You Are 644 Doctors Short and Getting Shorter
Hawaiʻi does not have a physician pipeline problem. It has a retention problem it has been misdiagnosing for decades. What the Numbers Actually Show Of the 12,688 physicians licensed in Hawaiʻi, only
HHTF Staff · 2026-05-25
Hawaiʻi does not have a physician pipeline problem. It has a retention problem it has been misdiagnosing for decades.
What the Numbers Actually Show
Of the 12,688 physicians licensed in Hawaiʻi, only 3,647 are currently providing patient care, according to a January 2026 report by Honolulu Civil Beat. That means fewer than one in three licensed physicians is actually seeing patients. When part-time practice is factored in, the full-time equivalent count in 2025 drops to 3,044, according to the JABSOM 2026 Physician Workforce Report. The documented shortfall is 644 FTE against current demand. When specialty distribution and geography are factored in, that number reaches 833.
These are not projections. This is where Hawaiʻi stands today.
The Numbers Are Getting Worse, Not Better
In 2025 alone, more than 88 physicians left Hawaiʻi and 81 retired. The state needs to add 100 physicians per year more than it loses just to stay even with current demand. Hawaiʻi County needs 224 more physicians, representing 43% growth from the current base. Maui County needs 179 more and has the greatest primary care gap of any county in the state, running 45 primary care physicians short. Statewide, primary care is 178 FTE below what patients require.
A quarter of Hawaiʻi's practicing physicians are 65 or older. The retirement wave is not coming. It is already underway.
The Recruitment Narrative Is Wrong
The dominant response to physician shortages is recruitment. Bring more doctors in. The state and hospital systems invest in recruitment campaigns, loan repayment programs, and residency pipelines. These programs are not useless. But the data makes clear they are not solving the problem, because the problem is not primarily a supply problem.
Hawaiʻi produces physicians through its own medical school. Many of them leave. The JABSOM 2026 Physician Workforce Report identifies the forces pushing them out: the cost of living, inadequate reimbursement, and the structural tax burden unique to private practice in Hawaiʻi. Recruiting new physicians into those same conditions produces churn, not capacity. You fill the bucket while the drain stays open.
The Economic Trap Is Documented
Hawaiʻi is the only state that taxes physician gross revenue from private practice through the General Excise Tax. The combined rate is 4.5%. For Medicare and Medicaid patients, physicians legally cannot pass that tax to patients, so they absorb it. The effective GET burden on an average family practice, when the payer mix is accounted for, represents a meaningful fraction of operating cost that no other state imposes on its physicians. A Brown University Journal of Public Health analysis found the effective impact reaches 15-20% of average family practice revenue when the Medicare and Medicaid volume is factored in.
Governor Green signed Act 47 in June 2024, which exempts Medicare, Medicaid, and TRICARE reimbursements from GET starting January 1, 2026. That is a real step. It does not address commercial insurance revenue, and it does not fix the housing arithmetic. The median home price in Honolulu exceeds $900,000. A physician finishing residency with $200,000-$300,000 in student loan debt, entering a market with below-national Medicare reimbursement rates and a uniquely structured tax environment, is doing math that does not work. Many of them do that math and leave.
The Geographic Asymmetry Makes It Worse
The shortfall is not distributed evenly. Neighbor island physician supply runs 30-43% below Oʻahu levels, according to JABSOM's Area Health Education Centers program. Maui and the Big Island are the largest counties by population outside Oʻahu, and they are also the counties with the largest gaps. The Big Island's 43% growth requirement is not a planning target. It is the gap between where that county is and where it needs to be to meet documented patient demand.
When a physician leaves Oʻahu, a patient loses a provider. When a physician leaves the Big Island, there often is no replacement available on that island at all. The structural incentive is to concentrate practice where the infrastructure, the professional community, and the facilities are. That means Oʻahu. The result is a compounding asymmetry that recruitment, alone, cannot fix.
What the $188.9 Million Cannot Do Alone
On December 29, 2025, Hawaiʻi received a $188,892,440 federal Rural Health Transformation Program award. That is a significant commitment and the largest federal acknowledgment of the scale of Hawaiʻi's rural and neighbor island healthcare gap in recent memory. It creates five years of runway to modernize the architecture.
But funding alone does not retain physicians who cannot afford to live where their patients are. It does not remove a tax structure that takes a unique bite out of physician practice revenue. It does not change the Medicare reimbursement rate differential that makes Hawaiʻi's Geographic Cost Practice Index of 1.06 look inadequate next to Alaska's 1.5, despite higher actual costs. The federal award is a foundation. It is not a solution if the structural conditions that are producing the exodus remain unchanged.
The Projection Is a Grade D
Research published in the Brown University Journal of Public Health projects a Grade D for Hawaiʻi's physician shortage by 2030. That is not a warning. That is a trajectory, based on current conditions and current trends, showing where this state will be in four years if the retention conditions are not addressed.
Recruitment fills slots. Retention changes math. Hawaiʻi has been running recruitment plays against a retention problem, and the gap is widening. The 644 becomes 833 when you account for geography. It becomes a Grade D by 2030 if the economics do not change.
The doctors are out there. Hawaiʻi trained many of them. The state needs to answer honestly why they are not staying.
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David Isei is the Executive Director of the Hawaiʻi Healthcare Task Force and Architect of the Hawaiʻi Healthcare Intelligence Platform (HHIP).