October 28, 2019
Hawaii Medical Education Council
Monday, October 28, 2019
John A. Burns School of Medicine
651 Ilalo Street, Medical Education Building
Parking Reserved in LOT B for RSVP’s
Hawai‘i Medical Education Council (HMEC)
University of Hawai‘i, John A. Burns School of Medicine
Date: Monday, October 28, 2019, 7:30 a.m. – 9:00 a.m.
Location: 651 Ilalo Street, Kaka‘ako Campus, Medical Education Building, Room 202
Honolulu, Hawaii 96813
- Review & Approval of July 29, 2019 Minutes –Dr. Hedges (distributed via email to members on 10/24/19)
- Report from HMEC Chair – Dr. Hedges
- Announcements (5 minutes)
- Update on Legislative Strategies – Jerris Hedges and Cynthia Nakamura (15 minutes)
- Physician Workforce Data Updates
- Physician Workforce Updates & Synergies – Aimee Grace & Kelley Withy (30 minutes)
- Loan repayment tracking
- Brief update on 2016 GME Strategic Plan – Lee Buenconsejo-Lum
- Review of draft 2019 HMEC report and recommendations to the 2020 Legislature
(2019) RECOMMENDATION #1 – recommend deleting this for 2020
UH JABSOM/HMEC recommends that the 2019 State Legislature assess the advisability and feasibility of an annual and recurring GME Appropriation to support HMEC-designated residency/fellowship programs with a particular emphasis on primary care.
(2019) RECOMMENDATION #2 – consider continuing this for 2020
UH/HMEC recommends that the 2019 State Legislature and State Executive Branch support the State Department of Human Services and UH JABSOM to work together to develop a State Medicaid GME-focused Matching program to augment GME faculty and resident/fellow funding.
(2019) RECOMMENDATION #3 – consider continuing this for 2020
UH/HMEC recommends that the 2019 State Department of Human Services and other stakeholders explore the mechanisms to obtain Federal Medicaid GME funding since many of the residency programs provide inpatient and ambulatory care for Medicaid populations.
(2020) RECOMMENDATION #1
The legislature support the inclusion of loan repayment support in the annual Department of Health (DOH) budget with the explicit instruction for the DOH to annually transfer those funds to JABSOM as long as the SoM oversees the health professional loan program for Hawaii – including coordination of the NLRP federal match.
(2020) RECOMMENDATION #2
The legislature support the expansion of JABSOM faculty and staff to provide satellite educational programs for year round undergraduate education on Hawaii and Maui Islands which will allow expansion of the medical school class size with more neighbor island medical education, and will allow exploration of residency training expansion to these islands.
- Additional Items
- Announcements – Next HMEC Meeting – Monday, January 27, 2020 @ 7:30am in MEB 202
Hawaii Medical Education Council (HMEC) Meeting October 28, 2019 Time: 7:30-9:00 a.m. John A. Burns School of Medicine, Room MEB 202 651 Ilalo Street, Medical Education Building, Honolulu, Hawaii 96813
Members Present: Mary Ann Antonelli (VA), Lee Buenconsejo-Lum, (Interim Associate Dean for Academic Affairs, Designated Institutional Official (DIO) for Graduate Medical Education, JABSOM), Christopher Flanders (representing health professions community), Jami Fukui (for Randall Holcombe, representing the UH Cancer Center), Jerris Hedges (Chair, JABSOM Dean), Allen ”Chip” Hixon via Zoom (representing the health professions community), Lorrin Kim (for Bruce Anderson, representing the Department of Health), Lisa Rantz via Zoom (representing person of the general public community), Kenneth Robbins, (representing hospital conducting ACGME programs), Todd Seto (representing hospital conducting ACGME programs), Joseph Sterbis (representing hospital conducting ACGME programs) and Sharon Vitousek via Zoom (representing health professions community).
Members Absent: Katherine Finn Davis (for Mary Boland, representing the School of Nursing) and Kathryn Ryder (representing federal healthcare sector).
Others in Attendance: Patricia Blanchette (Interim Associate Dean for Clinical Affairs, JABSOM), Aimee Grace via Zoom (UH Director of Health Science Policy), Cynthia Nakamura (Government Affairs and Legislative Consultant), Holly Olson (Deputy DIO, JABSOM), Richard Philpott (CEO, Hawaii Residency Programs), Larry Shapiro (CEO, University Health Partners), Linda Rosen (CEO, Hawaii Health Systems Corporation) and Kelley Withy (Director, AHEC).
