Developing the rural primary care workforce in Hawaii--a 10-point plan.

The shortage of physicians and resultant lack of access to care particularly on the rural neighbor islands of Hawaii has been well described. A recent report in the December issue of this journal by Withy, et al. documents a current shortage of 45 physicians on the Big Island. (1) Similar reports suggest that Hawaii's physician workforce lags 20% behind physician to population ratios in the continental US. It is projected that the aging population and the heavy burden of chronic disease will increase demand for health services by 40% by 2020 and even higher for specialties that focus on the care of elders. The existing physician shortage is heightened by the high percentage of doctors reaching retirement age. High business and living costs coupled with low reimbursement for health services makes it difficult to be competitive when recruiting physicians to Hawaii. Are there evidence based solutions to the state rural primary care workforce crisis? This article describes what is currently in place as well as new initiatives and a ten point plan to lay the framework for an improved state rural training pipeline.