Hawai’i, often hailed as a paradise, presents both alluring opportunities and daunting challenges for health care professionals. With pristine beaches, warm waters, and the famous Aloha Spirit, many are enticed to relocate for a life in this tropical paradise.
However, once the initial excitement fades, a troubling trend emerges: a significant number of health care workers find themselves leaving within a year of their relocation. This revolving door raises the question: Why is it so difficult to retain health care talent in Hawai’i?
One of the most pressing issues is the high cost of living. In places like O’ahu, the median home price surpasses $1 million, making homeownership feel like a distant dream for newcomers. Rent is also astronomical, with a typical one-bedroom apartment costing more than $2,000 a month.
Adding to this financial strain, grocery prices are at least 20% higher than the national average due to the fact that 90% of Hawai‘i’s food is imported. Other everyday costs, like gasoline and electricity, also hit hard, with gasoline priced at approximately $1.50 more per gallon than on the mainland, and electricity costs more than three times the national average.
Additionally, salaries in the health care sector can be surprisingly low compared to the steep cost of living. Many physicians find their paychecks diminished when adjusted for the inflated expenses associated with living in Hawai’i. The local health care landscape is dominated by a few large organizations, making it difficult for smaller practices to thrive, particularly under the burden of a 4% state general excise tax on medical services.
The challenges do not end with finances. Access to health care resources is a significant hurdle, particularly for patients on the neighbor islands.
Unlike most parts of the mainland U.S., where an ambulance can quickly transport a patient from a smaller hospital to a larger facility in a nearby city, patients in Hawai’i face unique logistical obstacles. For those on the outer islands, transferring the seriously ill often means relying on air transport, which can be complicated due to capacity issues at hospitals in O’ahu, which are frequently at or near full capacity.
Extreme weather conditions can also hinder these transfers. Although water ambulances do exist, they involve hours of travel across rough seas between the islands.
In particular, the health system on the Big Island faces significant limitations. The local hospital in Kona, for instance, is 50 years old and lacks key services like a cath lab, interventional radiology, and neurosurgery. There’s only one other hospital on the island that provides some of these services, but it, too, is often filled to capacity.
The situation becomes even more precarious for patients as the availability of specialists is limited, making access to specialized care challenging. For example, the only infectious disease doctor in Kailua-Kona covers a vast area, leaving the community without backup in case of illness or absence.
Living in such isolation can further strain health care providers and their families. Geographically, Hawai’i holds the title of the most isolated population center in the world, with the closest landmass being over 2,000 miles away from the U.S. mainland.
For those with relatives on the mainland, especially elderly family members facing health issues, the distance can feel overwhelming. The time zone differences, particularly during Daylight Saving Time, add to the disconnect for those trying to maintain close ties with loved ones far away.
Residents may also experience lifestyle adjustments that can be surprising. Power outages are not uncommon, particularly on the neighbor islands, where water supply can be hampered by low rainfall or malfunctioning equipment.
Additionally, many major retailers and restaurant chains limit their operations in Hawai’i due to the higher costs and reduced profit margins in such a unique market. This can make it difficult for newcomers to find familiar dining or shopping options.
For those who prefer online shopping, shipping delays can be significant, with typical delivery timelines stretching to two weeks rather than the two days many have come to expect on the mainland.
Entertainment options also differ from those on the mainland. There are no major professional sports teams in Hawai’i, and while some renowned music acts may occasionally perform in Honolulu, large national productions are sparse. Residents on the neighbor islands often have to fly to O’ahu if they wish to attend events featuring bigger names.
Transportation presents its own challenges. With public transit options underdeveloped, most residents rely on personal vehicles. The limited road infrastructure, due to high construction costs, can lead to unexpected traffic congestion, and auto repair options are in high demand. This often results in long wait times for necessary repairs and parts.
Despite the various challenges faced by health care workers in Hawai’i, many, including the author of this piece, cherish their experience living and practicing medicine in this unique setting. The journey to deliver health care in Hawai’i is undoubtedly complex, requiring resilience, creativity, and adaptability.
Healthcare professionals are often rewarded with the beauty of the islands, the warmth of the community, and the chance to make a real difference in people’s lives. Surrounded by stunning landscapes and a diverse cultural heritage, the impact of one health care provider in such a close-knit population can be significant and deeply fulfilling.
This perspective serves as a reminder that while Hawai’i may seem like a dream destination, it is crucial for potential health care workers to be aware of the realities they will face, as they begin what could be a deeply rewarding career in this captivating corner of the world.
The vision of Hawai’i as a place of opportunity remains intact, but the challenges must not be overlooked. By sharing these insights, it is hoped that the right people will find their path to a successful long-term health care career in the islands.
image source from：kevinmd
