Hawaii ended 2025 with fewer working physicians than it started the year with, and a widening gap between the doctors available and the doctors needed, according to a new report to the state Legislature. Of 12,688 licensed physicians in Hawaiʻi, fewer than a third — 3,647 — provided patient care, and when part-time practice is accounted for, the full-time equivalent count fell to just over 3,000, leaving the state 644 doctors short of demand.
The gap widens to 833 when the state’s island geography is factored in, because emergency, intensive care, and psychiatric physicians on Oʻahu cannot fill needs on the neighbor islands. The findings come from the Hawaiʻi Physician Workforce Assessment Project at the University of Hawaiʻi’s John A. Burns School of Medicine, which has tracked the state’s physician supply and demand since 2010.
The shortage is pushing neighbor island residents away from routine care and into emergency rooms, while high housing costs and below-mainland pay continue to drive both departures and retirements — pressures compounding a demographic wave that will put one in four Hawaiʻi residents over 65 by 2030.
Hawaii ended 2025 with fewer working physicians than it started the year with and a widening gap between the doctors available and the doctors needed, according to a new report to the state Legislature.
Of 12,688 licensed physicians in Hawaiʻi, fewer than a third — 3,647 — provided patient care in 2025, the report found. When part-time practice is accounted for, the full-time equivalent count fell to just over 3,000, leaving the state 644 doctors short of demand. The gap grows to 833 when the state’s island geography is factored in, because specialties such as emergency care, intensive care, and psychiatry cannot be shared across islands — a physician on Oʻahu does not fill the need for one on a neighbor island.
The findings come from the Hawaiʻi Physician Workforce Assessment Project at the University of Hawaiʻi’s John A. Burns School of Medicine, which has tracked the state’s physician supply and demand since 2010.
“If you don’t have the provider you need, you are going to have medical problems,” said Kelley Withy, a physician at the Burns School of Medicine who oversees the study. “If we don’t have enough providers it doesn’t matter if we all have insurance. We can’t get care.”
Neighbor Islands Face the Deepest Gaps
Hawaiʻi County had the largest shortage among the state’s four counties, needing 224 doctors to fill its demand gap — up from 201 the year before. Its physician supply needs to grow by 43%, nearly twice the statewide shortfall rate.
Maui County’s shortage stood at 179 doctors, with its physician population needing to grow by 41% to meet demand. Maui also posted the greatest shortage of primary care physicians among all four counties, running short by 45 primary care doctors — a 35% gap, more than double the statewide percentage shortfall for primary care. The county’s physician workforce has not recovered from the 2023 wildfires, which drove out health workers and destroyed facilities that have not been replaced.
The Big Island, by comparison, was short 21 primary care doctors and needs to grow that sector by 14%.
Summer Mochida-Meek, executive director of the Hawaiʻi State Rural Health Association, said the shortage is transforming how residents use the health care system.
“What happens is people aren’t going in to see their physicians unless it’s an emergency, and so now we’re inundating our ERs, which are already overloaded,” Mochida-Meek said. “We’re going from preventive care to crisis care.”
For neighbor island residents who require specialty or primary care not available locally, travel to Oʻahu is often the only option — and insurance typically does not cover those travel costs, she said.
“It’s an access issue that not only affects our rural communities worse, but our neighbor island communities, because the long wait times become longer because of the shortage,” Mochida-Meek said.
Housing Costs and Low Pay Drive Physicians Out
The report identified pay and housing costs as primary barriers to recruitment and retention. Physician compensation in Hawaiʻi runs below mainland levels while housing ranks among the most expensive in the country.
“Hawaii is worse off because we do not pay our physicians commensurate with what they would make on the continent,” Withy said. “And they have to be able to buy a house. If they can’t buy a house, they’re not going to stay.”
In 2025, more than 88 physicians left the state while at least 81 retired. The state needs to add 100 physicians per year more than it loses to meet projected demand, the report said.
Mochida-Meek said a recurring pattern plays out: physicians arrive with enthusiasm, encounter the cost of living, and leave.
“People come in thinking that they’ll have a great life. Set up a practice here. But housing is expensive. Childcare is expensive,” she said. “They’re here for one, two, maybe three years and then they move back (to the mainland). So not only do we have a big pool of retirement age physicians, but we have a big outmigration of our physicians as well.”
Nationwide trends compound the problem in Hawaiʻi. The general population is aging and requiring more care — one in four Hawaiʻi residents will be over 65 by 2030. The physician population is aging alongside patients: a quarter of Hawaiʻi’s doctors are already 65 or older.
Retention Programs and Federal Funding
The state has launched several programs to address the shortage. A loan repayment initiative has covered the education debt of 928 health care professionals who committed to working in Hawaiʻi, and a discounted-mortgage program for physicians is underway. Lobbying efforts to increase Medicare reimbursements are ongoing.
On Dec. 29, 2025, Hawaiʻi was awarded $189 million in federal Rural Health Transformation Program funds. The $50 billion program was created in the July 2025 domestic budget spending bill to offset Medicaid cuts to rural areas. The state said the money would go toward digitally connecting rural medical facilities, expanding telehealth services, and growing and retaining the health care workforce in rural Hawaiʻi.
Physicians surveyed for the report identified higher pay as the top priority for improving Hawaiʻi’s health workforce, followed by housing support for health care professionals and incentives for healthy patient behavior.