Solutions to expand Hawaii’s health workforce

There is a healthcare shortage in Hawaii.

Hawaii needs an estimated 710 to 1,008 physicians (not including nursing, dental, and mental health professionals) to ensure that people can receive the care they need.

I was excited to attend the 2022 Hawaiʻi Health Workforce Summit, a one-day conference for all healthcare professionals in Hawaiʻi. The summit focused on solutions to the workforce shortage and physician burnout.

Dr. Kelley Withy and the Hawaii/Pacific Basin Area Health Education Center (AHEC) did a fabulous job, as always, of putting together panel discussions on topics resolving around geriatrics, substance use, rural health, and provider resilience. It was amazing to see so many people take time off to talk about solutions, share their experiences, and create a feeling of energy and excitement in the room.

The first panel discussion, “Active and Emerging Solutions to the Workforce Shortage in Hawaii,” set the optimistic and practical tone for the summit. Nadine Tenn-Salle, MD spoke with healthcare leaders from diverse backgrounds, including practicing physicians and healthcare administrators.

As a healthcare administrator for a Hawaii nonprofit organization, I felt a shared experience when speakers talked about the administrative burden of healthcare, low payments, and high caseloads that challenge healthcare professionals everywhere.

All attendees and sponsors were invited to prioritize 5 of the 38 solutions to expand Hawaii’s health workforce for AHEC to focus on in the coming years, in the areas of professional factors, family issues, financial factors, training pathways, and models of care delivery.

Here are my top five solutions for healthcare in Hawaii:

1. Increase health insurance plan payments and salaries to health care providers. Medicare and Medicaid payments are lower than commercial payments (employer-sponsored plans). By increasing payments rates, adding cost-of-living or inflation adjustments, and creating allowances or incentives for rural communities where it is hard to find and retain healthcare providers, healthcare providers could have fewer barriers to working in Hawaii – and fewer reasons to look for a job outside of Hawaii.

• Expand telehealth services and ensure equitable payments for telehealth services. A 45-minute visit could turn into a 2-hour visit when factoring in traffic and parking, and can cost patients more in terms of time off from work, gasoline, transportation, and parking. Telehealth services are a practical and effective way to increase access to care for people with transportation or mobility issues, people on Neighbor Islands or rural communities, and people with caregiver responsibilities.

• Expedite health care provider credentialing with health insurance plans. Healthcare professionals cannot receive payments for their services until they are credentialed with health insurance plans. At our center, some healthcare plans take 2-4 weeks to approve providers, which others can take 4-6 months. With expedited credentialing, healthcare professionals could see patients sooner and healthcare organizations could receive payments for their services.

• Eliminate the general excise tax (GET) on health care. Food and healthcare are basic necessities, and should not be subject to the general excise tax. Without the GET, private practice physicians and clinics could see an immediate 4% savings, which could help them to hire, train, and retain healthcare staff.

• Expand training programs for health care providers. Looking to the future, we need to encourage students today to consider a job in healthcare and provide greater access to training, as well as support people who are considering a job in healthcare or who want additional licensing or education.

The ultimate goal of these discussions about health workforce shortages and barriers to practicing medicine is for each healthcare provider to find joy in healing (again).

What has been your experience with your primary care physician and your health insurance plan? If you are a healthcare provider, what drew you to healthcare – and what would encourage you to continue to practice in Hawaii?

4 ingredients for happiness at work

How do you feel when you arrive your office building or workplace? Do you dread the rest of the day or feel enthusiastic about your job?

In honor of International Week of Happiness at Work, let’s take some time to think about adding happiness ways to our workday.

After all, someone working 7-8 hours a day, 5 days a week, spends a third of the day and almost 70% of the year at work.

I don’t usually think about whether I’m happy at work. That’s why it’s called work. So I spent some time thinking about what happiness at work would look like.

For me, happiness at work has four ingredients:

Purpose. I feel that I am doing something meaningful, that it will have a positive impact on someone or something else, now or in the future. This might involve a little bit of “job crafting” – changing our mindset about what we do, and seeing value in even the smallest tasks and interactions.

