PCF— Health Care Day, part 1

JABSOM— John A. Burns School of Medecine

Dean of Clinical Affairs Roy Magnussen highlighted the coming health care crisis (as if we're not in one already) due to a man-power shortage and the increasing health care costs. There will be shortages due to:
— health care reform
— baby boomers retiring (and doctors retiring too)
— survival rates of patients
— obesity/diabetes
— gender changes (female doctors not able to out in as many hours due to family constraints)
— tight budgets
— generational differences (younger doctors want a life outside of medecine)
There are currently 3,253 practicing physicians in the state, leaving us with a 500 doctor shortage, and that will double over the next decade. Doctors in Hawaii are older on average than their mainland counterparts.

JABSOM started in 1965 as a 2 year school and then became a full-fledged medical training facility in 1973. There are over 250 full time faculty and over 1,000 volunteer faculty. The school brings in over $42 million a year in grants to Hawaii, providing jobs, a biomedical industry, and spin-off companies.
They rely on a Problem Based Learning model (versus just lecturing) in which students are given a clinical problem and then they are tasked with finding information (collecting, analyzing, syntesizing), and working in teams to come up with a diagnosis and course of action. The school also offers a Masters in Public Health that focuses on specific populations and preventive care.

At JABSOM, 90% of the students are local; 50% of practicing physicians in Hawaii are JABSOM graduates. 58% of the graduates go into some ind of primary care.
Imi Ho'ola is a program that provides opportunities to twelve students from disadvantaged backgrounds each year. Chessa DeCambra, spoke about how the program prefers applicants that can demonstrate ties to Hawaii and the Pacific Basin, but that is not required. They look at applicants' economic, social, and educational backgrounds and their willingness to serve. Their first move is to assess any pukas in their knowledge level and then they work to get them up to speed so they can get into the regular program.

Dr. Magnussen showed the impact of the current health care reform:
— greater coverage (demand up)
— incentives for primary care (currently these physicians are paid approx. 1/3 less than specialists— students graduate with $100-120,000 in school debt)
— no new residency increases

Where will the money come from:
— Accountable Care Organizations (eg. Kaiser, insurance companies, hospital care)
— electronic health records
— Quality agenda (no reimbursement for poor results; stop paying for readmittance in 30 days due to infections or complications)
————> save $600 billion

Challenges:
— health care companies kick back 50% of all claims ——> high administration costs dealing with duplicate paper work as a result; not necessarily due to liability since Hawaii is way ahead in terms of coverage and access, they're just behind in reimbursements

Finally, Vanessa Wong, assistant professor at JABSOM, spoke to us about the Native Hawaiian Center for Excellence that promotes physical and mental health of native Hawaiians. Part of the program also develops a cultural competence component of the graduates. Chess DeCambra