Keep Doctors Local: Why Professional Fees Matter

Hawaii’s physician shortage worsens as independent practices struggle to survive.

In Hawaii’s rural communities from Kaʻū to Hāna to Molokaʻi, access to a local doctor is more than a convenience; it is a lifeline. However, a growing crisis threatens to sever this lifeline for thousands of families. The steady erosion of professional fees paid directly to physicians, alongside rising facility fees that benefit large healthcare systems, is pushing independent rural clinics to the brink.

Rural Health at Risk

Hawaii faces a shortage of nearly 1,000 physicians and 3,000 nurses statewide, with the impact most severe in rural areas (Hawaii Provider Shortage Task Force, 2025). Family doctors in places like Kealakekua and Hilo are the backbone of their communities, managing everything from chronic illness to urgent care. Nationally, private practice has dropped by more than half since 2012 (American Medical Association, 2024). In Hawaii, this means longer waits, fewer local specialists, and, in some cases, entire communities losing access to care. When a clinic closes, care often disappears.

The Legislative Imperative

This crisis is the result of policy choices. Only large hospital systems can survive as professional fees are cut and facility fees rise. This consolidation gives insurers and administrators monopoly power, dictating salaries, working conditions, and available services. Rural patients face more extended travel, delayed diagnoses, and higher costs without independent practices.

The 2025 Hawaii Legislature has introduced bills to strengthen rural healthcare, expand telehealth, and address workforce shortages. However, these efforts will fall short unless lawmakers address the payment structures driving private practices out of business.

Turning Concerns into Solutions

Lawmakers must protect professional fees and sustain the private practices vital to rural healthcare. This means enacting payment parity so independent clinics are compensated fairly, requiring clear disclosure of facility fees, and reducing administrative barriers that keep doctors from seeing patients. Investments such as enhanced loan repayment, targeted tax relief, and direct support for rural clinics can help stabilize the workforce and keep care accessible.

Policy alone is not enough. Patients, community leaders, and healthcare professionals must speak up, testify at hearings, contact legislators, and prioritize rural health to ensure that solutions are practical and lasting.

The Stakes for Rural Hawaii

When a rural clinic closes, patients must travel hours for basic care if they can access it. Delays in treatment mean worse health outcomes, higher costs, and preventable tragedies. The loss of independent physicians also means the loss of trusted relationships and community advocacy.

Bottom Line

When professional fees disappear, so do local doctors, and with them, so does the health and resilience of our communities. Legislative action is urgent. The future of rural healthcare in Hawaii depends on it.

Sources:

• Hawaii Provider Shortage Task Force (2025)

• County Health Rankings (2025)

• American Medical Association (2024)

• MedPAC, June 2025 Report to Congress