1. Nā Kauka o ke Kau A`e (Physicians of the Future) Ku`ulei Miles MD Candidate, c/o 2014 University of Hawai`i John A. Burns School of Medicine October 8, 2011 Cross Cultural Health Care Conference Hyatt Regency Waikiki A nationwide look at the future practice plans of Native Hawaiian medical students

2. Background I ka wā ma mua, ka wā ma hope The future is the past

3. Background  1975: UH Medical School graduates first class 4 Native Hawaiian physicians Increased the number of known Native Hawaiian physicians from 7 to 11

4. Background Going way way back…  The first known Western-trained Native Hawaiian physician was Dr. Matthew Puakakoililanimanuia Makalua (c.1880s) From Lahaina, Maui Studied at King’s College, London Never Returned to Hawaii  What were the barriers then? Today?

5. Background  Native Hawaiians consistently at the top of health risk indicators like CVD, diabetes, obesity & cancer  Role of cultural competency and physician-patient trust in reversing these negative health statistics

6. Background  Native Hawaiians make up over 20% of Hawaii’s population  Today: 260 Native Hawaiian physicians worldwide Make up about 3% of practicing physicians in Hawaii

7. Objectives  Assess Native Hawaiians currently enrolled in US medical schools for the likelihood of practicing medicine in Hawaii  Help define the future Native Hawaiian physician workforce in Hawaii  Offer insight to increase Native Hawaiian physician recruitment and retention in Hawaii

8. Methods  Received UH IRB exempt status  68 Native Hawaiian medical students in 43 US medical schools during the 2010-2011 SY Identified by the Association of American Medical Colleges (AAMC)

9. Methods  Mass email invite  Individual email reminders  Online survey Background information Ties to Hawaii Educational Background Future Practice  Incentive

10. Results: General Demographics  n=26 (38% participation)

11. Results: Ties to Hawaii  Scored along 6-point Hawaii Ties (HT) Scale  Higher HT score = stronger ties to Hawaii

12. Results: Education

13. Results: Specialty Interest

15. Results: Future Plans HT Score = 4.3 HT Score = 0 HT Score = 1.1  Family  Duty to serve NH comm  Scholarship program commitment  Tuition repayment  Salary  No ties to HI

16. Results: Future Plans  Correlated with childhood home

17. Discussion  Most NH students likely to practice in Hawaii Higher HT score  Primary drivers Family Desire to serve NH population  Primary attractants Loan forgiveness Competitive salary

18. Discussion  Rural interest guided by area in which they lived during years 0-18  Many are first in their family/don’t have physician mentor Promote NH physician-student mentorship Medical student recruitment from MUA areas

19. Discussion  73% of Hawaii HS graduates went to a private HS  Networking role of survey Identify & maintain contact with NH medical students throughout their training Increase early medical field interest at the high school level, especially in public schools

20. Discussion  Scholarship commitments NHHSP Improve accessibility and availability of NH medical field scholarships

21. Challenges  Ethnicity was self-reported to AMCAS  Some departments sent email to all minority students  Survey middle man  Military medical school would not forward to students

22. Future Directions  Increase participation  Expand to include Residents Fellows Osteopathic students, residents and fellows  Longitudinal study

23. Mahalo  Drs. Vanessa Wong, Martina Kamaka, Gregory Maskarinec, & Kelley Withy for all of their encouragement & guidance  Kim Yamauchi for all your kōkua in getting the incentives out  My fellow classmates in the Native Hawaiian Community Health Elective for your feedback & camaraderie This project was supported by the Native Hawaiian Center of Excellence (NHCOE), Grant No. D34HP16044 from the Health Resources and Services Administration’s Bureau of Health Professions, U.S. Department of Health and Human Services.