Working under a tight budget, state House and Senate lawmakers have tentatively agreed to appoint a working group to study ways to lure doctors to rural and underserved areas.

The group would discuss the idea of a student loan repayment program this year and report to lawmakers next year on how to address doctor and dentist shortages in parts of the state.

The program, known as the Hawai'i Health Corps, could eventually provide loan repayment over five years for up to 100 doctors who agree to practice in underserved urban areas or on the Neighbor Islands.

The program would give priority placement to graduates of the University of Hawai'i-Manoa's John A. Burns School of Medicine. Doctors who agree to participate would also have to serve as first responders in state emergencies.

"It will help us bring needed doctors to rural and underserved areas of the state where patients don't have easy access to care, and invest in medical education so that Hawai'i will have the healthcare providers we need in the future," said state Rep. Josh Green, D-6th (N. Kona, Keauhou, Kailua, Kona), a Big Island doctor and chairman of the House Health Committee.

Lawmakers had wanted to establish the program sooner as part of broader incentives for doctors and healthcare providers but it was a victim of budget restrictions. Lawmakers also decided not to provide stipends or tax credits to doctors in rural areas or create health enterprise zones where healthcare providers would be eligible for general-excise tax exemptions.

"I think part of the reason the whole thing fell apart was money," said state Sen. David Ige, D-16th (Pearl City, 'Aiea), the chairman of the Senate Health Committee.

Green and Ige both said, however, that lawmakers are interested in providing incentives for doctors and looking at whether state and federal reimbursement rates are adequate.

Lawmakers also agreed to $14 million in emergency spending for the Hawai'i Health Systems Corp., the state's quasi-public hospital system that is integral to healthcare on the Neighbor Islands.

Several lawmakers said privately that the debate this session over reducing liability for medical malpractice, driven by the Hawai'i Medical Association and, to some extent, Green, may have sapped some of energy behind addressing some of the other factors that have led to shortages.

The House passed a resolution calling for the Legislative Reference Bureau to study the issue, but the resolution did not advance in the Senate, so that idea, too, is likely dead for the session.

Paula Arcena, executive director of the HMA, said she believes the debate encouraged lawmakers to address the larger issue of doctor shortages in underserved and rural areas and some specialist shortages in urban areas.

Arcena said she supports the loan repayment program but believes it falls short of more comprehensive action.

"Unless something is done, a system breakdown is inevitable," she said.

State Rep. Colleen Meyer, R-47th (La'ie, Hau'ula, Punalu'u), who supports reducing doctors' liability in medical malpractice suits, said she would consider incentives such as the loan repayment program but is concerned about the potential cost. She also said doctors could leave underserved and rural areas after having their loans repaid in five years, so it may not be a long-term solution.

"We just never talked enough about the figures. I want to see how much this is going to cost," Meyer said.

Tom Sanford, a third-year medical student at UH who is from the Big Island, said loan repayment programs are used on the Mainland to recruit young doctors.

He said such a program would help the state become more competitive in recruiting if, for example, doctors could choose between five years "in Hamakua instead of inner-city Detroit."

"If you can go somewhere and get your loans repaid, that's a huge benefit," Sanford said.