How Hilo Medical Center Is Solving the Health Care Staffing Shortage

Despite Hawai‘i’s overall shortage of doctors and nurses, Hilo Medical Center says it is nearly fully staffed thanks to its residency programs and other recruiting strategies.

HMC’s three hospitals, 14 outpatient clinics and other facilities cover the east side of Hawai‘i Island, from Hāmākua to Ka‘ū. Its network includes 166 inpatient beds and 45 long-term care beds, and 1,450 employees – all part of the Hawaii Health Systems Corp., a state agency that receives annual state subsidies.

HMC’s residencies are crucial to recruiting doctors and nurses, says CEO Dan Brinkman.

“After graduating from John A. Burns School of Medicine at UH Mānoa and doing an internship on the mainland, the odds of those residents returning are very, very low,” he says. “Medical schools don’t keep doctors here; residency programs keep doctors here. Where you last do your training, that is where you are working.”

Six residents a year graduate from HMC’s Hawai‘i Island Family Medicine Residency Program, and a high percentage of those doctors stay on the island or in the state, says Brinkman.

HMC also contracts with national employment companies that cast wide nets to recruit the right candidates.

“In the past, there may have been the idea that because we are rural and don’t have a lot of money, we should offer medical professionals less pay. That doesn’t work,” Brinkman says. “Or worse, we would get individuals who have a poor work history or are not at the top of their game anymore.”

The strategy is to recruit physicians who appreciate Hilo’s small-town way of life, and to pay them within the 40th to 60th percentile of their profession. “That’s about average, not the highest, not the lowest,” he says.

The overall approach has resulted in low physician turnover, and HMC is now staffed with about 100 doctors, Brinkman says, though the center is still looking for a few specialists, such as oncologists and gastroenterologists.

Recruiting and Training Nurses

HMC says it was the first hospital in the state to implement a nursing residency program – an approach since adopted across the state. For 13 years, HMC’s residencies have trained nursing graduates in specialties like obstetrics and ER so they can serve in those areas right after their residencies.

Hawai‘i Community College and UH Hilo both have nursing programs, and HMC offers specialized training to 20- 25 graduates a year, while paying them $76,000 to start. Within about a year, they may be eligible for RPN III positions, which pays $103,000 per year, according to HMC. Brinkman says the training produces high-quality nurses who often stay with the hospital long-term.

Melani Jumapit was named one of two nurse residents of the year in October 2023.

“We want them to transition immediately to working” on-island instead of feeling the need to go elsewhere, Brinkman says. “It’s expensive, but compared to what we would have to pay for contract workers and others, it’s a good investment and cost-effective in the long run.”

Many nurses retired during and after the pandemic, so the hospital offered positions to the entire 2023 graduating class from both schools, bringing in almost 40 new nurses.

“The best thing about this program is that many of these graduates are from East Hawai‘i. It’s a good job with good working conditions, and many will stay with us for 10 to 30 years,” he says.

Brinkman says the evolution of remote work has helped with staffing at HMC as well, provided one spouse can work remotely from home.

“That has significantly broadened the market of professionals for us, and — probably overall for the state as well.”