The doctor shortage on the Big Island has reached a critical level with three of the island's five orthopedic surgeons leaving soon, including the president-elect of the Hawaii Medical Association.

Drs. Doug Hiller, the incoming HMA president, John Bellatti and Vivian Chang are all scheduled to be gone by the end of January, leaving only one full-time and one part-time orthopedic surgeon on the island, and none on the west side. (Three O'ahu orthopedic surgeons fly to the Big Island part time to see patients.)

Dr. William Park, chief surgeon at North Hawaii Community Hospital in Waimea, is also scheduled to leave.

"We're still holding out hope that Dr. Park will stay and we would love for Dr. Hiller to change his mind," said Paul Dunne, vice president of fund development and marketing for NHC Hospital.

"One thing we fight in recruiting is the lack of reimbursement for doctors," Dunne said. "That's the obvious reason many doctors leave or don't come. You're looking at one of (the lowest), if not the lowest, reimbursements for doctors for all of the states. That gets difficult to battle when you put it up against having one of the highest costs of living."

Hiller and Bellatti yesterday each said the rising cost of malpractice insurance, low reimbursements from HMSA and huge workloads are the main reasons for their leaving. Chang, who came to the Big Island this year, is leaving for a fellowship.

"I've been practicing medicine in the Islands for 20 years and I feel horrible, absolutely horrible about leaving my patients, my friends and my home," said Hiller, who closes his practice Nov. 3 to practice medicine in Lander, Wyo.

"I've treated more than 30,000 on the Big Island and everywhere I go I know someone. But every year it's gotten harder and harder to practice medicine in Hawai'i. At some point, your income and costs hit a crossroads. I'm there now. I would love to stay here, but I can't."

Bellatti, who has practiced in Kona for 21 years, said he's closing his practice on Dec. 31 and is looking at jobs in California and Minnesota.

"The tough part is I can't tell patients where to go," Bellatti said. "There is nobody to refer them to when I'm gone. They'll have to get help on O'ahu or another Neighbor Island or the Mainland."

REIMBURSEMENT FEES

Cliff Cisco, senior vice president at HMSA, said its reimbursement fees for doctors are comparable to other parts of the country.

"We're not the highest, we're not the lowest," Cisco said. "We regret that three are choosing to leave. HMSA invests more than anyone on trying to recruit new physicians to the community.

"It's been well-documented that 95 cents of every dollar we collected from employers goes back to providers in benefits, and we've had operating losses. It's not that simple to change reimbursements."

Kona resident Fawzia "Berty" Fawzi said the doctor shortage in her area is "beyond critical."

"We're losing great doctors who have proven to be competent, who called Hawai'i their home," she said. "Now we're at the mercy of whoever you can get."

Hiller will be the second physician that Fawzi has lost. Last year she was treated by Dr. Douglas Brown for ovarian cancer and soon afterward he left for Washington.

"Both times they've told me they're leaving for the same reasons," Fawzi said. "They said they can't afford to practice here, that HMSA doesn't give them enough reimbursement."

The Big Island doctor shortage has been intensifying for years. The Hawaii Medical Association has held forums on the island to inform the public and seek answers, said Paula Arcena, HMA's executive director.

The shortage has spread to O'ahu. For instance, for the past two years, there have been only two orthopedic doctors on call at The Queen's Medical Center trauma center, Arcena said.

PRACTICING DOCTORS

Dr. Kelly Withy of the University of Hawai'i said that on Jan. 31, there were 7,775 doctors licensed in Hawai'i. However, that includes retirees, military doctors and doctors who have left the state. It only costs $225 a year to renew a license, so many who plan on coming back to retire keep renewing, Withy said.

A better indication of practicing doctors is the 4,047 with Hawai'i mailing addresses. But, Withy said, many of those may not be practicing full time.

Her research shows fewer than 260 full-time doctors on the Big Island. For an island with a population of about 170,000, Withy estimated, at least 350 full-time positions are needed for adequate care.

"There are no hard-core statistics to follow," Withy said. "That would just be my recommendation."

Hiller, Arcena, Bellatti and Dr. Josh Green, a state representative and now a state senator-elect from Kona, each said increasing reimbursement costs and having the money sent directly to the care provider are crucial to bringing in and retaining physicians in Hawai'i.

What would also help, Arcena said, are new laws governing malpractice suits and limiting the amount plaintiffs can win for pain and suffering.

"We've found that in 85 percent of the malpractice lawsuits filed in Hawai'i there's no type of settlement given," Arcena said. "But just because no money is paid out doesn't mean it was free. Defending the average case costs about $150,000."

Green believes changing Hawai'i's climate for doctors could be easy.

"People are finally becoming more aware of the shortage on the Neighbor Islands, and that something needs to be done," Green said. "My goal is to get a compromise (on tort reform) and increase reimbursement. If you do that you'll be able to attract doctors to the state, the greatest place in the world to live."