More JABSOM graduates staying in Hawaii for residency training

Some 41% of the University of Hawaii John A. Burns School of Medicine’s 2025 graduating class is staying in Hawaii for residency training — a 10-point increase from last year that will help chip away at Hawaii’s critical physician shortage.

“Having nearly half of the Class of 2025 continuing their residency training in Hawaii proves that JABSOM continues to meet the needs of our state,” said Dr. Sam Shomaker, JABSOM dean. “Some will be going away but many of them indicate the desire to return home.”

The uptick in medical school students staying in Hawaii for residency training comes as the state faces an estimated deficit of 768 full-time physicians, according to the 2024 Hawai‘i Physician Workforce Assessment submited to the Legislature by UH.

Key drivers of the shortage mentioned in the report include an aging physician workforce — 24% of active doctors are 65 or older — and burnout, exacerbated by COVID-19 and events such as the Maui wildfires. Ongoing challenges include low public insurance reimbursement rates, high administrative burdens and difficulties attracting physicians to rural areas.

The physician shortfall is most acute on the neighbor islands, and primary care remains most affected by the physician shortage, with a statewide shortfall of 152 full-time physicians, followed by sub-specialties such as pediatric gastroenterology, adult endocrinology and thoracic surgery.

Notably, 66% of JABSOM’s 2025 graduating class will enter primary care fields such as internal medicine, pediatrics, family medicine or obstetrics and gynecology.

“We’ve emphasized those specialties throughout the four years of medical education, and the state is reaping the benefits of these efforts,” Shomaker said.

To address the crisis, the Hawai‘i/Pacific Basin Area Health Education Center, which is based at JABSOM, has expanded recruitment, launched a $30 million loan repayment program and advocated for policy changes such as exempting public insurance reimbursements from the state’s general excise tax.

Still, the Hawaii Physician Workforce Assessment warns that unless the state increases its physician workforce by 100 full-time doctors annually, it will not meet projected health care needs by 2032.

“We’re filling those gaps as we speak,” Shomaker said. “At the beginning of the month, we announced a new Family Medicine Residency Program on Kauai. This is going to be huge for the Garden Isle because an additional 12 family medicine physicians will be on island to care for families.”

The new Kauai Family Medicine Residency Program is a partnership between JABSOM and Hawai‘i Pacific Health’s Wilcox Medical Center. Backed by federal funding and accreditation, the program will begin in 2026, with residents training on Oahu in their first year before completing the final two years on Kauai.

Shomaker said the expansion marks a major milestone in addressing rural physician shortages, noting that more than 80% of past family medicine graduates have stayed to practice in Hawaii.

“This is in addition to the Kauai Medical Training Track, sponsored by the Chan Zuckerberg Initiative, which puts six JABSOM students on Kauai each year to live, learn and train on the Garden Isle,” Shomaker said.

Graduates in the program will be required to serve on Kauai for several years after completing their residency. Similar initiatives are planned for Maui and Hawaii island.

Kerri Niino, 30, a Mililani High School alumna, is among the pediatric residents staying in Hawaii to train with JABSOM and Kapi‘olani Medical Center for Women &Children. She spent years away earning her undergraduate degree at the University of Washington and teaching special education before returning home to pursue medicine.

“This is the school that I really wanted to go to,” Niino said of JABSOM. “I knew that I would get to learn amongst the population and the community that I grew up in and be able to serve them that way.”

While a number of medical students from Hawaii leave for training, JABSOM’s mission is to develop physicians who will stay — or return — to care for local communities. Niino said JABSOM’s curriculum emphasizes not just clinical knowledge but cultural understanding and community service.

She was especially moved by her involvement in the medical school’s Department of Native Hawaiian Health, where she worked alongside traditional healers, volunteered at cultural sites and participated in workshops focused on Indigenous practices.

“They deepened all of our understanding of traditional healing practices and more holistic approaches to health,” she said. “They emphasize the connection between Native Hawaiians and the land, and kind of inspired us to explore different ways to integrate modern medicine with cultural traditions.”

That kind of training, Niino believes, is essential in a place like Hawaii, where cultural context deeply influences health outcomes.

Cadie Young, 21, also grew up in Mililani and shares a deep commitment to serving the community that raised her. Young, who graduated from UH-Manoa last week with a degree in molecular cell biology, hopes to attend JABSOM in 2026.

While she’s open to exploring mainland opportunities to broaden her training, her goal is to return home to practice medicine.

“I want to experience new cultures and perspectives on the mainland, especially in specialties that might be more advanced or have access to newer technology,” Young said. “But ultimately, I want to bring that knowledge back and use it to help keep Hawaii in the loop.”

Through internships, research and extensive volunteer work, Young said she’s developed a deep understanding of the needs in her community. One especially formative experience was working at a local ophthalmologist’s office, where she helped care for many kupuna.

“The doctor would talk in pidgin, speak really loud, laugh a lot. What might seem disrespectful on the mainland is actually cultural and appreciated here,” Young said. “He remembered patients and their families and took the time to bond with them instead of just treating them like a case. That’s what community care looks like.”

Hawaii is limited by size in the number of specialty programs it can support simultaneously, increasing the chances that some medical students will pursue residency training outside the state.

However, Shomaker said JABSOM has partnered with local residency programs and health care systems to support 20-plus medical residency and fellowship programs and together they are working to expand such opportunities to include a gastroenterology fellowship, neurology residency and hematology oncology fellowship.

To help address the physician shortage, particularly in rural and neighbor island communities, Shomaker emphasized the need for stronger financial incentives such as higher compensation packages, relocation assistance, salary differentials and signing bonuses.

He also suggested that lawmakers champion broader policy changes, including increasing Medicare and Medicaid reimbursement rates for providers in rural regions, strengthening partnerships with local schools and investing in telehealth infrastructure.

He said support for practice startup costs such as clinic infrastructure, training and technology, would ease barriers for providers.

Shomaker also advocates for expanding the use of care teams comprising physician assistants, nurse practitioners and community health workers in areas with physician shortages.