Across the islands, health providers now suffer from unprecedented levels of burnout. The sacred practice of medicine is under fire in Hawaii’s smallest practices and in our largest hospitals. Although COVID-19 is finally abating, two years of the pandemic has left providers drained, with many choosing to opt out.
As we return to a new normal, many industries are facing inflation, labor shortages and supply chain constraints. The combination of these factors places Hawaii at risk for a great hollowing out of our small-business community. Unlike law or construction, however, where one can charge what the market will bear, clinics and hospitals must make ends meet with a ceiling on revenues set essentially by Medicare.
At the heart of the problem is “the price of paradise.” Whether it is teachers or health care workers, wages are known to be lower in Hawaii, but the cost of living here is higher. In fact, nursing wages in Hawaii are among the highest in the country, but when factoring in the cost of living, they are among the lowest. Even before the pandemic, 1 in 5 physician jobs and 12% of all nursing positions remained unfilled.
Many in Hawaii have finally reached a breaking point. Energy prices increased by one-third in the past year, and the current annual rate of inflation is 7.2%, something not seen in Hawaii for over 30 years. In an effort to rectify a dire need, Hawaii lawmakers opened the current session proposing to raise the minimum wage to $18 from $10.10 per hour by 2026. It is unconscionable that someone can work full time at a fast-food establishment but earn too little to rent an apartment. No one who is fully employed should have to worry about being homeless.
However, by solving one problem, we will create another. An increase in the minimum wage to $18 per hour will have a ripple effect on jobs that pay up to $30 per hour. Combine increases in the cost of labor plus inflation of material, owing to supply chain issues and the cost of a container getting to Hawaii, and no amount of visitors or government contracts will solve the problem of margin compression.
In the health care field, small independent clinics are already buckling or being bought up throughout Hawaii. Wages and rents combined with the burden of finding staff, administrative compliance and billing health insurance have become overwhelming.
On the other end of the spectrum, we are witnessing a rapidly increasing consolidation in health care, with Hawaii Pacific Health and The Queen’s Health Systems in competition for patients and territory as both vertically integrate by purchasing practices, hiring whatever qualified physicians and nurses they can find and keeping their specialists and hospitals busy. In the spirit of Obamacare, they are also focusing on population management in an effort to lower the global cost of health care, which is approaching 20% of GDP in the U.S.
Sadly, though, many physicians in our two giant health care organizations complain of being burned out. Despite competitive wages, they tend to carry very large patient panels, albeit with streamlined ancillary support. Increasingly, however, some doctors feel stifled and overworked and complain that productivity takes precedence over humanity.
Manakai o Malama Healthcare Group finds itself somewhere in the middle. As Manakai approaches its 20th birthday this year, our 35 to 50 providers and staff have received over half a million visits. We seem to be small enough to effect change quickly. When COVID-19 hit we were quickly up on telemedicine. Yet, we are large enough to have the resilience to adapt to the onslaught of changes in the environment. It is our mission to nurture the soul of medicine and our intention to work as a team that keep us going. This enables us to treat each patient as a whole person, not simply as an accident that happens to be attached to a disease. Presently, we are offering positions to some of our burned-out colleagues and continue to expand in order to keep pace with the growing need.
The pandemic highlighted the importance of access to health care for all people. We must also be pragmatic and manage costs with eyes wide open. The U.S. has always spent much more of its GDP on health care than other countries, with much less to show for it. Yet access and cost control are for naught unless we nurture the human factors of our providers, virtually all of whom went into medicine with great optimism and the best of intentions. That is the only way the people of Hawaii will receive the health care they deserve.
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Ira Zunin is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
