Anyone have experience in Hawaii?

[medstudentmed]

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Hi,

Does anyone have any experience with EDs in Hawaii? Can anyone comment on the ED atmosphere? What is the scope of practice for EPs like in Hawaii?

Thanks.



(Sorry-I had posted a similar question on the "ED dominates" thread, but realized that no-one will rift through the hundreds of posts to read mine, so I started my own..)

 

[Apollyon]

I looked into it while I was on vacation there. There's one group that staffs 4 hospitals - 2 on O'ahu and 2 on the big island. I enquired to the group president, and he had an open position immediately - asked when I could start.

On O'ahu, the busiest hospital sees about 40K per year - it's the Queens Medical Center. Your other hospitals will see about 25K and less, and, on the outlying islands (like Mau'i or Lihue), the volume is much less.

 

[medstudentmed]

Thanks for your response--did you seriously consider the job (ie did you turn it down for pragmatic reasons or did it have something to do with the EDs?). In the context of the thread where I originally posted (which hospitals do EDs 'dominate') where does Queens (and/or the other EDs) stack up?

I know that there are no EM residencies in the state at all, and I am worried that as a result, the scope of practice would be drastically reduced--what do you think?

Thanks again for your help. And of course, I would love to hear more opinions if anyone else has any familiarity with HI.

 

[Apollyon]

The working world for doctors in Hawai'i is horrible. There are islands now that don't have an ob/gyn. Neurosurgeons are also in great demand.

Especially on O'ahu, it's the acuity you would expect for a city of 600K. There are also the (as expected) sunburned and gastroenteritis afflicted tourists.

I did seriously consider it, but I had just signed my contract at my current job for the year, so it would have been this summer at the earliest. Just didn't pan out.

 

[GeneralVeers]

The working world for doctors in Hawai'i is horrible. There are islands now that don't have an ob/gyn. Neurosurgeons are also in great demand.

Especially on O'ahu, it's the acuity you would expect for a city of 600K. There are also the (as expected) sunburned and gastroenteritis afflicted tourists.

I did seriously consider it, but I had just signed my contract at my current job for the year, so it would have been this summer at the earliest. Just didn't pan out.

Apparently the pay is quite low as well. I've heard $80-$100 is the norm.

 

[Apollyon]

Apparently the pay is quite low as well. I've heard $80-$100 is the norm.

I was offered a little bit more than that.

 

[GeneralVeers]

I was offered a little bit more than that.

Fortunately my soon-to-be group also covers a hospital outside of Honolulu so I may get the chance to vaca.....errr work there.

 

[medstudentmed]

The working world for doctors in Hawai'i is horrible. There are islands now that don't have an ob/gyn. Neurosurgeons are also in great demand.

Especially on O'ahu, it's the acuity you would expect for a city of 600K. There are also the (as expected) sunburned and gastroenteritis afflicted tourists.

I did seriously consider it, but I had just signed my contract at my current job for the year, so it would have been this summer at the earliest. Just didn't pan out.

Wow--I would have thought that the pay would be more than the nat. avg since it costs so much to live there...

In any case, what do you mean when you say that the working world is horrible? I get the impression that you mean that there are very few MDs to cover a large area/population(?) In that case, the ED would probably be very busy; but in terms of EP autonomy and scope of practice, it seems that it would probably increase due to there being a shortage of specialists.. Or is this not what you mean by that comment?

I am trying to parse out the atmosphere of the EDs (without actually being there) since it concerns me that there are no EM residencies in the state, which may not bode so well for practicing EPs..?

Thanks.

 

[Apollyon]

Pay is not great, and malpractice rates are high. Costs of living and housing are really high. That's the horrible medical climate.

 

[bartleby]

A friend worked a per diem job on the big island (Hawaii) and couldn't wait to get out of there. Poor access to primary care, often no MRI on the island. No neurosurg or ortho let alone hand coverage. It was patch 'em up and send 'em out with instructions to fly to Oahu for outpatient f/u, which obviously isn't feasible for people of average means a large proportion of the time.