HMEC Administrator: Lee Buenconsejo-Lum Recorder: Crystal Costa
|TOPIC||DISCUSSION / CONCLUSIONS / ACTIONS / DECISIONS||TASKS|
|1. Review of Minutes||Minutes from our last meeting, held on 7/29/19, were reviewed and approved. Motion to approve came from T. Seto and second by K. Robbins. Motion to approve carried unanimously. No opposed and no abstentions.||NA.|
|2. Chair Report Dean J. Hedges & Legislative Strategies Update by Cynthia Nakamura||a. Announcements (Dean Hedges):|
The incrementally increasing medical student class size is currently at 77 students per incoming year. Challenges include the need to increase clinical training opportunities for larger class sizes and limited facilities size (facilities were established for class sizes of 70 students). JABSOM is looking to the neighbor islands to expand training sites while also addressing the recruitment and workforce needs for physicians throughout the islands. A post-training service obligation for tuition support model, similar to the loan repayment model managed by Dr. Withy, will be further researched across the country to compare how other states and programs address educational debt. As recruitment strategies become increasingly competitive, reducing or removing educational debt through public (i.e. loan forgiveness programs state/federal) and private (i.e. scholarships) funding support could help keep our trainees in Hawai`i throughout and after training. We would also like to see neighbor island training opportunities expand for graduate medical education in areas of need. Dr. Antonelli shared that there are loan repayment opportunities through the VA as well.
b. Legislative strategies update for 2019 (Cynthia Nakamura):
Act 262 (SB1404): Relating to Loan Repayment for Health Care Professionals was signed into law on July 5, 2019. We received $150K, for a one-year period of time (2019-2020) which is about half of what was originally requested. We will continue to work closely with the DOH to request that the funding be part of the DOH base budget so that JABSOM would no longer need to make separate annual requests. Discussions are ongoing and the approach is pending approval by the Governor and Department of Finance before going to the legislature. Discussions also continue with community partners such as Queen’s Medical Center, Hawaii Medical Assurance Association, Healthcare Association of Hawaii, and others for matching loan repayment funds. Mahalo for the continued support and testimonies.
We are seeking to expand medical education and training to the neighbor islands where 5 students will be able to receive training and come to Oahu only occasionally. This strategy intends to train students, and eventually more residents, on neighbor islands. Such students will eventually serve and hopefully stay on the neighbor islands to meet the workforce needs. Maui and Hawaii Island have been identified as two islands where we could initiate this project and expand on leveraging the current infrastructure already in place, however given that JABSOM and UH have a fair amount of presence on Hawaii Island, Maui is being prioritized at this time. The funding request to the legislature is for $1.4M annually and thus far has received positive responses within UH leadership. The recommendation is to request funding for one site and demonstrate success before expanding to two sites. Much of the funding will go to personnel, staff and preceptors. We will need to connect with new preceptors which will also help to keep the current medical community up to date while training upcoming physicians.
The space needs on Maui should be met at the UH Maui Community College and the Maui Memorial hospital which may also include potential living spaces from former nurse’s’ quarters. Clinical educators will be asked to teach in classrooms settings in addition to supervise clinical practice activities (1st and 2nd year using Practice Based Learning (PBL) blocks throughout the year + distance-learing basic science lectures). Logistical details are still being developed. Though we may not have enough faculty to start a new or independent residency, the hope would be that these preceptors could also become core faculty for Oahu-based residency expansion.
|TOPIC||DISCUSSION / CONCLUSIONS / ACTIONS / DECISIONS||TASKS|
|Discussion included concerns related to the low pay scale in Hawai`i and encouragement to continue focusing efforts on making Hawai`i a great place to work with numerous opportunities for debt reductions and scholarships.|
Workforce Data Updates
Kelley Withy + Aimee Grace
|Workforce updates (Kelley Withy)|
Currently trying to locate more physicians and will have updated data once the physician licensing survey opens again in November 2019. Preliminary statewide shortages are between 593-830 FTEs with 49 retirements, 39 leaving the state, 58 decreasing time and 60 to be located since 2019. There are currently 250 open positions posted throughout the state. The shortages by island are: Oahu = 230-421, Hawai`i Island = 192, Maui = 166, and Kauai = 51 with the primary care shortage as follows: Oahu = 188, Hawai`i Island = 39, Maui = 52, Kauai = 15.
