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 said the other driver is suspected of reckless driving, with speed and alcohol or drugs believed to be contributing factors. Fitzgerald was 74.
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.
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No one believes Docs don’t want to live in Hawaii.
The problem is the Hawaiian medical monopoly restricts competition.
Retired Docs, with years of knowledge, would love to come work in Hawaii part-time, but Hawaii will not allow licensure. Vote smarter.
I’m a psychiatrist born and raised in Hawaii and have a private practice on Oahu. My business is essentially going bankrupt because of insurance companies like Tricare for military families not paying me for over 2 years and HMSA taking back all the payments they made to me for a specialty treatment I offered for depression. I continued to advocate for patients and am now facing insurance fraud charges for something I already paid back in an arbitration with HMSA that totalled over $330,000. These charges are false and are about to be dismissed for lack of evidence, but this further substantiates why doctors don’t want to practice in Hawaii even though this is our home.
Excellent article, Thank You. I would only reemphasize that the #1 reason for the doctor shortage in Hawaii is far & away that of income disparity. Most doctors in Hawaii can make nearly twice as much income on the mainland. I know personally that full well, and first-hand. The unmentioned “1,000 lb gorilla” in the room is the largest health insurance company in Hawaii, which has at least 2/3 market share, & it’s stubbornly low payments to physicians. Most other States have more health insurance competition, with multiple different companies providing health insurance. The #2 reason for the doctor shortage in Hawaii is it’s geographical isolation from the US mainland, with many providers not wanting to live that far away from family.
Drastic situations require drastic measures. To recruit new Doctors to Hawaii, make it worth it. For the first 15 years, offer this: No state income tax for Dr and spouse , no property taxes, and a set amount for an annual cash bonus ($25,000?)starting year 3. Not sure of the cost, but better than no doctors when needed. My guess is those incentives would get the attention of many doctors.
Great ideas. That would help!
Zero Hawaii residents care in any way about the plight of tourists and their healthcare woes.
That is totally not true. The same doctor shortage in Hawaii severely affects everyone who lives here. I’ve worked in healthcare in Hawaii for 41 years. I know. And Hawaii residents still have a caring attitude for all, truly the “Aloha Spirit” in action, which I have personally observed for 41 years. If that were not the case, I would live 100% somewhere else.
I’m not in the health care industry, and I feel that was an unwarranted dig at medical professionals. It’s pretty near universal that health care workers are in it to help all people, regardless of who they are.
I am in the health “care” industry and I can can tell you that you are naive. Always, Always get a second opinion before any procedures!
Docs are like any other group of people-some good, some evil.
I developed left lower lobe pneumonia on Kauai last August. I was very sick. There is only 1 pulmonologist on Kauai and I could not get an appointment for 6 weeks – I could have been dead by that point. I flew back to Florida for treatment.
And there is only 1 board certified dermatologist on Kauai. I guess I am learning the hard way but Kauai and Hawaii in general are both good places to grow old.
I traveled to Hawaii to interview for a full-time job as an Eye Doc.
Found out is is almost impossible to get a Hawaiian Med License, blame the government you voted for.
I have gotten medical care on Maui or Hawaii on 3 different occasions. One was pre-fire and the other two were last year and the year before. Both times I was able to get in quickly as I am a patient of Kaiser Permanente and Kaiser has a presence on both islands. Lucky for me I guess. I also was able to get help over the phone until I went for my appointment. This is one of reasons we keep returning, but not the primary reason.
One unfortunate fact as a result of the Lahaina fire is that the Kaiser clinic in Lahaina also burned down and there doesn’t seem to be a rush to rebuild it, assuming Kaiser plans to. While visiting on Maui I have twice used the services of the clinic in the past, but now the only facility Kaiser has on the island is over on the East side near Kahului, an hour’s drive from Napili with good traffic conditions.
I don’t understand the license issuing problem people have been talking about. Why would the state make it difficult for doctors desiring to move to HI to practice??? Doesn’t make sense. Politics and ‘good-ol boyism’?
There is a small clinic on Kaanapali Pkwy.
