Hawaii patients express frustration with doctor shortage on Oahu

Keith Daszek was thrilled to learn of a healthcare clinic opening near him.

He had seen announcements about the new Mililani Clinic & Urgent Care last summer and was pleased it would be right in his neighborhood.

But when Daszek, 73, tried to make an appointment, he soon learned the primary- care doctors there were not taking new patients. He had just moved back to Hawaii from Las Vegas, and the doctor he used to see at Pali Momi Medical Center had retired.

"Once I moved back here, I tried to find a PCP," he said. "I couldn't find one anywhere. I went in immediately and asked are they accepting new patients — no, they're not. I called Pali Momi. I called Straub, Queen's and, of course, I called HMSA."

Daszek said that his insurer, Hawaii Medical Service Association, provided him with a list of doctors to call, but he still came up empty.

"Everybody talks as if we all have a physician in our pockets," he said.

The retired federal worker is grateful to have health insurance, however, the reality is that he and others are having a tough time accessing doctors as they get older and deal with multiple ailments.

Hawaii has had a doctor shortage for more than 15 years, with the latest University of Hawaii report noting a gap of 833 full-time- equivalent doctors in 2025, worse than in the previous year. The greatest shortage was among PCPs, with a gap of 178 doctors.

Some patients and physicians say they feel it has only gotten worse and that the problem is becoming severe not only on the neighbor isles, but on Oahu as well.

Dr. Susan Nishida, a Honolulu physician for more than 30 years, calls it a crisis.

"It's now gotten to the point where it's affecting everyone, not just neighbor islands," she said. "It's affecting Honolulu and it's affecting people where you could talk to anybody and they will tell you the same story regardless of what kind of insurance plan they have."

Nishida, who works half time at a clinic in Honolulu, said she has recommended some of her patients with multiple chronic conditions see a primary-care provider.

"I'm not on call. I'm not here on weekends," she said. "So it's best if they're very unstable or complicated that they get a PCP that's full time."

But these patients have come back to her to report they couldn't find one.

Nishida took it upon herself to call various referral lines and experienced firsthand what it was like. The referral lines provided her with lists, she said, that were out of date.

From a list of 17 physicians she called, only three were taking new patients. She was put on extended hold, sent to voicemail or simply told "no" and hung up on.

Nishida said she learned the wait to see a PCP, such as at Queen's Primary Care Centers, can be anywhere from six months to a year.

She recounted colleagues who retired early or moved to the U.S. continent due to operational hurdles, citing the burden of paperwork and prior authorizations, and inadequate insurance reimbursements as the last straw.

"They just said they had it and they cannot make a living here, they cannot make their overhead," Nishida said. "It's common sense. You go someplace that pays you more and where the cost of living isn't as high."

Other colleagues have gone concierge — adopting the direct primary-care model — where they bypass the insurance process and ask patients for a membership fee of up to $200 per month.

Kailua resident Denise Raia, 64, made an appointment this summer in anticipation of her current doctor at a Hawai'i Pacific Health Straub facility retiring this year. She managed to get an appointment via HPH's referral line last month but not until April.

"That was the only available doctor accepting new patients," said Raia, who has HMSA insurance.

The wait for a specialist also can be long, particularly for those in short supply, such as neurologists and Parkinson's disease specialists.

The Hawaii Healthcare Task Force's informal online survey, launched in July, indicates access to healthcare is a major issue. In the unscientific poll, which received more than 200 responses statewide, 78% reported having trouble getting care in the past year.

When asked which access problems they experienced, 76% reported a long wait for an appointment, 68% had trouble finding a PCP and 55% said they lost their choice of doctors or clinics.

Another 43% said their doctor stopped taking their insurance. More than half, 53%, used urgent care or an emergency room, not knowing where else to go.

DR. NADINE Tenn Salle, president of the Hawaii Medical Association, said it is troubling to see an increasing gap in doctors now affecting patients on Oahu.

"It really was in many ways a rural or neighbor island issue in terms of crises," Tenn Salle said. "Honolulu was in trouble but the neighbor islands were in crises."

A crisis level on Oahu potentially means slower acceptance of referrals from the neighbor isles, which could in turn result in an even greater backlog in access to care for rural areas.

The shortage on neighbor isles, meanwhile, remains dire.

The most recent doctor shortage report showed Hawaii County had a 43% gap in care, followed by Maui County, with a 41% shortage. Maui County also had the greatest shortage of PCPs, with a 35% gap.

The task force said that based on its analysis, three Hawaii counties are among the worst in the U.S. for per capita PCP shortages. Hawaii County has the third largest PCP shortage among all U.S. counties, while Maui County has the fifth and Kauai County, the 13th.

Statewide, more patients may be relying on urgent care due to the inability to find a PCP or seeking help from Advanced Practice Registered Nurses, who have full practice authority in Hawaii, meaning they can evaluate patients, diagnose illnesses and prescribe medication.

But Hawaii also has an APRN shortage.

Nishida said PCPs are important for patient care because they take care of routine checkups and preventative care.

"They're kind of like the orchestra leader," she said, "and they do referrals for you if you need them. They're the person that knows you best."

She said urgent-care doctors, meanwhile, focus on addressing a one-time medical issue until it is resolved. They are not typically the ones overseeing routine medications for conditions such as high blood pressure and diabetes.

HMSA said it provides members with help finding doctors several ways, including through an online "find a doctor tool" that offers searches by health insurance plan, location and specialty.

The insurer updates the providers listed based on information from a credentialing team that checks on a quarterly basis whether the participating provider is still practicing at the listed location and that their phone number is current.

"This has been, hopefully, a successful way that we can accurately get that information to our members," said Dr. Stefanie Park, HMSA's chief medical officer.

Upon request, members also can get printed copies of provider directories from HMSA.

Additionally, members who need help finding a doctor or navigating the system may call the customer service phone number listed on the back of their membership card, she said, or visit one of HMSA's neighborhood centers in person.

Daszek shared that he also sought an appointment with a dermatologist at the Straub clinic in Mililani. He was told at first that under his HMSA preferred provider organization, or PPO, plan, he needed a referral. But after some persistence, he managed to get an appointment with a dermatologist.

It was a six-month wait.

Unfortunately, he said, a week prior to his scheduled appointment, the clinic called to report the dermatologist had left and his appointment had been canceled.

Daszek is grateful to have insurance where he can choose his own doctors, but the problem is finding one.

"After awhile I get so frustrated, I just give up," he said.

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