 

[edinOH]

A friend worked a per diem job on the big island (Hawaii) and couldn't wait to get out of there. Poor access to primary care, often no MRI on the island. No neurosurg or ortho let alone hand coverage. It was patch 'em up and send 'em out with instructions to fly to Oahu for outpatient f/u, which obviously isn't feasible for people of average means a large proportion of the time.

Hence the high malpractice premiums I would imagine.

 

[kidhaole]

Hello,

I am a current transitional year intern at the University of Hawaii. We rotate through Queen's Medical Center for our ED month as well as for medicine/surgery. Additionally, I know several of the ED attendings at QMC.

I would say that if you are set on being in an ED that has higher acuity care and active education going on, QMC would be the only place on the islands for you. Although there is no residency program here, the medicine and TY residents and interns rotate through Queen's throughout each academic year. Also, there are EM residents from the mainland that rotate here regularly. There is a formal curriculum for the rotation, and many of the attendings are relatively fresh out of residency and into teaching. Additionally, although there isn't a ton of penetrating trauma(occasional shark bite!), there is definitely plenty of blunt trauma and critical care.

The pay here is average to below average for nearly all physician specialties. HMSA insurance essentially has a monopoly here, and they are perpetually trying to reimburse accordingly.

Most docs I know are here for family or because they love what this place has to offer (year round beautiful weather and outdoor activities, interesting culture). Therefore, they are willing to accept less income for the positive intangible treadeoffs. I haven't met too many attendings that are unhappy here. I can certainly say that I will strongly consider coming back to practice once my training is complete.

If I can provide any other info, let me know. Good luck.

 

[medstudentmed]

Hi kidhaole,

Thanks for your response. Yeah--I figured that Queens would be the only place to go for that stuff. Hope you don't mind sharing some of your insight!

In the ED, who runs the traumas/directs the resuscitations (surg, EM, or rotate)? Who performs most of the procedures (chest tubes, central lines, etc.)? Do EPs have admitting privileges to all services? (As you can tell, I am mostly concerned with scope of practice/autonomy issues--my concern arises from the fact that, as you mentioned, there is no EM residency program.)

Lastly--I understand and expect to be taking a paycut, as I would be going there for familial reasons, but combine that with the skyhigh cost of living and it seems to add up--what kind of difference are we talking here?

In any case, thanks so much for your insight!

 

[medstudentmed]

bump..hey kidhaole if you're still out there, I'd love to hear more about your experience..

 

[Aloha Kid]

Hey,

I'll be looking for jobs in Hawaii soon. Probably this Summer. From what I've seen, there are jobs available but the only ones that seem to be advertising as of now is Queens (locum tenen position) and Kona - Hawaii. Occasionally a democratic group handling Castle medical center, Wahiawa, and Hilo advertises mainly in Emergency News and Annals. I'll probably need to email and write the rest of the hospitals and see if they are hiring. These include (Straub, St. Francis, Kuakini, & Kaiser). I'm not sure if Tripler hires civilians. The way I see it, I'll write, see whose hiring and then go from there. It should be a pretty easy job search due to the number of hospitals. I'll probably need a secondary search going on in the mainland in case things fall through in Hawaii.

From what I've seen on the outer islands, get used to stabilizing and shipping patients. Critical patients are all yours until a chopper arrives. For Oahu, the system functions like a big city. Queens is the designated Trauma center but probably only meets level II certification. They have many subspecialties covered but have had significant coverage issues for Ortho and Neurosurgery. Kapiolani Childrens is the peds referral hospital.

I have strong ties to Hawaii and would like to practice there and settle if the opportunity is right. I have literally conceded the fact that if you wish to practice in Hawaii, you can expect to push retirement back about 10 years and settle for a lot less of everything. You will not find the generous 300+ contract offers as you would in the United States. In fact, I think the starting may be around $190,000. When you average it to the cost of living in hawaii as compared to some place like Texas this actually turns out to be more like $110,000. check out the website Sperlings best place to live. Google it and compare.