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Retiring Lahaina doctor predicts primary care staffing crisis

By Staff | Jul 14, 2011


LAHAINA — Dr. James Ard last month retired from Kaiser Permanente Maui after working at the Lahaina Clinic for 15 years as a family physician.

Ard also provided after-hours care on a regular basis in Wailuku at the Maui Lani Clinic.

“It has been my privilege to serve my patients in Maui, and I appreciate the trust they had in me. Many special relationships will certainly be missed,” he commented.

Ard, his wife, Jeanet, and daughter, Stacey, 11, are moving to Poway, a pleasant suburb of San Diego with a top-rated school system.

His employer was Hawaii Permanente Medical Group, which provides physicians for Kaiser Permanente in Hawaii.

As a family doctor, Ard provided the full spectrum of medical care for patients of all ages and types.

When patients needed specialty care, he made referrals to areas such as surgery, dermatology or cardiology.

“When hospitalization was required, I made the arrangements and was able to see patients through good times and bad times,” he added.

Recent trends — including increased paperwork and the funneling of patients into primary care medicine, because specialty, redundant and emergency room care are all more expensive — changed Dr. Ard’s job and made it more demanding during the past few years.

“Many primary care physicians are now overburdened with patients and the details of care, so their satisfaction level has significantly decreased. For many primary care physicians, a theoretical eight-hour day is stretched to ten to 12 hours or longer with a brief lunch and no breaks,” he explained.

“They spend inordinate hours at work but find actual time with patients rushed and inadequate. More and more tasks and expectations are being added without any staffing adjustment for the increased workload. EMRs (Electronic Medical Records) and computerized scorecards now constantly push primary care providers to not only do more, but do it better, even though they are already working beyond their capacity,” he continued.

“That is a recipe for burnout and dissatisfaction, which is prevalent and will greatly worsen nationwide if health reform adds millions of new patients without addressing the primary care provider shortage.”

The critical shortage of primary care doctors nationwide includes Maui.

“Even though I have retired and gave six months advance notice, my replacement has not yet been found. There are actually multiple unfilled job openings for primary care in Maui, despite it being ‘paradise’ to live and work in. Statewide, Hawaii has a current shortage of around 600 doctors, of which 300 are primary care,” said Dr. Ard, 60.

He feels primary care expectations and workloads need to be adjusted to more realistic levels.

“Maybe we need four family docs to take care of the same population three are currently caring for. That is a challenge, since there is a current shortage of primary care providers,” he explained.

The industry is in a rut, Dr. Ard said, and recruiting medical students to work in primary care nationwide is a challenge.

He believes the country is headed for a primary care staffing crisis. More primary care with preventive care is cost-effective for the long-term, but government and insurers — including his former employer, he said — are reluctant to support increased staffing and greater workload compensation for primary care/family doctors.

In addition to working full-time at Kaiser, Ard also served in the Army Reserve one weekend per month and completed five 90-day deployments after September 2001.

“I first enlisted in the Army in 1974 as a medic, and that experience sparked my interest in medicine,” said Ard, who rose to the rank of colonel.

In 1984, Dr. Ard completed medical school at Michigan State University as an Army Health Professions Scholarship Program recipient.

“After completing my internship at Botsford General Hospital in Farmington Hills, Michigan, the Army sent me back to Korea for two years as commander of the 545th General Dispensary. I was then able to return to Fort Ord, California, to complete two years of Family Practice Residency training before being sent to Germany for a three-year tour at the 67th Evacuation Hospital,” he recalled.

“With ten years of active duty under my belt, I transferred to the Army Reserve and worked as a traveling locum tenens physician for more than three years until I ‘discovered’ my Kaiser job in Maui. Along the way, I based myself in San Diego and worked in Alaska, Arizona, California, Michigan, Minnesota, Guam and Saipan.”

He met his wife while working in Guam, and they were married at the Royal Lahaina Resort in 1997.

“She has been my loyal supporter to help me survive the demands of medicine over the years,” he commented.

Stacey, who loves computer games and just graduated from King Kamehameha III Elementary School, qualified for honors in math. She chose to attend Twin Peaks Middle School in San Diego, where members of Jeanet’s family live.

Ard also has a 25-year-old daughter, Hayley, who graduated from Oxford University in England. She is currently busy in fashion journalism in London subsequent to obtaining her Master’s Degree at Central Saint Martins.

Ard thanks the Lahaina community for its support during his years here.

“I have appreciated the opportunity to serve Maui as a family physician. Lahaina has been a beautiful and supportive community to live and work. I give my thanks for everything everyone has done for me and my family,” he said.