dear pokey82: i haven't worked in a hospital myself, but i might be able to help answer the q. someone else told me this, and i’m passing it along to you.
i'm originally from phoenix. metro phoenix has over 4 million people. if you need a specialist, you can find one in the city. you can find the-best-of-the-best. one hospital has the best burn unit in the state. another hospital has the best neurological unit in the state. another hospital has the best "heart doctors" in the state because the hospital only treats heart patients. etc.
if someone lives in a smaller town in arizona, with population < 50,000 people, it's a little different. if a guy gets into an accident, that person is going to go to the-only-hospital-in-town. it could be a major burn, a neurological problem, a heart problem, etc... the patient is going to only 1 hospital.
the patient would get "good care" at a family doctor's office or an urgent care.
the patient would get "better care" at the-only-hospital-in-town
the patient would get "best care" at the-burn-unit-hospital or the-neurological-hospital or the-heart-hospital, etc.
i hope that makes sense. it's not that there's anything wrong with the-only-hospital-in-town. it's about the numbers. they see 1000 patients each year, including 20 burn pts, 80 neurological pts, 200 heart pts each year.
the-burn-unit-hospital sees 2000 burn patients each year, so they learn more.
the-neurological-hospital sees 8000 nuerological patients each year, so they learn more. etc.
another way to explain... me personally... i can change the oil in my car just as well as any mechanic i know. to rebuild an engine, i need to go to a specialist, a mechanic, who does it everyday. there's nothing wrong with me. i still have great work ethic, great people skills, and am an intelligent woman. i just don’t know how to rebuild an engine. i don’t do it every day.
my husband had left-hand-surgery 18 months ago and right-hand-surgery 9 months ago. the phoenix doctor... all he does, all day, is hands. he's done 1000 hand surgeries, and told my husband he had the worse case of ring-finger-contracture he has ever seen. if he needed hand surgery again, i would tell my husband to fly back to phoenix to see the hand specialist there.
island of moloka'i: 8,000 people.
kingman, arizona: 40,000 people
island of maui: 120,000 people.
island of o'ahu: 900,000 people.
tucson, arizona: 1,000,000 people
metro phoenix: 4,000,000 people.
in my humble opinion... it's not just hawai'i. this is true, no matter what state you live in. it’s a numbers game. hope that helps answer your q.
on another note: people in phoenix are generally impolite, unkind, unfriendly, and disrespectful. (i’m a native, lived there 30+ years. that’s my opinion.) i want to pay a compliment to people in maui… they are the nicest people in the world!!! polite, kind, friendly, respectful.
if my email helps you, please click “thanks.” mahalo!