Hawaii moves to lure mainland doctors

Doctors from other states may soon be able to quickly acquire licenses to practice medicine in Hawaii after state lawmakers passed a bill this month enabling the governor to join the Interstate Medical Licensure Compact, an agreement among states that streamlines the licensing process.

The measure, which must still be signed into law by Gov. Josh Green, has broad support from the health care industry, which hopes it will ease Hawaii’s doctor shortage, improve access to medical specialists particularly in rural parts of the state, and increase access to telemedicine.

Currently, it can take months for doctors to obtain a license to practice in Hawaii, a process that is overseen by the Hawaii Medical Board. By joining the compact, that process is expected to be shortened to a couple of weeks. In 2022 more than half of applicants received a license in seven days or less from the time their application was deemed qualified, according to data compiled by the commission that oversees the compact.

“It’s a game-changer,” said state Sen. Joy San Buenaventura, who chairs the Senate Committee on Health and Human Serv­ices and introduced Senate Bill 674.

Buenaventura said initially it was the military that really wanted the legislation. She said officials wanted to more easily bring in doctors, including spouses, who are licensed elsewhere to Tripler Army Medical Center on Oahu. But the measure also attracted support from the state’s major hospitals, including Hawaii Pacific Health, The Queen’s Health System and Kaiser Permanente.

Currently, the compact includes 37 states, the District of Columbia and Guam. Launched in 2017 with the support of the state medical board, its aim is to increase access to health care, particularly in underserved and rural areas.

Hawaii is in need of hundreds of doctors. There were 3,290 physicians practicing in Hawaii, according to a 2021 report by the Hawaii Physician Workforce Assessment Project. But that figure equates to just 2,812 full-time doctors because not all of the physicians were practicing full time. The report estimated that Hawaii needs another 710 doctors to fulfill demand.

The biggest shortage is in primary care, with more than 400 more doctors needed, according to the report. Shortages in specialty care are greatest among doctors specializing in colorectal surgery, pathology, pulmonology, infectious diseases, allergies and oncology.

“This will further allow our nation’s limited physician stock to mobilize where there is the greatest need,” the Hawaii Primary Care Association wrote in testimony supporting the bill. The association represents the state’s Federally Qualified Health Centers, which serve as a safety net for Hawaii’s low-income population.

Green declined to say whether he intends to sign the bill, one of hundreds that he must decide on by July 11. His office said in a statement that bills are undergoing a thorough legal and fiscal review, in addition to an assessment by the governor.

“As such, even if there is a bill that it would seem he would agree with on its face, it must still be determined that there are no unintended fiscal implications and there are no legal or constitutional infirmities,” according to the statement. “Until that analysis is completed, which will be ongoing for the next several weeks, the office is unable to officially comment on whether the governor will or will not sign a bill.”

Green, who is also a doctor, has made improving access to health care a top priority of his administration. In a column this month in the Honolulu Star-­Advertiser, he touted other recent initiatives that he and the Legislature advanced this year to support doctors and increase access to care.

With the support of Green’s administration, lawmakers inserted $60 million in the state biennium budget to boost reimbursement rates for Medicaid, the government health insurance plan that primarily covers low-income and residents with disabilities. State officials expect that funding to be matched by $43 million in federal funding annually through the 2025 fiscal year.

Medicaid patients often find that doctors won’t take their health insurance because of the low reimbursement rates. The increased funding will align Medicaid rates with Medicare, the government insurance program for seniors, which pays about 38% more than Medicaid.

Hawaii has also created a loan repayment program for medical professionals who commit to working in Hawaii, allocating $30 million to the initiative over the next two years.

If SB 674 becomes law, doctors in other states could begin practicing in Hawaii under the streamlined licensing process in 2025. The compact allows doctors to practice medicine in multiple states within the compact by completing just one application, rather than going through the often cumbersome process of applying for separate licenses in each state.

States that have joined the compact have on average seen a 10% to 15% increase in the number of physicians being licensed in their state, Marschall Smith, executive director of the Interstate Medical Licensure Compact Commission, said earlier this year during a panel discussion hosted by the Rutgers Center for State Health Policy. Smith said the rate has been as high as 30% to 35% in states such as Wyoming and West Virginia, which have high underserved populations.

“So it does have an impact,” he said. “It is not the end-all, be-all answer, but it is certainly an important tool for states to use to expand their practitioner population.”