Interstate compacts are painless way we can improve healthcare access

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By Keli‘i Akina

Imagine that licensed medical professionals from various mainland states are lined up to work in Hawaii.


Let’s say they all arrived by plane and are now in a locked room at the Honolulu airport, waiting for state officials to let them come in and start treating people.

Under current law, they will be waiting there for a long time, since each of them would need separate a Hawaii license to practice here, and it’s a long and costly bureaucratic process to obtain one.

Keli’i Akina

Sure, sometimes our governors issue emergency orders that let out-of-state medical professionals practice in Hawaii immediately so they can address local needs, as during the COVID-19 crisis. But that’s only on a temporary basis.

In general, healthcare workers — doctors, nurses, physical therapists, psychologists, emergency medical service specialists and many more — have to jump through a bunch of hoops before they can leave that metaphorical waiting room and do their part to alleviate Hawaii’s critical healthcare shortage.

So why am I saying this? Because for doctors, that will soon change.

This year, the Legislature and governor approved a measure, SB674, that allowed Hawaii to join the Interstate Medical Licensure Compact, which will make it easier for doctors from member states to practice in Hawaii.

Currently, there are 37 states that participate in the IMLC, plus Guam and the District of Columbia. Four other states, including Hawaii, are in the implementation phase and will eventually be full members of the compact.

Once Hawaii is a fully participating member of the IMLC — ideally by the beginning of 2025 — we will start to see measurable improvements in Hawaii’s healthcare access and quality.

Marschall Smith, executive director of the IMLC Commission, told Grassroot that states generally see a 10% to 15% increase in the number of new licenses issued, and about 45% go to physicians who have chosen to practice in rural and underserved areas. A separate study of IMLC states found that compact participation is associated with better quality hospital care.

More doctors in Hawaii could mean more specialists, which would reduce the need for Hawaii residents to travel to the mainland for certain medical procedures.

It also will mean greater access to telemedicine for patients interested in consulting with their physicians over the internet — something that has great potential to improve care in Hawaii, given our geographic limitations.

Currently, a doctor must have a Hawaii medical license to practice telemedicine in our state. So making it easier for doctors to be licensed in Hawaii will expand the pool of doctors able to provide telehealth services to Hawaii patients, even if many of those doctors are still on the mainland.

Aside from doctors, can we make it easier for other medical professionals to treat patients here? Absolutely.

So far, we have opened the door to physicians, but there are other medical compacts that Hawaii could join as well, including the Nursing Licensure Compact, the Physical Therapy Licensure Compact, the Advanced Practice Registered Nurses Compact, the Psychology Interjurisdictional Compact, the Audiology & Speech-Language Pathology Interstate Compact and the EMS Compact.

Our legislators debated joining many of these other compacts during the legislative session earlier this year, but only the IMLC was approved. Next year, the Legislature should consider broadening Hawaii’s compact participation.

As we explained in a recent Grassroot report, “Joining multiple interstate compacts could be the simplest route to address the difficulties medical professionals face in moving to Hawaii.”

Given how long it takes to get through the implementation stage, delaying passage of new compact legislation would mean years of waiting before we could start to see any benefits. Rather than drag their feet, state policymakers should leap at the opportunity to join these additional medical licensure compacts.

Let’s make Hawaii a more welcoming place for healthcare professionals to practice. It’s a simple way to improve healthcare access for all Hawaii residents.

Keli‘i Akina is president and CEO of the Grassroot Institute of Hawaii.



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Grassroot Institute of Hawaii is a nonprofit, nonpartisan research institute dedicated to the principles of individual liberty, the free market and accountable government. Through research papers, policy briefings, commentaries and conferences, the Institute seeks to educate and inform Hawaii's policy makers, news media and general public. Committed to its independence, the Grassroot Institute of Hawaii neither seeks nor accepts government funding. The institute is a 501(c)(3) organization supported by all those who share a concern for Hawaii's future and an appreciation of the role of sound ideas and more informed choices.

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