Hawaii Vacations Assume Doctors Exist. That’s No Longer Safe.

When Hawaii travelers think about island infrastructure problems, they picture aging airports, broken escalators, or potholed roads that don’t match the premium prices they’re paying. What almost never crosses anyone’s mind is something far more basic: the doctor might not be there, not nearby, not quickly, and sometimes no longer at all.

That assumption, that a domestic vacation automatically comes with mainland-level healthcare access, is breaking down in Hawaii, and most on the neighbor islands, where visitors love to concentrate and where the system is weakest.

A system losing doctors it cannot replace.

On Christmas Eve, longtime Big Island emergency room physician Dr. Judith “Judy” Fitzgerald was killed in a head-on crash on Daniel K. Inouye Highway. Police believe speed, alcohol or drugs, and reckless driving were contributing factors, and she was 74 at the time of her death.

Fitzgerald was part of a small, aging group of physicians keeping emergency care functional on an island already stretched thin. Her death left fewer experienced hands in emergency rooms that already relied on limited coverage, on-call rotations, and thin staffing margins.

Hawaii’s healthcare shortage is not static and has been ongoing for years. It has accelerated recently through retirements, relocations, burnout, and sudden loss. When a doctor leaves Hawaii, there is often no replacement waiting.

Where the shortage hits hard.

Hawaii is now short roughly 833 full-time equivalent physicians statewide, up again from last year, and the burden is unevenly spread. The Big Island faces a shortage of more than 200 additional doctors needed to meet basic staffing requirements. Big Island is down 43%, while Maui County’s shortage follows at 41%, Kauai is short 28%, and Oahu is minus 15%. Kauai’s shortage, however, is increasing faster than any other island.

These gaps are already changing care access. Rural clinics have closed or are close to closing, and it isn’t unusual to wait for months for appointments or travel long distances, typically to Honolulu and sometimes the mainland, for care that was once available locally.

Specialty coverage is by far the thinnest, with shortages in pediatric critical care, pulmonology, and cardiothoracic surgery, areas that are critical when medical issues in Hawaii escalate quickly.

Maui’s compounded healthcare collapse.

Maui’s doctor shortage didn’t begin with the August 2023 wildfires, but the fires removed capacity on an island that couldn’t afford to lose it. In Lahaina, clinics that burned have not been rebuilt, leaving West Maui visitors with fewer healthcare options than before the fires.

Of note to visitors, Maui now has the highest percentage shortage of primary care physicians in the state. While urgent care options still exist and some allow online booking, overall access can tighten quickly when cases move beyond basic treatment or during outbreaks such as the current flu. These are the doctors visitors rely on most for sudden acute illness, chronic condition management, and referrals when symptoms worsen.

A state report just noted that the fires worsened an already significant shortage of providers. That translates into longer waits, fewer appointment slots, and more off-island referrals.

Why visitors are especially vulnerable.

Hawaii visitors who pay some of the highest accommodation rates in the country assume that pricing equates to an infrastructure depth that does not exist, especially outside Honolulu. The hospitality experience and still being in the U.S. signal an abundance, even as healthcare availability reflects scarcity.

Hawaii has about 13k licensed physicians, but notably fewer than 4k actively provide patient care. Once abundant part-time doctors are accounted for, the full-time equivalent drops further. Add to that the fact that a quarter of all Hawaii doctors are already 65 or older and nearing retirement.

An assumption that can ruin trips or worse.

Most travelers do not think about medical evacuation when booking a domestic Hawaii vacation. For many, that assumption holds until something serious happens on a neighbor island.

In practice, many health insurance plans, including Medicare, will cover emergency transport from a neighbor island to Honolulu when it is clearly the nearest appropriate facility. That is often how the system is designed to work.

Where coverage becomes uncertain is after stabilization. Transport beyond Honolulu, including to the mainland, is frequently treated differently by insurers and is often not covered as an emergency benefit. At that point, air transport can shift from a medical necessity to an out-of-pocket expense, with bills that can quickly reach tens of thousands of dollars.

A fall, an accident, or a sudden illness can escalate quickly, not because care doesn’t exist, but because higher-level care may be located on a different island. Visitors should know where emergency facilities are located and understand their limitations, because a hospital presence does not guarantee specialist availability, ICU capacity, or immediate advanced care.

Urgent care clinics can be a practical first step, and most now allow online appointment booking, with next-day availability even during busy travel periods. That’s a detail many travelers may not realize until after they arrive.

Why this trend hasn’t reversed.

In Hawaii, doctors are forced to absorb mainland-level workloads with sub-mainland pay. For many, that financial tradeoff no longer makes sense, particularly on the neighbor islands where operating a practice is expensive, and reimbursements are thin.

Administrative demands compound the problem. Prior authorizations, benefit hurdles, and insurance paperwork pull doctors and staff from patients and have accelerated burnout.

The state is trying. Hawaii’s loan repayment program offers healthcare workers up to $50,000 annually toward student debt in exchange for a two-year commitment to practice here. Nearly 1,000 have already received assistance, and the program has fully paid off loans for more than 400. But the numbers haven’t reversed the overall trajectory as doctors continue to leave faster than incentives can replace them.

Some legislative changes are underway too, including plans to reduce administrative burdens and a new tax exemption for medical practices serving Medicare patients, among others. These measures may help at the fringes, but they will not reverse the trajectory.

What visitors should keep in mind.

Hawaii’s healthcare shortage is a largely invisible infrastructure failure. You will not notice it while planning your vacation, checking into your hotel, or driving to a beach, but you will notice it quickly when something goes wrong and options bottom out.

This is not about discouraging travel. It is about understanding how to travel smarter in a place where limited healthcare access depends on the island, location, and timing more than most visitors expect.