Demystifying Hawaii’s physician scarcity

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It’s no secret that Hawaii has a healthcare drawback. 

The state is brief greater than 1,000 medical doctors, which implies some sufferers can’t get care, and those who do have to attend a very long time. 


In response to one latest survey, almost six in 10 Hawaii residents have endured lengthy delays in receiving medical care up to now yr; for a lot of sufferers, that can lead to everlasting hurt and even dying.

Physician shortages are particularly extreme within the neighbor islands, the place there are only a few specialists. On Kauai, for instance, there aren’t any endocrinologists, psychiatrists, oncologists or outpatient neurologists. Anybody who wants these companies should journey to Honolulu on the primary island of Oahu, and even probably to a mainland metropolis, which implies additional prices for airline tickets, lodge reservations and different requirements as effectively.

So why aren’t medical doctors shifting to Hawaii? 

There are a bunch of causes, however the state’s common excise tax, stringent licensing necessities and excessive price of residing all make it more durable to be a frontline healthcare employee. 

>> The final excise tax

In contrast to many states, Hawaii doesn’t have a gross sales tax, which is levied on customers solely on the retail stage. As an alternative, it has a common excise tax, which is a tax on the gross receipts of companies.

The GET is utilized at each transaction stage,which implies it pyramids in worth because it proceeds to the ultimate stage — the patron — at which level the efficient charge is definitely higher than regardless of the nominal charge is likely to be. 

In Hawaii, the nominal charge is 4% tax, together with for healthcare clinics. Three of the state’s 4 counties additionally add a surcharge of 0.5%. Within the counties the place the mixed charge is 4.5%, the nominal charge customers find yourself paying is 4.712%, attributable to a quirk in how the speed is calculated.

Hawaii is one in all solely 4 states that taxes healthcare on this manner.

Typically, medical doctors can go alongside the GET to sufferers, however to not these with Medicare, Medicaid and TRICARE, in accordance with a spokesman for the Hawaii Doctor Scarcity Disaster Activity Pressure. This implies medical doctors can earn more money by shifting their practices to a different state.

In response to a Grassroot Institute of Hawaii examine, exempting medical care from the GET would save medical doctors and sufferers greater than $200 million a yr, which may encourage medical doctors to remain in Hawaii and probably entice extra medical doctors to the state. 

In an try to alleviate Hawaii’s physician scarcity, the Grassroot Institute lately launched a petition asking lawmakers to exempt medical companies from the GET. The petition will probably be introduced to the Legislature earlier than its 2023 legislative session.

>> Occupational licensing legal guidelines

Each state requires medical doctors to have a license to apply medication. Licenses are meant to make sure that unqualified folks don’t apply medication. However in some instances, licensing legal guidelines do extra hurt than good. 

For instance, Hawaii’s licensing legal guidelines make it unattainable for a health care provider with a license from Oregon to apply in Hawaii with out getting a license from the state of Hawaii — even when that physician has an ideal medical file and needs to serve in an space that desperately wants physicians. 

That’s why another states have created interstate licensing compacts, which permit licensed healthcare staff from member states to apply in different member states. For instance, a health care provider from Arizona who needs to apply in California may accomplish that with out having to spend 1000’s of {dollars} in charges or numerous hours to obtain a brand new license. 

Compacts exist for physicians, doctor assistants, nurses, radiation therapists, emergency medical companies staff and different healthcare professionals. Sadly, Hawaii is just not a member of any of those compacts. Becoming a member of all or any of them would make it simpler for healthcare staff from different states to apply in Hawaii. 

>> Hawaii’s excessive price of residing 

Hawaii’s excessive price of residing makes it laborious for everybody — even medical doctors and nurses — to afford primary requirements like housing and electrical energy.  

The median house value in Hawaii is effectively over $1 million, which makes it laborious for latest medical faculty graduates to afford to reside right here. Saddled with a whole bunch of 1000’s of {dollars} of debt from medical faculty, many graduates look elsewhere for his or her first job. 

Medical doctors additionally undergo from Hawaii’s excessive revenue taxes — the second highest within the U.S. In comparison with states corresponding to Nevada and Florida, which wouldn’t have revenue taxes, Hawaii is a comparatively unattractive touchdown spot for healthcare personnel, regardless of its pure magnificence. 


Hawaii is without doubt one of the worst states for medical doctors to apply, in accordance with the private finance web site WalletHub. Hawaii’s healthcare staff are saying the identical factor. 

At a latest discussion board on the state’s physician scarcity, James Winkler, president and CEO of the Kauai Neighborhood Well being Alliance, requested: “Why is it laborious to retain and recruit [medical personnel]? What are the monetary obstacles?” 

“Nicely,” he answered, “you simply can’t pay folks sufficient to reside right here. It truly is that easy.” 

So what can Hawaii do to draw and retain healthcare professoinals? Clearly, reducing the price of residing — and the price of doing enterprise for medical doctors — can be a great way to do it. 

Particularly, lawmakers may:

>> Exempt medical companies from the state GET.

>> Decrease the state’s private revenue tax charges.

>> Liberalize the state’s medical certificate-of-need legal guidelines, which prohibit the introduction of latest medical amenities and medical companies.

>> Let licensed medical personnel from different states apply in Hawaii with out having to spend money and time to acquire a Hawaii occupational license.

>> Scale back land-use and zoning laws to allow extra homebuilding, which might make housing extra plentiful and inexpensive

These and lots of different actions are essential to eliminating Hawaii’s acute scarcity of medical doctors and medical personnel. The longer they’re postponed, the longer will Hawaii should endure its healthcare disaster.