Aloha From Kauai: AccLimited Access
Sunny beaches. Tropical views. Who wouldn’t love it? Each day of life goes on in Kauai just like everywhere else. However, it is a different pace. This presents some interesting challenges, including various access issues for specialists.
Access issues are common within small populations. First and foremost, patients are incredibly thankful when a new specialist comes to Kauai. The population on Kauai has nearly doubled since the early 1970s. Currently, the population is just over 69,000. Not every specialty is represented on Kauai. Many times there is only one specialist for the entire island. For example, there is only one neurologist on island. This is my experience, as I am the onlypain specialist on the island. Also, there is only one addictionologist and only three other psychiatrists total for the entire population. This severely limits the access to behavioral management. When trying to achieve balanced care and a multi-disciplinary approach for pain medicine patients, this means sending many patients off islandfor alternative care.
Access to all healthcare specialists remains a multifactorial problem here. The tiers include: economical, political, educational, cultural and media challenges. One would think that with the roll out of Obamacare socioeconomics would not play as much of a role in healthcare related access issues. However, the overallfacilities and reduced number of physicians on our island limit the number of patients within a doctor’s panel. Some control the acceptance of insurance plans. Many patients must wait for pre-authorization prior to scheduling appointments. Transportation can be a problem too. Many patients do not want to wait three hours to take the Kauai bus system around the island and claim gas costs as a hardship when traveling to a physician’s office. This relates to the political climate and the infrastructure which has been ingrained for so long on the island. Many have spent years flying to Oahu, the big city of Honolulu, for care. They have opted out of any care whatsoever in order to avoid inordinate travel expenses as well as days of missed work and loss of income. Biases exist to pain medicine worldwide; however, on Kauai it's a mixed bag of prejudice related to too many medications or not enough. Some of the advents related to seeking medical care are limited secondary to language and customs. Using media can help to close this gap. However, it's not the typical social media that many providers on the mainland use. Patients on Kauai prefer good ‘ole fashion business cards, flyers, and handouts. Awareness of the differing cultural aspects can help physicians succeed with the diversities related to island living. Bringing neuromodulation to an area unfamiliar with its benefits has its own challenges. Not every distributor covers Hawaii. For the industry that is present, there are few representatives for the entire state. This limits the number of physicians that can operate on the same day. With the technology constantly changing, patients may seek care in the continental US if not covered here. Many people relocate to Kauai, either to retire or for a different pace of life. Yet, they also keep their residences as well as their health care providers where they lived previously. This means more coordination between providers. Patients may restrict their involvement with healthcare on the island if they still feel connected to other physicians prior to relocating.
Overall, access issues plague doctors everywhere. Some deal with them more frequently than others. In general, with a bit of patient education as well as physician assimilation into the culture one can still find this paradise. And life here on the Garden Isle is filled with aloha.