Nā Kauka o ke Kau A`e(Physicians of the Future)

Ku`ulei MilesMD Candidate, c/o 2014

University of Hawai`i John A. Burns School of Medicine

October 8, 2011

Cross Cultural Health Care Conference

Hyatt Regency Waikiki

A nationwide look at the future practice plans of Native Hawaiian medical students

Background

I ka wā ma mua, ka wā ma hopeThe future is the past

Background

1975: UH Medical School graduates first class4 Native Hawaiian physicians Increased the number of known Native Hawaiian

physicians from 7 to 11

Background

Going way way back…The first known Western-trained Native Hawaiian

physician was Dr. Matthew Puakakoililanimanuia Makalua (c.1880s) From Lahaina, MauiStudied at King’s College, LondonNever Returned to Hawaii

What were the barriers then? Today?

Background

Native Hawaiians consistently at the top of health risk indicators like CVD, diabetes, obesity & cancer

Role of cultural competency and physician-patient trust in reversing these negative health statistics

Background

Native Hawaiians make up over 20% of Hawaii’s population

Today: 260 Native Hawaiian physicians worldwideMake up about 3% of practicing physicians in Hawaii

Objectives

Assess Native Hawaiians currently enrolled in US medical schools for the likelihood of practicing medicine in Hawaii

Help define the future Native Hawaiian physician workforce in Hawaii

Offer insight to increase Native Hawaiian

physician recruitment and retention in Hawaii

Methods

Received UH IRB exempt status

68 Native Hawaiian medical students in 43 US medical schools during the 2010-2011 SY Identified by the Association of American Medical

Colleges (AAMC)

Methods

Mass email inviteIndividual email remindersOnline survey

Background informationTies to HawaiiEducational BackgroundFuture Practice

Incentive

Results: General Demographics

n=26 (38% participation)

Results: Ties to HawaiiScored along 6-point Hawaii Ties (HT) ScaleHigher HT score = stronger ties to Hawaii

Results: Education

Results: Specialty Interest

Results: Specialty Interest

Results: Future Plans

HT Score = 4.3

HT Score = 0

HT Score = 1.1FamilyDuty to serve NH comm Scholarship program commitment

Tuition repaymentSalary

No ties to HI

Results: Future PlansCorrelated with childhood home

Discussion

Most NH students likely to practice in HawaiiHigher HT score

Primary driversFamilyDesire to serve NH population

Primary attractantsLoan forgivenessCompetitive salary

Discussion

Rural interest guided by area in which they lived during years 0-18

Many are first in their family/don’t have physician mentorPromote NH physician-student mentorship

Medical student recruitment from MUA areas

Discussion

73% of Hawaii HS graduates went to a private HS

Networking role of survey Identify & maintain contact with NH medical students

throughout their training

Increase early medical field interest at the high school level, especially in public schools

Discussion

Scholarship commitments

NHHSP Improve accessibility and availability of NH medical field

scholarships

Challenges

Ethnicity was self-reported to AMCASSome departments sent email to all minority

students Survey middle manMilitary medical school would not forward to

students

Future Directions

Increase participation

Expand to includeResidentsFellowsOsteopathic students, residents and fellows

Longitudinal study

Mahalo

Drs. Vanessa Wong, Martina Kamaka, Gregory Maskarinec, & Kelley Withy for all of their

encouragement & guidance

Kim Yamauchi for all your kōkua in getting the incentives out

My fellow classmates in the Native Hawaiian Community Health Elective for your feedback & camaraderie

This project was supported by the Native Hawaiian Center of Excellence (NHCOE), Grant No. D34HP16044 from the Health Resources and Services

Administration’s Bureau of Health Professions, U.S. Department of Health and Human Services.