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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.
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