By Leland Kim
KONA (KHNL) -- We continue our look at the health care crisis on the Big Island, the fastest growing county in our state.
Last week, we looked at the Hilo side. Wednesday night, we focused on Kona. The doctor shortage there has already reached a dangerous level.
Kona Hospital stands as the medical backbone of the community. It's also where Dr. Stephen Denzer now calls home. He closed down his internal medicine private practice last year, after fifteen years of serving Kealakekua, Hawaii.
"We were working harder and harder for less and less in an environment where there were no subspecialists, and increasingly large demands on our skills and time, and it simply was not possible to stay in business," said Dr. Denzer.
He's not alone. In the last five years, 20 doctors have left Kona. Only five have come to replace them.
Doctors say the high cost of practicing medicine in Kona is partially to blame.
"Essentially we have the highest cost of living and the lowest reimbursement for primary care services in the U.S.," said Dr. Denzer. "So it's very difficult to get people who are in very high demand elsewhere to make the move to Kona."
"I think the primary reason why people moved away from here was economic reasons," said Dr. Barry Blum, a long-time Kona orthopaedic surgeon. "It was a direct result of a steady decline in reimbursements for work they were doing."
But the Hawaii Medical Service Association, or HMSA, disagrees.
"Our fees here in Hawaii is like in the median, in the middle," said Cliff Cisco, HMSA's senior vice president. "There are metropolitan areas that have higher fees."
The shortage is compounded by growth on the Kona coast.
"So it's really a primary care crisis," said Dr. Denzer. "The population has probably doubled during that time. The hospital is full, perhaps saturated to the breaking point."
Saturated, and overflowing to other medical care facilities.
Twenty years ago, there were 13 primary care physicians serving the Kona community. Now there are only four. So more and more patients without doctors come to the emergency room, even for the most basic medical needs.
The ER has become the default doctor's office.
"The emergency department on an average day is seeing anywhere between 20 to 40 people that do not have primary care physicians here in this community," said Lori Cannon, an ER registered nurse. "And they are unable to get physicians in this community that are willing to accept them."
"That's what we're seeing," said Rose Schilt, a Kona resident. "We've seen many doctors come in, stay a short time, try to make it, and then they're leaving. And new ones are being recruited, and that's not consistent care for the community."
So, the ER has been forced to become a safety net for a patient population without doctors.
"Some days we have two or three patients double and tripled up in a one-patient cubicle space," said Cannon. "You get into privacy issues. You get into infectious control issues. So yes, the ER is deeply saturated."
It becomes a bigger issue if a patient needs a specialist, like an orthopedic surgeon.
"The problem is that you need doctors where people live," said Dr. Blum. "When people fall down and break, they need to see a doctor right away."
Physicians say it's never been this bad.
"The insurance system has failed," said Dr. Blum. "There's no question about that. Medicare has failed and HMSA has failed."
And patients hope something happens soon before this crisis gets even worse.
"I'm afraid," said Eulma Schenck, an 80-year-old Kona resident. "I pray every day that no real big catastrophe will happen that everybody will have to leave. But I don't know. It's a real sad situation."