Certainly a fair warning, but are things any better in places like Fiji, Tahiti, or Aruba? Travel IS risky and travelers need to understand that. Let’s continue paying for school loans. Maybe expand. Recruit local kids, who are most likely to stick around for the long run. We’ve all known that the outer islands have marginal medical infrastructure. When someone gets really sick or injured, they are flown to Queens. Like our entire Nation, we have to make a decision on what we want our country to look like and the benefits we can all get.
You guys do a great job in reporting Hawaii travel related stuff, but your article on the Doctor shortage in Hawaii (and especially Kauai) is the best one yet. Keep up the good work!
Certainly a fair warning, but are things any better in places like Fiji, Tahiti, or Aruba? Travel IS risky and travelers need to understand that. Let’s continue paying for school loans. Maybe expand. Recruit local kids, who are most likely to stick around for the long run. We’ve all known that the outer islands have marginal medical infrastructure. When someone gets really sick or injured, they are flown to Queens. Like our entire Nation, we have to make a decision on what we want our country to look like and the benefits we can all get.
Agreed. For example, there are zero (0) neurosurgeons on the Big Island, despite it’s having three (3) hospitals. So all head or spinal injury patients are flown to Honolulu for those types of injuries, for example.
As a keiki, our best Dr. was the ranch Veterinarian. The medical for big emergencies has always been having to fly to Honolulu. At least there are planes now…:) My Tutu wahine used to have to go by boat. But it’s true, people don’t ever think about medical problems on Vacation. We have the same problem here in rural AZ. mediocre medical care.
Dear Rob and Jeff,
Once again you are giving critical information that is often overlooked. Puerto Rico is experiencing the same problem. We have been traveling to the Caribbean for the past 12 years and as we have aged, remoteness and lack of medical facilities is forefront in our minds. We love the island of Vieques off the eastern end of Puerto Rico but hurricane Maria wiped out their hospital in 2017. Rebuilding did not start until 2023 and still is ongoing. Once completed the building will be great but how are they going to staff? Of late, I purchase travel insurance to include reimbursement for medical travel back to the mainland. I really enjoy your writing!
I’ve know of the Doctor shortage, but this article puts the financial issues at top of mind. Is there a supplemental insurance that part time medicare residents can purchase. Travel agents sell travel insurance that will cover evacuation in an emergency. Wondering if you know the details of travel insurance?
The lack of medical care was one of the reasons my wife and I moved back to the mainland in 2016. They had one hospital, Maui Memorial and they didn’t have Any cardiologists. My good friend had a heart issue and needed to be flown to Oahu. It saddens me to know things have worsened.
Please consider editing your description of the car accident. It reads like Dr. Fitzgerald was intoxicated or under the influence of drugs, driving recklessly, or her age contributed to her death, none of which is true.
In the middle 70’s medical and dental schools had 2 classes per year or increased enrollment 50% because the federal government predicted a doctor shortage.
Of course they were wrong, they produced too many, so by the 1990 dozens of professional schools closed. In the 2010’s they realized they were going to be short professionals so more schools opened.
Now the boomer doctors are 70 and older. A wave of retirements is happening now. Maybe 60% of professionals will retire in a 10 year period.
If they are smart, which is unlikely, they will fast track great foreign professionals to work here.
Yes, but there is now a $100,000 visa charge for foreign professionals to come here. If I am not mistaken, that is per year. You can thank the federal government for that one. So I’m not sure that is a solution for Hawaii unless the state can get an exemption for foreign medical visas.
Came here to say the same thing — the paragraph is very poorly written. The other driver crossed the center line and caused the head-on collision. “The driver of the Toyota, identified as 34-year-old Hilo woman, sustained minor injuries and was taken to the HBMC for treatment. She was later arrested for first-degree negligent homicide, operating a vehicle under the influence of an intoxicant and reckless driving.”
She was a friend & a colleague. Coworkers tell me that she was driving a Mazda Miata, and that the other driver was driving a Toyota Tacoma truck which had crossed the center line. Local newspapers clearly reported that the other driver was arrested for DUI. Two separate Celebration of Life events are scheduled for next month.