{'fraction_non_alphanumeric': 0.01696113074204947, 'fraction_numerical': 0.007067137809187279, 'mean_word_length': 5.194748358862144, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Physician workforce: addressing shortages in Hawai'i.

In the February 2010 Medical School Hotline, we reviewed initial findings of a JABSOM study commissioned by the Hawai‘i State Legislature to assess trends in physician workforce in Hawai‘i. The results demonstrated that the population adjusted physician workforce of actively practicing physicians in Hawai‘i is lower than national norms and that this deficit will grow rapidly over the next 20 years.1 
 
In March, the performance of the State was assessed against seven recommendations made by the Physician Workforce Task Force of the American Association of Medical Colleges published in June of 2006. Initial steps have been taken with several of the recommendations such as increasing the size of the medical school class and the availability of graduate medical education programs which remain important but incomplete in addressing the developing physician shortages.2 
 
While it makes sense to start with general assessments of overall numbers of physicians and training positions in the state, the reality is that solving workforce shortages will require attention to additional factors. In this article key factors are considered in addressing the training and distribution of the physician workforce in an Island state. 
 
Lessons from Civil Defense 
 
On February 27th, 2010, an earthquake measuring 8.8 on the Richter scale hit Chile creating a tidal wave in the Pacific. Tsunami watchers sounded the alarm that set off a series of well orchestrated efforts to preserve life and property. While several elements of the plan were centralized and/or standardized (e.g. tracking the wave or sounding sirens) key elements of the assessment of risk, emergency services, and evacuation plans were distinctly local. Rural communities are often isolated in a disaster but none so much as an island community. Planning must take into consideration local challenges and include Island specific solutions. 
 
Using this same State/local self-sufficiency approach will be important when planning health service delivery, as resources, including physicians, become scarcer. JABSOM can provide a statewide workforce assessment with trained medical students and post-graduate trainees (Residents and Fellows). The Department of Health can contribute specific plans for the integration of disease/injury focused or population focused health services. Recruitment, retention, and distribution of physicians to best serve the population will require collaboration by hospital systems. The needs of each Island individually and the State collectively will need to be considered. Leaders across the state are examining creative ways to address these issues. 
 
Recent promising activities to improve the situation of physician shortages that should be encouraged and expanded are: