Hawaii boasts the highest life expectancy in the United States, a fact celebrated by many. However, this demographic milestone brings with it significant challenges, particularly in the realm of geriatric care. As Hawaii’s population ages more rapidly than the national average, the healthcare system is struggling to meet the increasing demand for services tailored to seniors, leaving many kupuna (elders) waiting too long for care. Physicians are expressing concerns about the overwhelming caseloads faced by those in the field.
“We have a higher percentage of people over the age of 65, but we also have a lot of what we call ‘super-agers’ — people in their 80s, 90s, and beyond,” explained Kamal Masaki, chair of the Department of Geriatric Medicine at the University of Hawaii John A. Burns School of Medicine. “Our growth rate is higher than the national average … We know the aging population in Hawaii is really going to continue expanding over the next few decades.”
Dr. Masaki pointed out that the state is facing shortages in nearly all aspects of elder care, not just among physicians. “It’s not just physicians,” she noted. “It’s nursing, nurse practitioners, social workers, pharmacists — even the front-line staff like certified nursing assistants. The entire workforce that takes care of older patients is short.” This scarcity of resources is highlighted in the 2025 Hawaii Physician Workforce Report, which suggests that while there may be more geriatric specialists than needed in some areas, the reality on the ground does not align with these estimates.
Mismatch Between Supply and Demand
According to the report, the state may have a projected demand of 32.4 full-time geriatrician positions compared to a supply of 46.7, indicating a surplus. However, these figures do not capture the unique demographic trends of Hawaii. “Geriatrics is a critical shortage specialty across the United States,” Dr. Masaki emphasized, noting that as the population continues to age, the shortage of geriatricians is expected to worsen. Even on Oahu, patients frequently face long waits for appointments, often stretching into months.
One of the key initiatives aimed at bolstering the geriatric care workforce is the geriatric fellowship at JABSOM, one of the largest programs of its kind in the nation, which has seven funded training positions each year. Nearly half of its graduates over the past decade have chosen to remain in Hawaii or the Pacific, contributing to the local healthcare landscape. However, significant shortages persist, particularly outside of Oahu, where Hawaii Island currently has only three practicing geriatricians, Kauai has three, and Maui has none.
Challenges for Primary Care Physicians
Hawaii’s healthcare landscape is further complicated by the overwhelming demand for geriatric care. Kaimana Kalei, a physician practicing at the Veterans Affairs clinic on Hawaii Island, expressed the challenges he faces. “I wanted to give back to my community,” he said, recalling his experience caring for his grandmother. “Taking care of kupuna is important in our culture.” Despite his specialization, he manages around 900 patients, more than half of whom are kupuna, indicating that he often operates more as a primary care physician than a geriatrician.
Kalei warned that if the specialty of geriatrics is not prioritized, the burden will continue to fall on primary care physicians, leading to increased burnout and stress among healthcare providers. Dr. Masaki reiterated that care for older adults must be shared between geriatric specialists and primary care physicians, as geriatricians are uniquely trained to handle the complex medical and social needs of older patients. “Without that support, primary care doctors may not have the time or expertise to address those complexities,” she added.
The Complexity of Geriatric Care
Geriatric care often requires more time than standard appointments allow, as older patients frequently contend with multiple chronic illnesses and complicated medication regimens. “The patients are much more complex — they’ve accumulated 10 diseases and they’re taking 30 medications,” explained Aida Wen, a geriatrician at The Queen’s Health Systems. “Patient care and patient evaluations take a lot longer and require a lot more detail.” The nature of these appointments, which often necessitate coordination with multiple specialists and family members, means that geriatricians are doing more yet receiving less compensation relative to other specialties.
As reimbursement systems often reward volume over the quality of care, geriatrics remains one of the lowest-paid specialties, which can deter new physicians from entering the field. In response to this issue, initiatives like the Nohara-Abaya Loan Repayment and Scholarship Award, which offers $50,000 to physicians pursuing geriatric medicine, aim to alleviate some financial barriers. Recipients like Kalei and Kiana Choo Loy have expressed gratitude for such support, helping them to establish careers in elder care.
Rising Dementia Cases
Another layer of complexity is introduced by the rising number of dementia cases in the state. An estimated 31,000 individuals in Hawaii are living with Alzheimer’s disease or a related form of dementia, according to the Alzheimer’s Association. Kore Liow, the founder of Hawaii Pacific Neuroscience, pointed out that Alzheimer’s disease is now the sixth-leading cause of death in the United States, affecting around 6 million Americans. “It’s actually more common than prostate cancer and breast cancer combined,” he stated, highlighting the significant financial burden associated with the disease, particularly for Medicaid patients.
The increasing prevalence of dementia, often referred to as the “silver tsunami,” is largely driven by the aging population. Researchers in Hawaii are participating in efforts to develop new treatments, including the recent infusion of an experimental drug called trontinemab in a state patient, which uses advanced technology to minimize side effects associated with existing treatments.
Preparing for the Future
To address the challenges posed by an aging population, educators at JABSOM are collaborating with numerous partners through the Pacific Islands Geriatric Workforce Enhancement Program. This initiative focuses on training students in various fields, including nursing, pharmacy, social work, and public health, while promoting “age-friendly” health systems. The program emphasizes key elements such as what matters to the patient, medications, mobility, and mentation.
As Hawaii’s healthcare system grapples with these pressing challenges, experts assert that expanding geriatric care will require long-term investment and a reevaluation of how healthcare systems measure value. “The health care systems that employ geriatricians have to be committed to the fact that What we have is not going to be a moneymaker,” Dr. Masaki noted. However, she also emphasized that improved elder care can lead to reduced hospitalizations and complications, ultimately saving health systems money in the long run.
The situation underscores a critical need for the healthcare system to support those providing care for Hawaii’s kupuna, ensuring that elders receive the time and attention they deserve. As the state continues to navigate its aging crisis, the call for reform and investment in geriatric care has never been more urgent.
