Senator Josh Green on the expansion of physician assistant training

Healthcare is changing rapidly in response to high costs and the evolving needs and preferences of consumers.  Increasingly, insurers are rewarding prevention and positive outcomes in patient-centered primary care practices.  But adopting new models of care is challenging, especially for many neighbor island communities where the supply of primary care doctors is limited.  Moreover, access to care is increasingly problematic in many rural areas, and people covered by Medicare and Medicaid, who are often the sickest, are finding more practices closed to them.

Many healthcare workforce experts point out that Hawaii can’t solve primary care provider shortages by training or recruiting more physicians.  The time and resources needed to train physicians is extensive and the economic realities and geographic isolation of Hawaii put it at a disadvantage for recruiting and retaining doctors, who, because shortages are nationwide, are being wooed all across the country.  One of the most viable strategies for both transforming health care and increasing timely access to it is expanding the team of primary care clinicians to include advanced practice nurse practitioners, psychologists, and physician assistants.  While these highly trained, licensed professionals do practice in Hawaii, policy and support for expanding their availability can rapidly increase their numbers and ease provider shortages and access barriers.

A couple of things are in the works to accomplish such expansion:  physician assistant training, currently not provided in Hawaii, is being explored at the University of Hawaii at Hilo in partnership with the University of Washington.  Per Dr. Josh Green, who practices on the Big Island and represents Kona in the State Senate, such a joint initiative would help Hawaii quickly establish a credible training program.  Locating the school at UH Hilo, which hosts the UH System’s School of Pharmacy, has the added advantage of training primary care PAs right where they’re most needed.  “We know that physicians trained in Hawaii are most likely to practice here long-term.  We’d expect the same for PAs,” said Dr. Green, “which means training PAs in Hilo would increase PAs practicing in Hawaii County.”

As “Senator Green” he plans to introduce legislation to provide tax credits for primary care physician practices that include APRNs, PAs, or psychologists.  He added, “We need to align all these strategies to make sure our health care system works for all the people in Hawaii and we need to do it now.”