You Are 644 Doctors Short. The Number Is Getting Worse.

Hawaiʻi has 12,688 licensed physicians. Only 3,647 of them are currently seeing patients. That gap is not a clerical quirk. It represents the distance between a credential on file and a doctor who will actually pick up the phone when you call.

When part-time practice is counted at full-time equivalent, the true practicing workforce drops to 3,044. Against current patient demand, Hawaiʻi is short 644 physician FTE. Factor in the reality that different islands have different specialties available in different quantities, and the shortfall reaches 833.

These numbers come from the JABSOM AHEC Hawaiʻi Physician Workforce Assessment, December 2025 and a January 2026 Honolulu Civil Beat investigation. They are not projections. They are the current state of the system.

Where the Gaps Are Largest

Hawaiʻi County, the Big Island, needs 224 more physicians. That is about 43 percent short of the physicians the county needs. Maui County needs 179 more and has the largest primary care deficit of any county in the state: 45 primary care physicians short. Statewide, primary care is 178 FTE below what patients need.

Neighbor island physician supply runs 30–43% below Oʻahu levels, according to JABSOM's Area Health Education Centers program. That gap is not static. A quarter of Hawaiʻi's current practicing physicians are 65 or older. In 2025, more than 88 left the state and more than 81 retired. The pipeline adding new physicians is not keeping up with the departures.

Why Physicians Are Leaving

The instinctive answer to a doctor shortage is to recruit more doctors. Hawaiʻi has been running recruitment programs for years. The shortage is getting worse. That tells you the problem is not on the supply entry side. It is on the retention side.

Three conditions are driving physician departure.

Hawaiʻi is the only state in the country that taxes physician private practice revenue through a gross receipts tax called the General Excise Tax. The combined rate is 4.5%. For Medicare and Medicaid patients, physicians cannot legally pass that tax to patients. They absorb it. A Brown University Journal of Public Health analysis found this effectively costs the average family practice 15–20% of its revenue from government-payer patients. Governor Green signed Act 47 in June 2024, which removes the GET from Medicare, Medicaid, and TRICARE reimbursements starting January 1, 2026. That is a meaningful step. The tax on commercial insurance revenue remains.

Hawaiʻi's Medicare reimbursement rate does not reflect what it actually costs to practice medicine here. The federal formula that adjusts Medicare payments for local cost has Hawaiʻi at 1.06. Alaska, with a similar geography and isolation profile, is at 1.50. Hawaiʻi physicians collect less per Medicare patient than physicians in many lower-cost states.

The median home in Honolulu costs over $900,000. A physician finishing residency with $200,000 or more in student loans, entering a market with the tax and reimbursement conditions above, often decides to practice somewhere that pencils out. Many of them trained at JABSOM. Hawaiʻi paid to educate them and then exported them because the economics here did not work.

The 2030 Projection

Research published in the Brown University Journal of Public Health projects a Grade D physician shortage for Hawaiʻi by 2030. That is the trajectory if current conditions continue. The state received a $188,892,440 federal Rural Health Transformation Program award in December 2025, the largest federal healthcare infrastructure investment in Hawaiʻi's recent history. That funding creates five years of runway to modernize the system. It does not, by itself, change the economic conditions that are driving physicians out.

What Needs to Happen

The state needs to extend Act 47's GET exemption to commercial insurance revenue. The congressional delegation needs to push the PATCH Act forward to fix the Medicare reimbursement formula. Loan repayment programs need to be sized to Hawaiʻi's actual cost-of-living gap, not continental benchmarks. And Hawaiʻi needs island-specific workforce tracking, because the statewide numbers hide how bad the situation is on Maui and the Big Island specifically.

The Hawaiʻi Healthcare Task Force and HHIP track physician supply conditions and workforce trends as part of the independent intelligence work we do for the state. If you are a policymaker, a health system leader, or a community organization that wants to understand what these numbers mean for your island, we want to hear from you.

Learn more about HHIP and the Hawaiʻi Healthcare Task Force →

David Isei is the Executive Director of the Hawaiʻi Healthcare Task Force and architect of the Hawaiʻi Healthcare Intelligence Platform (HHIP).