hawaii’s healthcare transformation.

Additionally, a state initiative aims to train healthcare providers who serve seniors in various fields, including nursing, pharmacy, social work, and public health. This initiative aligns with the federal programs and is designed to enhance accessibility to care for the aging population. The Pacific Islands Geriatric Workforce Enhancement Program collaborates with over 50 organizations, including the Alzheimer’s Association and AARP clinics, to promote age-friendly health systems and support rural clinics and community health centers.

As Hawaii approaches the impending demographic shift known as the “silver tsunami,” it is imperative that the state prepares adequately to meet the healthcare needs of its aging population. The path to a robust geriatric care system requires not only additional specialists but also systemic changes that prioritize quality care for seniors across the islands.