|Ongoing updates to be provided by Dr. Withy and Dr. Grace.|
|The payment transformation survey (still open during time of this meeting) has received 156 responses to date from doctors in Hawai`i. Dr. Withy asked everyone to please keep in mind the selection bias as the people who answer the survey are more likely to be unhappy. Physicians that are doing well may not report in the survey and we are unable to determine if the physicians are in private practice or not solely based on the survey results.|
|Handout shared of physician resources for recruitment that includes practice assistance, financial resources, welcome activities, professional organizations, and much more throughout the islands.|
|To help tackle the 250 open positions, AHEC is hiring a physician recruiter that would assist various institution-based recruiters. This person would aim to connect everyone across institutions and islands, and could be a one stop shop resource providing information relating to loan repayment, cost of living support, bridge to practice opportunities, and assist our military partners (TAMC and the VA) to identify those that retire and recruit them to stay in Hawaii to practice. The job description is complete and pending approval. It would also be helpful to track where Hawaii-born/raised students train on the mainland and invite them back to Hawaii for medical school or residency rotations and if possible, cover the costs of their housing and airfare.|
|Hawaii’s Health Workforce Development for the 21st Century Legislative Informational Briefing (Aimee Grace)|
Over 300 community members participated (either in-person or remotely) in the legislative informational briefing led by Senator R. Baker and Representative J. Mizuno held in August 2019. Goals were to share potential solutions to health workforce challenges across sectors (i.e., entry-level, nursing, medicine, and more) as well as how to best optimize Hawai`i’s health workforce and address shared health workforce challenges, while garnering community input on solutions (legislative/administrative/policy). Next steps are to work with legislators and state agencies to advance collaborative solutions addressing workforce, appropriations and administrative action, including better utilization of pharmacists and rural/neighbor island training hubs, engage task forces on payment reform, pharmacist reimbursement and telehealth workforce, and continue to pursue partnerships including with the Hawaii Community Foundation. In addition, next steps will include advancing discussions on improving clinical training site opportunities, health professions career advising, expanding interprofessional training and services, working with industry partners to expand entry-level health science programs, and
initiating planning for a UH Manoa Doctor of Physical Therapy (DPT) program.
|TOPIC||DISCUSSION / CONCLUSIONS / ACTIONS / DECISIONS||TASKS|
|4. HMEC Recommendations to 2019 and 2020|
|JABSOM continues collaborative efforts between state hospitals systems and affiliated partners. The Council reviewed the Hawaii Medical Education Council annual report focusing on the 5 priority strategies identified during the 2016 GME strategic planning process. The UH Board of Regents has requested to see the strategic plan progress in our GME Annual Institutional Report (now depicted as Appendix B) which will continue to be updated and included annually. Strategy updates are as follows:|
STRATEGY 1. Secure additional resources to maintain and expand GME programs. This includes funding for additional faculty and clinical training sites (especially on the neighbor islands), resident positions, and supplemental educational activities.
Accomplishments include the Family Medicine increase to 20 residents (from 18) securing funding for 7-7-7 starting in July 1, 2020. This still needs several layers of approval. The entire FM residency program will be moving to Pali Momi Medical Center in Spring of 2020 which would benefit patient care and education by reducing travel time and centralize program and clinic activities. The Addiction Medicine Fellowship program began July 1, 2019 with 1 fellow and is approved for 2 fellows by the ACGME. Will continue discussions with Dr. Antonelli as the VA could be a partial funding source for the second fellow in future years. The Preceptor Tax Credit (up to $5000) has been offered to those teaching UME/GME in the approved specialties (300 registered, though not all qualify). Barriers to and strategies to address include faculty protected time and consider what the future of health care will look like.
STRATEGY 2. Develop a multi-pronged approach to improve physician retention in Hawai‘i.
Accomplishments include: full-ride scholarships for a proportion of the JABSOM students from the Weinmann Foundation, HPH, QMC, and KSBE-private donors, loan repayment programs offered through the State, the Queen’s Health System and solo/small practice loan repayment programs, collaborations between hospitals, health systems and private industry in recruitment and retention strategies, favorable options for home financing, spousal employment assistance, and a bridge to practice program. Barriers and strategies to address include uncertainties related to payment transformation.
