Frequent windsurfing adventures in Maui led oncologist Linda W. Wilson, 64, to Hawaii. In the early 1980s, she was in a solo private practice in Los Angeles, but when the medical climate changed she began the transition to full-time medicine in the Aloha State, about two years ago.
She is currently the only medical oncologist at the Pacific Cancer Institute, specializing in breast cancer. She works part time, and nearing retirement, Wilson "sees all patients regardless of their insurance or financial status," she told Physicians Practice. There are three other radiation oncologists in her part of the Institute.
For you, what is the best part of practicing medicine in the state of Hawaii?
Practicing in Hawaii is perfect for me because I am able to do exactly what I want. By concentrating on breast cancer, I am able to focus my studies in one narrow field of oncology. I am also in charge of the educational oncology programs and CMEs that requires me to keep up with the oncology literature. And the Pacific Cancer Institute is a great place to work.
Other advantages are:
• There are unlimited numbers of patients and there is little or no competition amongst doctors to see them; there are more than enough patients and too few oncologists.
• There is very interesting pathology in Maui. In Los Angeles, for example, the rare cases are referred to oncology centers, so private doctors don’t really get to see them.
• There is no traffic to worry about and it takes just a few minutes to get to work, or go from hospital to office. This is in contrast to L.A. where the traffic prohibits efficiency in getting from place to place.
What, if anything, would you change about the climate for physicians in Hawaii?
My present contentment does not translate into a recommendation for practicing medicine in Hawaii.
The major disadvantages are:
• Hawaii Medical Service Administration is the state-run insurance program which is difficult to deal with and reimbursements are low.
• The environment is not academic. Doctors don't keep up with the literature and it is difficult to get attendance at a journal club for oncology.
• Lots of turnover amongst doctors and staff. There have been five oncologists in Maui over the past four years; now there is only one main oncologist employed by the hospital and two other part-time oncologists including myself. The major subspecialty group closed their oncology service due to inability to keep a full time oncologist and inability to stay financially solvent.
• There are a limited number of subspecialists on the island and it is difficult to get patients in for appointments.
• It is expensive to live here, but Medicare reimbursements are structured on cost of living for the pacific islands in general and not based on similar cost of living areas like California or New York.
• There is no access to state of the art plastic surgery, breast reconstruction.
• There is no cross-coverage available since so few oncologists and other specialists.
• Although Honolulu offers some services not available on Maui (like PET scans), there is no state of the art oncology there compared with the mainland.
(read psychiatrist Jon Betwee's take on Hawaii on the next page)