HFH update for our patients & community

To our valued patients and community:

We are not planning on closing. Now that that is out of the way, let me please put my pride aside for a moment and ask for your help. I’ll start with a short version, and provide a more detailed explanation below for those who have more interest and time.

It is absolutely true that I have withdrawn from my retirement plan in order to replace a paycheck for the 18 months. It is true that I have wonderful staff who have taken pay cuts because they believe in our mission to provide high quality medical care to East Hawaii and the importance of the health of our community. It is also true that I am looking into locums (traveling doctor) positions 2 days / week to support my Family Practice habit and keep Hawaii Family Health open on the other days. I want all of you to know that Hawaii Family Health is here for your medical needs.

This business model is not sustainable, and that is where we need your help. You’ve watched the other doctors close their doors or go to a concierge / direct primary care practice. You’ve seen more doctors offer aesthetics in place of medical care. None of this is because of poor business practices or the physician no longer wants to practice medicine; they do it because medicine is not a sustainable business model. Sadly this is magnified in Primary Care and in Hawaii, where insurance reimbursement rates (particularly with the changes within the last 2 years) are so low we are driving physicians out of practice. We are currently asking for help in two ways:

First, please consider visiting and donating at our GoFundMe page. If insurance companies are unwilling to pay enough to keep doctors in Hilo, we are hoping the community will help support us:


Second, please consider adding your voice to speak up for Hawaii in need of physicians. The insurance companies, the insurance commissioner and the legislature have not listened to the doctors saying that insurance plans need to pay a fair and reasonable wage – but you are the consumer and perhaps your combined voices will be heard.

Write to the state legislature (https://www.capitol.hawaii.gov/members/legislators.aspx?chamber=all) for insurance reform.

Write/call to your own insurance company (address on the back of your insurance card) calling for fair wages. 

It is important to note that HFH isn’t alone in this problem. The East Hawaii Independent Physicians Association (EHIPA) has recently started working with the local physicians to establish a medical group from the previously independent practices because the costs and administrative burden of running a private practice exceed the payments received by insurance companies. They are doing this because “The IPA Board feels that the future of independent practice and the future of primary care in Hilo is [sic] at risk.”

Interestingly, the EHIPA is presenting a model where they will employ multiple physicians, hopefully including new physicians to Hilo. This is the model Hawaii Family Health has proposed for several years (except we offer the addition of our team-based care) and for which we have built our new medical office. It’s nice to see my colleagues recognizing other ways to practice medicine after firmly insisting on their independence for the last 7 years. But it’s sad to see physicians who have been pillars in our community for decades have their hand forced by insurance companies failing to pay a livable wage.

Please share this information with others so that the knowledge can be passed on.


For those of you who would like some additional information, please read on.

The State of Hawaii has a shortage of 797 physicians (increased from 769 last year).

The Big Island has a shortage of 213 physicians, 41% of the required number to serve the population, and increased from 196 last year.

The State of Hawaii has a shortage of primary care physicians of 263 (improved from 282 last year).

The Big Island has a shortage of 47 physicians, 25% of the required physicians needed to serve the population, and increased from 46 last year.

The State of Hawaii lost 51 physicians within the last year.

22% of Hawaii’s physicians are over age 65 (Compared to U.S. 12%)

50% of Hawaii’s physicians are over age 55 (Compared to U.S. 37%)

24% of Hawaii’s physicians are under age 45 (Compared to U.S. 36%)

These numbers worry me for my patients, my community, my fellow healthcare providers. And they should worry you too.


The following are published articles regarding a physician’s patient panel (number of patients):

  1. The primary care panel size of 2500, which is often cited, was unfortunately pulled from the air.  The original citation for this appears to come in an article in which the authors speculated the panels size a physician could manage (original citation in Family Practice Management 2000.  There is no data or review of actual physician panel sizes to support this)
  2. Estimates based on the time required to provide all recommended acute, chronic and preventative care for 2500 patients is 7 hours/day (Prevention of Chronic Disease 2009, American Journal of Public Health 2003, Annals of Family Medicine 2005)
  3. Estimates based on the time required to provide chronic care management to the top 10 chronic conditions, if already controlled, for a panel of 2500 patients is 828 hours/year or 5 hours/day (Annals of Family Medicine 2005)
  4. Estimates based on the time required to provide chronic care management to the top 10 chronic conditions, if not controlled, for a panel of 2500 patients is 2484 hours/year or 6 hours/day (Annals of Family Medicine 2005)

Utilizing this information, studies indicate that a conventional medical model of primary care can manage approximately 1,000 patients with appropriate care. There are time delegation models, which allow for a PCP to manage a panel of nearly 2,000 – only if there is a team (midlevel + RN) in place to which the PCP can delegate appropriate care.

Based on this information, insurance companies should either expect a physician to 1) provide appropriate care to 1,000 patients, 2) provide sufficient reimbursement to staff a team to support a physician to provide appropriate care to a larger number of patients, or 3) expect a physician to provide substandard care.


A local insurance company pays an average of $24 per patient per month and advised the doctors that we are expected to carry a panel of 1500. There is no change in this insurance reimbursement, no matter what services the patient requires – acute illness or injury, nebulizer for asthma flare-up, routine follow up, skin biopsy to check for cancer. PCPs get the same $24/month.

                1500 patients x $24 per patient per month x 12 months = $432,000 annually to run a medical office (rent, electricity, malpractice, electronic medical record, staff, licensing, billing, etc)

Other insurance models offer a fee every time you come into the office, but the payments have increased minimally (1-5%) in the last 5 years. When that is compared to inflation (9%) and the increase in minimum wage (40%) over the same time frame, it is impossible to keep up.


Once more, I’d like to say, Hawaii Family Health is still committed to proving you with high quality medical care. We’d love your support in our efforts to gain physicians a fair and reasonable wage in order to provide our community with more access to health care.


Thank you for reading and sharing.


Michelle Mitchell, M.D.


I’ve been posting information on Facebook – check it out: https://www.facebook.com/michelle.mitchell.7330763

We’re Moving!

Hawaii Family Health has been working hard, not just at making sure you receive the best healthcare in Hilo, but making sure all of Hilo has access to the highest quality health care around.  We been working for years to build our integrated healthcare team, currently including medicine, psychology, psychiatry, nutrition, nursing, care management and education of the next generation of healthcare providers.  And, as we have done so, we have outgrown our small office.  With the help of Koa Architects and Sun Construction, we have a new building on the way. [Read more…]