SB62 SD2

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 number 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.

Existing 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 for a similar demographic population. Primary care, internal medicine, and some specialty physician shortages represent Hawaii's greatest areas of need. Without these physicians, the people of Hawaii do not have access to the health care they need.

Research from the John A. Burns school of medicine suggests that if graduates complete their medical school and residency training in Hawaii, about eighty per cent of those physicians remain in Hawaii to practice. Medical residents who train on the neighbor islands are more likely to subsequently practice on the neighbor islands. Expanding capacity for year-round medical education training will create a pipeline of new physicians positioned to initiate neighbor island practices. With a fully developed program that focuses on medically underserved areas such as the neighbor islands, it will be possible to expand the State's primary care, family medicine, internal medicine, and some specialty residencies.

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 and training using the newly available American Rescue Plan Act funding.

Existing primary care residencies hosted in Hawaii's health systems on the neighbor islands could be leveraged to expand medical education and training, which would require the hiring of dedicated teaching faculty. Funding is also required for student and resident support, including travel, housing, and other coordinated activities across all sites.

The legislature recognizes that ongoing funding of medical education is vital to address the physician shortage in Hawaii. Considerable public outcomes can be achieved by expanding capacity for training medical students 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.

In addition, there is strong collaboration between the John A. Burns school of medicine and the United States Department of Veterans Affairs. The United States Department of Veterans Affairs health system currently invests in Hawaii-based residency positions using a separate federal pool of resources for support. With additional faculty members, the capacity to train additional Hawaii-based residents through the Veterans Health Administration's program will enable the John A. Burns school of medicine to expand the number of residency rotations and create new training opportunities.

Therefore, the purpose of this Act is to:

(1) Reestablish the Hawaii medical education 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;

(2) Appropriate moneys to the John A. Burns school of medicine for graduate medical education and training programs established under chapter 304A, Hawaii Revised Statutes;

(3) Appropriate moneys to the John A. Burns school of medicine to expand medical residency and training in Hawaii, with an emphasis on supporting residency training on the neighbor islands and in medically underserved populations throughout the State; and

(4) Appropriate moneys to the John A. Burns school of medicine to create further medical residency and training opportunities through a partnership between the John A. Burns school of medicine and the United States Department of Veterans Affairs.

SECTION 2. Chapter 304A, Hawaii Revised Statutes, is amended by adding a new section to part V, subpart C, 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 moneys received by the medical education council, including:

(1) Moneys from the federal Centers for Medicare and Medicaid 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. There is appropriated out of the Hawaii medical educational special fund the sum of $ or so much thereof as may be necessary for fiscal year 2023-2024 and the same sum or so much thereof as may be necessary for fiscal year 2024-2025 for graduate medical education and training programs established under chapter 304A, Hawaii Revised Statutes.

The sums appropriated shall be expended by the University of Hawaii at Manoa John A. Burns school of medicine for the purposes of this Act.

SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2023-2024 and the same sum or so much thereof as may be necessary for fiscal year 2024-2025 for the creation of additional medical residencies and training opportunities for medical students in counties with populations of not more than five hundred thousand.

The sums appropriated shall be expended by the University of Hawaii at Manoa John A. Burns school of medicine for the purposes of this Act.

SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2023-2024 and the same sum or so much thereof as may be necessary for fiscal year 2024-2025 for the expansion of medical residency and training opportunities in partnership with the United States Department of Veterans Affairs.

The sums appropriated shall be expended by the University of Hawaii at Manoa John A. Burns school of medicine for the purposes of this Act.

SECTION 6. New statutory material is underscored.

SECTION 7. This Act shall take effect on July 1, 2050.

THE SENATE	S.B. NO.	62
THIRTY-SECOND LEGISLATURE, 2023		S.D. 2
STATE OF HAWAII