They Know What They Lack

On Oʻahu, we read the state's numbers and move on. On Hawaiʻi Island, people pick up the list and start calling names. 783 listings, 194 practicing clinicians, and an island that checks its own count.

HHTF Staff · 2026-09-23

The Big Island does not wait to be counted. It checks the count.

David Isei, MPH, MAOL, PMP · Executive Director, Hawaiʻi Healthcare Task Force

I'll give the credit to the Big Island.

I said that on a press call last week, and I meant it. I work out of Honolulu. On Oʻahu, when a number comes out of a state report, most of us read it and move on. On Hawaiʻi Island, people pick up the list and start calling names.

That is not a small thing. It is the first thing.

The list, and the people who read it

Last September, a radiologist in Hilo wrote to the state's physician workforce researcher. He had her new county numbers in front of him. He did not argue with them. He offered to go through her doctor list, name by name, before she finalized it.

She sent him the county table that same evening. The next day, she and the head of the state's health planning agency both asked to join the Task Force call that night. One of them answered in two words: "me too."

This September, it happened again. Same island, same question, a bigger table. A volunteer pulled every possible primary care provider on the island out of the federal registry as a starting point. A nurse practitioner, a family physician, a former health plan executive, and a foundation director joined the thread. The radiologist, 33 years in practice here, said plainly that he did not recall many of those names ever ordering an imaging study.

A physician in Kona said it best. A lung specialist who comes to town two days a month, she said, shows up on the list as the town's pulmonologist.

Nobody on that thread called anybody a liar. They asked a data question and offered to help answer it. My job was to ask who the answer was for. We agreed it goes to the state's researcher first, as a partner, with her data and ours side by side.

What the count looks like when you check it

We have done this once already, with numbers we can stand behind.

Listed in the network report 783 After removing duplicates 513 After fixing wrong specialty 487 Clinicians actually practicing 194 MEASURED Hawaiʻi Island primary care entries in a health plan's network report to the state, run through our validation funnel, against the clinicians licensed and practicing in primary care (physicians, nurse practitioners, and physician assistants together). Hawaiʻi Healthcare Intelligence Platform, May 2026. A health plan's network report to the state listed 783 entries for primary care on Hawaiʻi Island. Take out the duplicates and 513 remain. Correct the ones filed under the wrong specialty and 487 remain. Check them against the clinicians actually licensed and practicing in primary care, and the island has 194.

That is two and a half listings for every clinician.

I am using the milder of our two cuts on purpose. If we counted physicians only, the gap is wider. The case does not need the scarier number.

What this cannot tell you. It does not say any one listed provider is not practicing. It says the list, taken as a whole, is not a map of care a patient can reach.

Knowing what you lack is a strength

There is a way to read all of this as bad news. By the state's own 2025 assessment, Hawaiʻi County is short 223.6 full-time physicians across all specialties, 43 percent of what the island needs. Radiology alone is short 71 percent.

Here is the other way to read it. The Big Island knows exactly where it is thin. It knows because the people who carry the load keep the count. And a community that knows what it lacks can do something most places cannot. It can bring together resources that nobody thought belonged in the same room.

A foundation director in Hilo told me something this summer that I have not stopped thinking about. Her rural workforce program took in about 150 applications, and every one of them told her something about wait times across rural Hawaiʻi. Nobody had that picture before.

"It doesn't exist. But it's going to exist now."

That is the island. The data is missing, so they build it.

What I am asking

If you practice on Hawaiʻi Island, you will hear from us about the provider list. Answer. Tell us who is still seeing patients, who has retired, and who flies in twice a month. It takes five minutes, and it will do more for your community than anything I write.

If you practice anywhere else in the state, pay attention. The Big Island is showing the rest of us how to read a report about ourselves.

Truth in the data. Care in the community.

Sources and data modes. MEASURED means computed by us from record-level data. DIRECT means published by a named authority. FIELD-VERIFIED means reported by the people doing the work, corroboration pending. Hawaiʻi Island validation funnel (783, 513, 487) and verified primary care clinicians (194, all primary care clinician types): Hawaiʻi Healthcare Intelligence Platform over NPPES, DCCA professional licensing, PECOS, and the Hawaiʻi APCD; health plan network report obtained from the Department of Human Services. MEASURED, May 2026.

Hawaiʻi County physician shortage, all specialties, island-adjusted, 223.6 FTE (43 percent), and radiology shortage (71.0 percent): John A. Burns School of Medicine, Hawaiʻi Physician Workforce Assessment, 2025. DIRECT.

Quoted remarks are from Task Force correspondence and working calls, used with permission and without names.