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Expand interstate licensure compacts

Photo by Charley Myers

The following was originally published as an “Island Voices” commentary in the Honolulu Star-Advertiser on Nov. 28, 2023.
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Hawaii lawmakers took a major step this year toward fixing Hawaii’s doctor shortage by having the state join the Interstate Medical Licensure Compact (IMLC). Now they should go the extra mile and also green-light compacts for other medical professionals, such as nurses, physical and occupational therapists, emergency medical service personnel, psychologists, audiologists and many more.

Medical compacts are catching on across the country: 39 states plus Guam and the District of Columbia are members of the IMLC alone, which allows physicians from each member jurisdiction to more easily practice in all the other IMLC jurisdictions. And the benefits are evident.

Marschall Smith, executive director of the IMLC Commission, said during a visit to Hawaii in July that states see, on average, a 10% to 15% increase in their number of licensed physicians after joining the compact, with about 45% of those physicians serving rural and underserved areas. Smith also noted that research shows that joining the IMLC improves health-care quality, particularly in hospitals.

It is welcome that we are addressing Hawaii’s doctor shortage — which stood at almost 800 at the end of 2022, according to the University of Hawaii’s Annual Physician Workforce Report. But doctors aren’t all we need.

According to the Heathcare Association of Hawaii, Hawaii lacks almost 3,900 health-care workers across 89 professions aside from doctors — a 76% increase since 2019. Open positions include 999 registered specialty nurses, 744 certified nurse aids and nursing assistants, 278 medical assistants, 211 licensed practical nurses and 126 social workers.

Fortunately, interstate licensure compacts exist for many of these professions as well, and joining them would mean that Hawaii could reduce its shortages in those fields, too.

But it takes time to implement licensure compacts, so we shouldn’t dally. Smith estimated it might be mid-2025 before the IMLC can begin issuing expedited licenses for doctors in other member states to practice here. So it would be prudent for Hawaii’s Legislature and governor to approve joining other licensure compacts as soon as possible.

One concern is that joining medical compacts could put a strain on staff at the state Department of Commerce and Consumer Affairs, which oversees occupational licensing. But the benefits of beefing up that agency would far outweigh the costs.

In general, an inflow of medical personnel licensed to practice in Hawaii would be a win for local patients, and a relief for Hawaii’s existing physicians, many of whom are overworked or near retirement — or both.

Of course, joining more interstate medical compacts wouldn’t completely cure Hawaii’s medical woes. Hawaii’s cost of living, highlighted by high taxes and housing prices, also are a problem.

But lawmakers need to address those issues not only for doctors and nurses, but also for teachers, firefighters, police officers and other professions that are in short supply as well — if not for all Hawaii residents.

In the meantime, interstate medical compacts are a cost-effective way to increase Hawaii’s health-care capacity and quality, and the sooner we can join them, the better.

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