a terminal to talk to a provider 2 hours away.” Though technology is the bread and butter of IR, it also must be thought through carefully, she says.
“Technology is an amazing tool. But we must make sure that as we advance, we’re not outpacing our ability to connect with patients.”
Connecting communities Though telehealth can play a role in improving disparities, everyone agrees: the state needs more providers, especially ones who understand the local populations.
The Access to Care report proposed solutions, such as reaching out to engage local students at earlier stages to promote and encourage their pursuit of medicine. Local home-grown talent is a real win for all small and rural practices and pipeline initiatives are vital to this end. The study also recommended targeting bilingual individuals and those from underrepresented racial and ethnic groups, as well as offering free or reduced tuition to those who commit to residency within the state.6
“I’m Filipino and sometimes that makes it easier to connect,” Dr. Ignacio says. “Patients in Hawaii may feel more comfortable being cared for by a physician who looks like them and understands their cultural perspective.”
She reiterates the need to help young physicians, especially those who can speak the local languages and understand the cultural sensitivities of patients, see the advantage of practicing in their home region.
“We’ve seen in California and Texas that, if you understand the language and community of your patients, you will be more invested in the community and have more engaged patients.”
BONUS: Hear more about being a medical student in Hawaii with
Roger T. Tomihama, MD. Read an extended version online at
irq.sirweb.org.
32 IRQ | WINTER 2023
In addition, physicians should get creative and embrace different practice models, Dr. Ignacio says.
After working in a regular practice for several years, Dr. Ignacio chose to open her own practice, which would allow her to work all over the state.
“The traveling IR isn’t a new idea,” she said, “but it’s a successful one.” In addition to gaining control over her own schedule, Dr. Ignacio says part of the value of her model is that she can travel between islands, cover practices when they are shorthanded and support patient access directly to IR specialists.
“A rotating contract IR physician of a small and rural practice can make an immense difference and connect with a whole new patient population if you are flexible, and you can showcase the positive downstream impact of IR therapies.”
Changing policy Recruitment and retention efforts must also come from the top down, Dr. Ignacio says, which requires changing policy and gaining advocates at every level.
“There is nothing ground-breaking or shocking in the Access to Care report,” Dr. Ignacio says. “But look at everyone who is involved. The report is important not only because it affirms what we already know, but because it is concrete patient evidence developed in collaboration with the stakeholders who have the ability to change things. Projects like this demonstrate the strength of collaborators who are listening and willing to help.”
In recent months, several large sources of funding have been earmarked for identifying ways to improve health disparities and workforce shortages. In Oct. 2022, the University of Hawaii received nearly $1 million to launch a new rural health policy research program,7
Glossary
Underrepresented minorities (URM): A group whose percentage of the population in a given group is lower than their percentage of the population in the country.
million for 14 community health centers throughout the state.8
“We have to be creative, leverage the funding and resources,” Dr. Ignacio said. “Unless we support small and rural practices, the development of reimbursement reform and sustainable practice models, states like Hawaii won’t be able to recruit and retain physicians.”
Change is on the horizon, according to Dr. Ignacio. Societies like SIR have become increasingly aware of and supportive of healthcare disparities and workforce shortages and have efforts underway to improve access, reimbursement rates and support the next generation of culturally competent physicians. It’s a long road, but with awareness and buy-in, Dr. Ignacio believes that patients will see the benefits in time.
References
1. U.S. Dept of Health and Human Services. Minority population profiles, Native Hawaiians/ Pacific Islanders.
minorityhealth.hhs.gov/omh/ browse.aspx?lvl=3&lvlid=65.
2. Hawai’i Pacific University. Ways to eliminate Hawaiian health disparities: Improving health equity.
bit.ly/3Vwb5ZG.
3. U.S. Dept of Health and Human Services. Health Resources and Services Division. HPSA Find tool.
data.hrsa.gov/tools/shortage-area/hpsa-find.
4. Tucker N. 631 Rural hospitals at risk of closure by state. Becker’s Hospital Review. Nov. 8, 2022.
beckershospitalreview.com/finance/631-rural-
hospitals-at-risk-of-closure-by-state.html.
5. World Population Review. Cost of living index by state. 2022.
worldpopulationreview.com/ state-rankings/cost-of-living-index-by-state.
6. Access to Care, July 2022 Report.
drive.google. com/file/d/1E4jhUY7UME7P_ht-c3DceN0zHy JGTsaI/view.
7. Improving rural healthcare goal of new UH research and policy center. University of Hawai’i News. Nov. 10, 2022.
hawaii.edu/news/2022/11/10/ uh-rural-health-research-center.
and Congress designated $23
8. Peterkin, O. Hawaii health centers to receive more than $25M in federal aid. Pacific Business News. March 15, 2022.
bizjournals.com/pacific/ news/2022/03/15/hawaii-health-centers-
receive-23-million.html.
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