Hawaii Faces Urgent Need for More Geriatric Specialists

Hawaii is experiencing a significant challenge in geriatric healthcare as the state grapples with a rising senior population and a shortage of medical professionals equipped to provide specialized care. Despite having the longest life expectancy in the United States, Hawaii’s healthcare system is struggling to meet the needs of its aging residents, which has raised concerns among healthcare providers and policymakers alike.

The demand for geriatric specialists is increasing, yet the number of physicians trained in this field remains inadequate. Many geriatric specialists often serve as primary care physicians (PCPs), but Hawaii is already facing one of the most pronounced shortages of PCPs in the nation, particularly in rural areas. According to Kamal Masaki, chair of the geriatric medicine department at the University of Hawaii’s John A. Burns School of Medicine, the current health care infrastructure is not conducive to attracting more geriatricians, as these roles are often not viewed as financially viable.

The financial constraints impacting healthcare practices are compounded by a fragmented insurance system, where profitability frequently takes precedence over quality of care. “The health care systems that employ geriatricians have to be committed to the fact that this is not going to be a moneymaker,” Masaki stated, highlighting the challenges faced by those looking to enter the field.

Federal Programs Set to Transform Geriatric Care

In an effort to address these pressing issues, Hawaii has an opportunity to improve its geriatric care landscape through two federal initiatives: the Rural Health Transformation Program (RHTP) and Achieving Healthcare Efficiency through Accountable Design (AHEAD). These programs aim to enhance primary and rural healthcare services by incentivizing participation and requiring a substantial commitment from the state, healthcare providers, and both public and private insurers.

In January 2024, Gov. Josh Green announced a funding allocation of $189 million to implement the RHTP, which aims to bolster access to quality primary care, behavioral health services, emergency responses, and modern technology. Part of this funding will support rural providers in adopting innovative, value-based care models, as encouraged by AHEAD. This approach seeks to enhance patient care while controlling costs and stabilizing the healthcare system.

The shift from traditional pay-per-service models, which often cap the number of services provided, to a system that compensates healthcare providers based on overall patient care is a significant aspect of this transformation. While traditional Medicare has limited cost controls, the rising expenses associated with healthcare necessitate a reevaluation of how services are delivered, particularly for patients with complex medical needs that require more than just short consultations.

Building a Sustainable Future for Geriatric Care

As Hawaii implements these ambitious programs, it is crucial that the state ensures they meet the needs of its senior population. Geriatric specialists typically care for patients with intricate health issues, which demand a level of care that cannot be met through reduced service offerings. The challenge now is to find ways to cut costs without compromising care quality, such as utilizing telehealth for routine consultations—a tool that Gov. Green has expressed support for.

Additionally, Hawaii’s geriatric specialists and primary care providers must receive higher reimbursement rates for their services to address the state’s elevated cost of living. Leveraging federal incentives will be essential if Hawaii aims to successfully transform its healthcare system.

A collaborative initiative, the Pacific Islands Geriatric Workforce Enhancement Program, is also underway to train healthcare providers in disciplines such as nursing, pharmacy, social work, and public health to better serve the aging population. This program works in conjunction with over 50 organizations, including the Alzheimer’s Association and AARP, to foster age-friendly health systems and staff rural clinics and community health centers.

As Hawaii stands on the brink of a demographic shift often referred to as the “silver tsunami,” it must act decisively to ensure that its healthcare system can accommodate the growing number of seniors. The stakes are high, and the time for action is now.