STRATEGY 3. Develop strategies, in partnership with the health systems and insurers, to address and prevent physician burnout and to promote physician well-being.
Accomplishments include health system-specific well-being and physician engagement activities for medical staff, JABSOM faculty and GME learners, formal resiliency and well-being curriculum with protected time scheduled in most GME programs, programs to continue efficiently improving use of the electronic health records, increased physician organization support to primary care practices that include JABSOM faculty and GME trainees to improve patient flow and team-based care processes, and forming physician groups for Hawaii Young Physicians and neighbor islands physician groups. Barriers and strategies to address include complexities in changing health care systems and payments.
STRATEGY 4. Expand neighbor island and telehealth training opportunities for residents and fellows.
Accomplishments include Hilo OB-Gyn faculty practice supports a resident rotation in gynecology, available VA rotations on Kauai, Maui, Hawaii Island, Guam and American Samoa, elective rotations available in Family Medicine and Pediatrics, Surgery rotation in North Hawaii, and telemedicine training incorporated into Child and Adolescent Psychiatry (CAP) and General (Adult) Psychiatry on Kauai and Lanai. Barriers and strategies to address include the need to expand faculty on the neighbor island. Ideally, faculty will be partially compensated to ensure that there is sufficient time to create high-quality and safe clinical learning environments for residents and fellows. Lisa Rantz will be meeting with Sneha Sood (Pediatrics/neonatology) to create an experience similar to the Gynecology pilot rotation.
STRATEGY 5. Incorporate more aspects of population health and inter-professional education and training into all GME programs.
|Dr. Buenconsejo- Lum will continue to seek input from HMEC members and provide updates at future meetings.|
Approved Annual BOR Report will be sent to UH.
Dr. Withy to provide updates on Preceptor Tax Credit progress at the next meeting.
|TOPIC||DISCUSSION / CONCLUSIONS / ACTIONS / DECISIONS||TASKS|
|Accomplishments include increased curriculum in almost all GME programs, Family Medicine and Internal Medicine provide care in transformed practices, interprofessional rounding occurs in most GME programs (largely inpatient); true interprofessional practice occurs in the outpatient Family Medicine setting with behavioral health, community outreach worker, pharmacy, and there will be an Interprofessional patient safety simulation in the Spring of 2020 to meet an ACGME requirement to teach principles of root cause analysis and implementation of action plans. This simulation will include senior residents/fellows, senior nursing students and pharmacy residents. Barriers and strategies to address include the need to balance all the new ACGME requirements with the existing content and competency- based requirements.|
Recommendations for HMEC Report to the 2020 Legislature:
As the UH BOR report is due in November, we will take edits, recommendations and comments until the middle of November. Recommendations to the 2020 Legislature are:
UH/HMEC recommends that the 2020 State Legislature and State Executive Branch continue to support and provide a State match to continue the Hawaii State Loan Repayment Program. Ideally, this match could be provided as a supplement to the annual Department of Health (DOH) budget with the explicit instruction for the DOH to annually transfer those funds to JABSOM as long as JABSOM oversees the health professional loan program for Hawaii - including coordination of the National Loan Repayment Program Federal match.
UH/HMEC recommends that the 2020 State Legislature and State Executive Branch support the expansion of JABSOM faculty and staff to provide satellite educational programs for year-round undergraduate medical education on Hawaii and Maui Islands which will allow expansion of the medical school class size with more neighbor island medical education, and will allow exploration of residency training expansion to these islands.
UH/HMEC recommends that the 2020 State Department of Human Services and other stakeholders explore the mechanisms to obtain Federal Medicaid GME funding since many of the residency programs provide inpatient and ambulatory care for Medicaid population.
Discussions included recommendations to focus on loan support, reiterating that biannual monies are not helpful for sustaining GME programs, and a consideration for future legislation (not this coming year) that could ask for Program Administrators salary support that are currently under HRP which could allow HRP funding to support additional physician trainees. Will also need to meet with Judy Mohr Peterson and continue discussions around Medicaid GME funding.
|Schedule meeting with Judy Mohr|
|5. Additional Items|| Next HMEC meeting: Monday, January 27, 2020 at 7:30 am, JABSOM MEB 202.|
|6. Adjournment|| Meeting adjourned by Lee Buenconsejo-Lum at 9:03 am.|
|Minutes Approved: (Recorders Initials & Date)|