SB2655

SECTION 1. The legislature finds that many Hawaii residents are unable to obtain timely and appropriate health care due to a shortage of health care providers in the State. The ongoing shortage threatens individual health and may pose adverse effects to the State's health care costs. The neighbor islands, which have been designated by the federal government as medically underserved areas, have been disproportionately adversely affected by shortages of physicians in all areas of practice. The John A. Burns school of medicine has engaged in strategies to increase the numbers of physicians in Hawaii, including, among other endeavors:

(1) Enrolling more students each year;

(2) Rotating medical students to the neighbor islands for preclinical rotations for up to twelve weeks;

(3) Developing longitudinal third-year rotation sites where a small number of students are in the same location for five months;

(4) Developing a small number of sites for four-week fourth-year clinical rotations;

(5) Developing residency or fellowship rotations on neighbor islands; and

(6) Administering the State's loan repayment program that places recipients in underserved communities, especially the neighbor islands.

Current physician workforce data indicate that Hawaii has a shortage of about seven hundred fifty doctors when compared to the general United States physician-patient ratios of a similar demographic population. Primary care, internal medicine, and some specialty physician shortages represent Hawaii's greatest area of need. Without these physicians, the people of Hawaii do not have access to the health care they need.

In Hawaii, graduate medical costs are largely borne by the University of Hawaii and its affiliated health systems. Although some federal funding has been used by the health systems to cover a portion of the costs, there are areas where the State can invest and expand medical education training using the newly available American Rescue Plan Act funding.

The Hawaii medical education council is tasked with overseeing the State's graduate medical education programs and their ability to meet the health care workforce requirements. Additionally, the Hawaii medical education council must ensure the adequate funding of health care training programs, including graduate medical programs. According to the Hawaii medical education council's 2022 report to the legislature, graduate medical education programs, especially those in primary care, geriatrics, psychiatry, and addiction, serve a high proportion of the most vulnerable populations. However, there has been a reduction in the overall graduate medical education positions in Hawaii from two hundred forty-one in 2009 to two hundred thirty in 2021. Nationally, Hawaii is in the bottom quintile of the graduate medical education positions per population. Decreased federal and state funding have had a significant impact on the number of available training positions.

The legislature recognizes that ongoing funding of medical education is vital in addressing the physician shortage in Hawaii. Considerable public outcomes can be achieved by expanding capacity for training medical students, especially on the neighbor islands with the goal of having these students ultimately remain in Hawaii to practice. One way to promote this outcome is to reestablish the Hawaii medical education special fund as a means of funding graduate medical education and training programs to support an expansion of key positions.

Therefore, the purpose of this Act is to reestablish the Hawaii medical education council special fund to enable the John A. Burns school of medicine in consultation with the Hawaii medical education council to provide funding for medical education and training in Hawaii, with an emphasis on supporting residency training on the neighbor islands and in medically underserved populations throughout the State.

SECTION 2. Chapter 304A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§304A- Hawaii medical education special fund. There is established in the state treasury a Hawaii medical education special fund, into which shall be deposited all funds received by the medical education council, including:

(1) Moneys from the federal Centers for Medicaid and Medicare Services and other federal agencies;

(2) Appropriations made by the legislature; and

(3) Grants, contracts, donations, and private contributions.

The fund shall be administered by the John A. Burns school of medicine. Moneys deposited in the fund shall be expended by the John A. Burns school of medicine for the purposes of the graduate medical education and training programs established under this chapter."

SECTION 3. New statutory material is underscored.

SECTION 4. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2655
THIRTY-FIRST LEGISLATURE, 2022
STATE OF HAWAII