Withy Kelley, Andaya January, Vitousek Sharon, Sakamoto David
John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI 96813, USA.
Hawaii Med J. 2009 Dec;68(11):268-72.
Anecdotal reports of a doctor shortage on the Big Island have been circulating for years, but a detailed assessment of the health care workforce had not previously been accomplished.
The Hawai'i Island Health Workforce Assessment used licensure data, focus groups, telephone follow up to provider offices, national estimates of average provider supply and analysis of insurance claims data to assess the extent of the existing medical and mental health workforce, approximate how many additional providers might be effectively utilized, develop a population-based estimate of future demand and identify causes and potential solutions for the challenges faced.
As of February 2008, the researchers were able to locate 310 practicing physicians, 36 nurse practitioners, 6 physician assistants, 51 psychologists, 57 social workers and 42 other mental health providers. Based on national averages, claims analysis and focus groups, the Island could use approximately 45 additional medical professionals to care for the 85% of the population that is medically insured; a larger number to care for the entire population. Ascertaining a complete roster of mental health professionals was not possible using this methodology.
The researchers compared the current supply of physicians with the national average of physicians to population and the number of visits to different specialists for the year 2006 and found specific regional shortages of providers. The focus groups concentrated on solutions to the workforce crisis that include the formation of a well-organized, broad collaboration to coordinate recruitment efforts, expand and strengthen retention and renewal activities, and reinvigorate the health profession pipeline and training opportunities. The researchers recommend collaboration between the community, government, business, health center care providers, hospitals and centers to develop a plan before the tenuous state of healthcare on the Big Island worsens. In addition, continued surveillance of the health workforce is vital to tracking the impact of interventions. This could be accomplished through community informants and data collected at the time of professional relicensure to include practice location and practice intensions for future planning estimates.
关于大岛医生短缺的传闻已流传多年，但此前尚未完成对医疗保健劳动力的详细评估。
夏威夷岛医疗劳动力评估利用执照数据、焦点小组、对医疗机构的电话随访、全国平均医疗服务提供者供应估计以及保险理赔数据分析，以评估现有医疗和心理健康劳动力的规模，估算可有效利用的额外医疗服务提供者数量，基于人口估计未来需求，并确定面临挑战的原因和潜在解决方案。
截至2008年2月，研究人员能够找到310名执业医生、36名执业护士、6名医师助理、51名心理学家、57名社会工作者和42名其他心理健康服务提供者。根据全国平均水平、理赔分析和焦点小组，该岛可能需要约45名额外的医疗专业人员来照顾85%参加医疗保险的人口；若要照顾全体人口，则需要更多。使用这种方法无法确定心理健康专业人员的完整名单。
研究人员将当前医生供应情况与全国医生与人口的平均比例以及2006年不同专科的就诊次数进行了比较，发现特定地区存在医疗服务提供者短缺的情况。焦点小组着重讨论了劳动力危机的解决方案，包括形成组织良好、广泛的合作，以协调招聘工作，扩大和加强留用及续约活动，重振健康专业人才输送渠道和培训机会。研究人员建议社区、政府、企业、健康中心医疗服务提供者、医院和中心之间开展合作，在大岛脆弱的医疗状况恶化之前制定计划。此外，持续监测医疗劳动力对于跟踪干预措施的影响至关重要。这可以通过社区信息提供者以及在专业执照续期时收集的数据来完成，以纳入执业地点和未来规划估计的执业意向。
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