Hawai'i Island Family Medicine Residency
- Need: Hawaii is experiencing a huge shortage of family medicine physicians.
- Intervention: The Hawai'i Island Family Medicine Residency (HIFMR) program uses an interprofessional team-based approach so residents learn how to care for many types of patients in different healthcare settings.
- Results: In 2017, the first class of residents graduated from a fully accredited program as Board-certified Family Medicine physicians. There were over 1,000 applicants to the residency program, and the residency increased its complement from 4 to 6 residents per year.
Hilo is the largest town on the rural island of Hawaii (also called the Big Island). While the state is attractive to tourists and locals alike, the Big Island struggles to recruit and retain family medicine physicians.
The shortage of physicians hurts the diverse and complex populations who receive care at Hilo Medical Center (HMC), a safety net hospital that serves the entire east side of the island and hosts the second busiest emergency room in the state.
Hawai'i Island Family Medicine Residency (HIFMR) began in 2013 with a complement of four residents. Fully accredited by the Accreditation Council for Graduate Medical Education (ACGME), HIFMR's team-based model provides a supportive educational environment with a robust community medicine experience with the hope that residents will stay and practice in rural Hawaii after graduation. Residents work with other providers such as Advanced Practice Registered Nurses (APRNs), behavioral psychologists, and clinical pharmacists to care for their patients' needs.
With a "grow local" approach to creating a healthcare workforce, HIFMR encourages applicants with ties to Hawaii. In the spirit of a multidisciplinary learning environment, the Hilo Medical Center-based program also hosts learners from:
- I Ola Lāhui, a clinical psychology graduate program
- University of Hawai'i (UH) at Hilo's Daniel K. Inouye College of Pharmacy
- UH at Hilo's School of Nursing
- UH Mānoa's School of Nursing
HIFMR runs on a modified block schedule format, with at least 2 half-day outpatient family medicine clinics each week. HIFMR residents learn and work in varied hospital settings – from surgery to emergency medicine – with all ages of patients, including those with acute illnesses and chronic diseases. In addition to the usual scope of family medicine, residents learn from faculty members who also have special expertise in HIV medicine and addiction medicine.
HIFMR residents also work in other communities on the island, including Kona, Waimea, and Pahoa. The clinical pharmacists in the clinic, along with their Doctor of Pharmacy (PharmD) students, provide consultation to patients, manage the diabetes groups, and provide education on pharmacology. The APRN students commit to the clinic for 1 to 2 years so continuity is developed among the residents, mid-level graduate students, and patients.
HIFMR residents also learn about ocean safety and rural EMS and participate in disaster-preparedness training for tsunamis, hurricanes, and volcanic emergencies and eruptions. The residents cared for patients during the 2015-2016 Big Island epidemic outbreak of dengue fever, potentially foreshadowing how the Zika or Chikungunya viruses may spread.
The Big Island is also home to other tropical diseases rarely encountered on the mainland, including rat lung worm disease and leptospirosis, allowing the residents to gain expertise in infectious diseases.
Residents learn about cultural competency and humility in working with different populations in the community, such as Native Hawaiians, Micronesians, Filipinos, Mexicans, Russians, Japanese, and tourists from around the world.
HIFMR is the first and only Hawaii residency program not on the island of Oahu and is the second civilian family medicine residency program in the state. In 2015, over 750 medical students – many with ties to the state – applied to the Hawai'i Island Family Medicine Residency program. In 2017, over 1,000 applied.
In 2018, the Hawaii Island Family Health Center (HIFHC), the residency's outpatient clinic site, moved to Hilo Medical Center, the inpatient site, thereby increasing the accessibility and seamlessness of patient care. HIFHC is pursuing patient-centered medical home (PCMH) recognition and works hard to ensure continuity of care for its patients.
The residency program took nearly 20 years of coordinated financial, political, and educational effort to gain momentum and backing from the hospital and community and received initial accreditation in October 2013 from ACGME. State funding remained uncertain several months before the first class began but was provided, and HIFMR is now a line item in the State of Hawaii budget.
Developing a program in a "residency naïve" community requires educating the medical community about the requirements, responsibilities, and regulations associated with residency programs today. As the only Hawaii program sponsored by a state hospital system, HIFMR has found the Hilo Medical Center Foundation's financial support to be essential in providing funding for things that state laws prohibit.
The clinic was established prior to the residency program, anticipating that the ACGME would grant approval. Faculty were hired and alliances with the health professional education partners were developed and codified to establish an interprofessional worksite, allowing for residents to have a patient base from the beginning.
Having advocates who can speak personally about their loved ones unable to be treated by a primary care practice helped to persuade the state legislators that the need is real. Community support from individuals, the Rotary Clubs, and the Hilo Medical Center Foundation has buoyed HIFMR's efforts and are continuing to help link residents to employment opportunities on the island.
Culture and cultural competency
Graduate medical education
Native Hawaiian or Pacific Islander
Recruitment and retention of health professionals
August 9, 2016
Date updated or reviewed
December 17, 2018
Suggested citation: Rural Health Information Hub, 2018. Hawai'i Island Family Medicine Residency [online]. Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/project-examples/921 [Accessed 27 October 2020]
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