Native Hawaiian physician location and service to the underserved in Hawai'i

This study examined the influence of demographic characteristics, training location, and "practice values" on geographic practice location and serving a medically underserved area/population (MUAP) among physicians of Native Hawaiian ancestry practicing within the State of Hawai'i. A survey assessing factors influencing practice location was mailed to 104 identified Native Hawaiian physicians in the State of Hawai'i with a response rate of 79% (n = 82). Factor analysis was used to identify underlying "practice value" variables important in physician practice location, resulting in three robust factors: (1) professional opportunity, (2) lifestyle, and (3) service. Data were analyzed using chi square, analyses of variance, and logistic regressions. Seventy-eight percent of the Native Hawaiian physicians sampled specialized in primary care, which is significantly more than in the general physician population in Hawai'i (57.3%) and in the continental United States (33.1%). Despite not being located in a MUAP, over half of the physicians felt that they provided important services to their medically underserved patients. Logistic regression models predicted 42% of the variance in practice location and 52% of the variance in serving a MUAP. In general, professional opportunity may be more important for non-MUAP physicians whereas service value may be more essential for MUAP physicians. Additional implications and further research are discussed.