People. I feel a sense of belonging, of shared values and shared goals, with the people I work with; and that some of my co-workers have the potential to become friends.

Independence. I feel that I am trusted to do tasks and projects, to identify and solve problems, to manage my time – and also that I can ask for help if I need it.

Growth. I feel that I can learn something new or improve skills I already have, and that co-workers and supervisors encourage learning and questioning.

This recipe for happiness at work made me realize that while I often I feel frustrated, challenged, and overwhelmed, I also feel… happy.

Here are 5 things you can do in your organization to add a little happiness…

• Invite an expert to give an inspirational talk over lunch and discuss what you can do.

• Organize a discussion about what makes you happy at work with colleagues.
• Sign the Happiness at Work Manifesto and pledge to make happiness at work the norm, or write a team manifesto.
• Start an initiative to give more positive feedback.
• Take the 30-Day-No-Complaining Challenge and keep your workplace a positive space.

What are your ingredients to happiness at work? What one thing could you do to feel happier at work?

Poetry: O Wai ‘Oe

A few weeks ago, I attended a poetry workshop, “Creative Coping: Odes” with ‘Ihilani Lasconia, poet, activist, and scholar. She led us in a discussion about the importance of water, our connection to the land of our birth, and our identity. She asked us to remember our connection to water in a guided exercise called O Wai ‘Oe. These are my memories of water:

O Wai ‘Oe
By RLC

I remember the taste of clean warm water from the garden hose wetting my dry mouth, wetting the the front of my shirt, until the water cooled and it was clean cool chill and I flicked some water onto the ground like a blessing before turning off the hose;

I remember the way the bamboo pole felt in my hand as I crouched along a stream, it might have been Kalihi Stream or Manaiki Stream near Moanalua Gardens, fishing with my dad. It was never about catching fish;

I remember the feel of the salt waters of Waimanalo as they surged around my young uncoordinated self, tumbling me in the shallow surf, flashes of sand and fractured light revolving;

I remember the smell of salt and fish food as I peered into the salt water aquarium my husband nurtured, beautiful vivid colors of fish who had little left to fear, they had already lost the ocean;

I remember the sound of rain pit-patting on the windshield like kitten’s paws with a sunlight diffusing through the clouds along the highway near Manoa, turning clear glass into spotted patterns;

Most of all, I remember water is a blessing.

What are the waters of your birth? What waters do you feel connected to?

Hope for those affected by suicide

You are valued. You are love. You are not alone. Your life has meaning.

Please remember this, always, as we talk about something difficult: suicide and hope for those affected by suicide.

September is National Suicide Prevention Month, shining a spotlight on support, advocacy, research, and resources.

A friend told me that her first-grade son said to her, “I don’t want to live.” I can’t imagine hearing those words from any child. She didn’t ignore his words and she was persistent in getting him help.

This Saturday, September 10, 2022 you can participate in the American Foundation for Suicide Prevention’s Out of the Darkness Walk. The Oahu Walk starts at 8:30 am at Skygate Park, near the Honolulu Municipal Building and the Mission Memorial Building. There’s no registration fee, leashed dogs are welcome, and anyone can make a donation. You can register or join my Oahu Walk team.

“It’s only by learning more about what leads someone to suicide, the ways we can help to prevent it, and what resources are available – and not being afraid to ask when we’re worried about someone, or for help when we need it ourselves – that we can empower our communities to address this leading cause of death,” AFSP reminds us.

Your support will help raise awareness about suicide and help make it possible for people to receive the care and support they need in challenging times.

A woman told me about a time when she had the sudden feeling that she needed to call her friend. They hadn’t spoken in a while, and after talking, her friend admitted that she had been having thoughts of suicide. Her call was a lifeline.

Now, we have a new lifeline –anyone can call 988 to reach the Suicide and Crisis Lifeline. Someone will answer, 24/7, and offer free and confidential support.

Always have hope. Learn more about risk factors, resources, and support at the American Foundation for Suicide Prevention, the National Institute of Mental Health, and the National Alliance on Mental Illness.

Have you had thoughts of suicide? Are you worried that someone may be thinking of suicide? Who can you reach out to for help? Share your story of hope and connection.