Third-year pediatric resident Arlene Parubrub Kiyohara appreciates the state’s ongoing efforts to keep home local health care workers like her but believes two bills moving through the Legislature would limit educational and career options for University of Hawaii medical students like her and her classmates.
House Bill 221 and Senate Bill 101 would require students who pay in-state tuition to attend UH’s John A. Burns School of Medicine to work in Hawaii for two years after they graduate.
If they don’t, they would have to pay the state the difference between their in-state tuition and the cost, nearly double, of nonresident tuition: $36,372 for each academic year, compared with $71,328.
Kiyohara was born and raised in Kalihi and always wanted to go into health care after growing up with a younger sister with Down syndrome.
While studying at JABSOM, Kiyohara and her classmates often changed focus and specialties as they learned more about medical specialties.
But residencies and opportunities to pursue different specialties are limited in Hawaii, Kiyohara said.
So some of her JABSOM classmates had little choice but to pursue residencies in their chosen specialties on the mainland.
“It’s not guaranteed we can stay in
Hawaii,” Kiyohara said.
Students who go to the mainland “get exposed to so many different programs that it might change your mind. … These bills (will make) it really hard for JABSOM students if they are required to stay here after they graduate.”
Kiyohara remains grateful that the state Legislature and Gov. Josh Green approved $30 million in funding over two years to pay off up to $50,000 in student debt for each of two years for health care workers like her who agree to practice in Hawaii for two years.
Green’s current budget proposal calls for a second round of $30 million to pay off student debt for even more Hawaii health care workers with the goal of keeping them from leaving for less
expensive states.
State Rep. Darius Kila (D, Nanakuli-Maili) helped introduce HB 221 and, like Green and state legislators, continues to search for ways to fill Hawaii’s perennial shortage of health care workers, especially the need to find hundreds more physicians.
Kila called the cost of a “world-class” JABSOM education “a bargain.”
So “it’s only right” that local students should stay in Hawaii and treat local patients, especially after the state pays off their student loans, Kila said.
HB 221 and its Senate companion,
SB 101, represent another effort to keep local students from joining “the exportation of our students and not being in our local workforce,” Kila said.
Especially with the loan repayment program, Kila said, “It’s not too much to ask … that they give back to the state.”
Kila understands concerns that the two-year commitment might discourage some local students from even applying to JABSOM and, instead, enroll in medical schools on the mainland where there are more career opportunities.
So HB 221 and SB 101 offer the opportunity “to have the conversation,” Kila said.
State Sen. Chris Lee (D, Kailua-Waimanalo-Hawaii Kai) helped introduce SB 101 and supports it “conceptually.”
It should be discussed this legislative session as another potential tool, Lee said, because “obviously, we have a shortage of health care workers.”
Both bills would impose the two-year requirement on JABSOM graduates starting with the class that earns medical degrees after Jan. 1, 2029, unless the JABSOM dean determines that a student has “extenuating circumstances.”
UH also would be responsible for tracking which students paid in-state tuition, which ones did not and whether they stayed or left Hawaii after receiving their degrees.
UH also would have to enforce
payment for the difference or hire a collection agency.
The UH med school, according to HB 221, typically admits 77 new students each year, and 67 of them are local.
“The legislature believes that each graduate who benefits from less expensive Hawaii resident tuition, which is subsidized by the tens of millions of dollars in general funds appropriated to the John A. Burns school of medicine by the Legislature each year, should be committed to using their medical knowledge for the benefit of Hawaii,” according to the House bill.
JABSOM’s dean, Sam Shoemaker, also appreciates the Legislature for funding Green’s plan for the Hawaii Healthcare Education Loan Repayment Program, or HELP, to make it easier for a long list of health care workers to afford to live here.
JABSOM administers the program.
In its first two years, HELP “has already ensured that more than 800 healthcare professionals have stayed home, and more than 1,500 applicants on the wait list are looking to do the same,” Shoemaker told the Honolulu Star-Advertiser in a statement. “We encourage their continued support of this proven success.”
But, Shoemaker said, “Although well-intentioned,”
HB 221 and SB 101 “would likely deter Hawaii applicants from selecting
JABSOM for their training, as many are unclear about their specialty path when entering medical school. Some will choose to or need to do their residency and fellowship training on the continent.
Although all Hawaii applicants intend to serve the people of Hawaii, many
may not want to commit
7-12 years in advance of when they will be able to practice independently, as there are major financial consequences if they cannot immediately return to Hawaii after their training due to life circumstances or lack of jobs.”
He cited 2024 data from the Association of American Medical Colleges “that 81 percent of our graduates desire to work in Hawaii after they complete their medical training, which is among the highest in the nation. That mirrors JABSOM’s demographics, as 83% of our medical students come from our state. We believe the number could be even higher
if Hawaii had residency
and fellowship training opportunities in more specialties, and we are currently working to develop Graduate Medical Education programs that our population and healthcare systems can support and sustain.”
Kiyohara was born and raised in Kalihi.
Her dad works as a housekeeper, and her mother is produce manager at the Joint Base Pearl Harbor-Hickham commissary.
None of her four sisters went into health care, and their youngest has Down syndrome, which inspired Kiyohara to go into health care.
But it wasn’t until her third year at JABSOM that Kiyohara decided to specialize in pediatrics.
She estimates that half
of her classmates also could not immediately pick a specialty.
Kapi‘olani Medical Center for Women &Children only offered eight pediatric residencies when Kiyohara
applied and then “matched” with Kapi‘olani for her residency training.
She’s grateful for her Kapi‘olani residency and for being able to stay home to continue her studies and training.
Some of her other
JABSOM pediatric classmates who grew up in Hawaii weren’t so lucky.
Nine of them also applied with Kiyohara for Kapi‘olani’s eight pediatric openings.
Six of the residencies went to local students, and two to students from the mainland, Kiyohara said, forcing the other four local JABSOM students to pursue pediatric residences on the mainland.
“We all wanted to stay,” she said.
The others who left for mainland residencies, Kiyohara said, “all want to come back.”
Kiyohara is on track to graduate with a provisional medical license in June
before taking her board
certifications on her way
to becoming a new and fully licensed pediatrician in her home state.
Kiyohara, 36, and her husband, Kendall Kiyohara, 37, have two children: daughter Melody, 12, and son Cadence, 5.
Kiyohara is thankful that she’s able to work and live on Oahu, where her children can grow up surrounded by their grandparents and aunties — unlike her classmates who were forced to pursue their residencies on the mainland.
“I love my job every day,” Kiyohara said. “I love taking care of the kids and watching them get better and finding lots of ways to help. Taking care of the community here was the greatest reason I wanted to stay. I’m really grateful.”