The following commentary was published originally in the Hawaii Filipino Chronicle on March 17, 2023.
Hawaii is a highly sought-out vacation destination. People all over the world spend their whole lives dreaming of visiting our paradise in the middle of the Pacific.
However, the reality for those of us who live here is a ballooning cost of living that is driving many of us to the mainland in search of lower costs and greater opportunities — including medical professionals who have found Hawaii to be an increasingly uninviting place to practice. As more and more of them leave the islands or simply retire, replacing them has become one of the state’s primary policy challenges.
Fortunately, the Grassroot Institute of Hawaii recently issued a policy brief, “How changing Hawaii’s licensing laws could improve healthcare access,” that outlines several pathways on how to do that, all involving reform of the state’s medical licensing laws.
As I say in the preface of the report, our laws require “medical professionals who hold valid, unencumbered licenses in other U.S. states to endure expensive and time-consuming Hawaii bureaucratic hurdles in order to practice here. This serves no public interest. It only discourages them from coming to our state, depriving Hawaii residents of capable healthcare providers.”
I don’t believe Hawaii’s licensing laws were put in place with ill intent. Protecting the public is a commendable motive. But there comes a point when too many hoops for professionals to jump through can cause unintended consequences that outweigh the benefits.
The value of lifting Hawaii’s licensing laws was certainly recognized during the COVID-19 crisis. Then-Gov. David Ige issued an order that allowed certain out-of-state medical professionals to work in Hawaii to help ease our shortage of healthcare workers. But as those emergency orders have lifted, our healthcare shortage that predated the coronavirus crisis remains. The Hawaii Physician’s Workforce Assessment Project estimates that Hawaii is short of almost 800 physicians. In addition, the Hawaii State Center for Nursing estimates Hawaii needs 300 to 400 more nurses to meet our current healthcare demands.
Clearly, it’s time to make some changes — a fact recognized by the Legislature, which is considering more than a handful of bills this session that would reform our licensing laws related to a variety of medical specialties, or at least set up working committees to study specific licensing-reform proposals.
Pathways to reform outlined by the Grassroot Institute report include joining interstate compacts, licensure recognition and licensure reciprocity.
Interstate compacts create a streamlined process that makes it easier for licensed professionals in participating states to practice across state lines. For example, the Interstate Medical Licensing Compact for doctors has 37 member states. Allowing doctors from those other states to practice in Hawaii more easily could be huge for us. Licensing recognition is similar to measures ordered during the COVID-19 crisis. This simply means Hawaii would recognize a license issued by any other state as valid to work in Hawaii. However, because recognition laws are set by the state legislature, they would allow Hawaii to tailor its recognition so that it is extended to only extended to states with similar licensure requirements.
Licensing reciprocity involves a single state reaching agreements on an ad hoc basis with other states to accept the licenses of the others as valid.
As you can see, I am not talking about letting just anyone provide medical care. We are talking about lifting administrative burdens and opening our doors to healthcare professionals who are already licensed to practice in other states.
Medical licensing reform would not be a cure-all or quick-fix for our healthcare shortage, but it would be a step in the right direction. If capable professionals want to work here and help improve healthcare access in the islands, it is possible to welcome them with open arms while still maintaining public safetyI’m pretty sure making it easier for medical professionals to work in Hawaii would draw a few to our shores — not just to visit but to stay and practice.