Senate committee advances bill tying in-state medical tuition to two-year Hawaii practice requirement

Chair Kim, chair of the Senate Committee on Higher Education, opened the Feb. 4 hearing on Senate Bill 101, which would require graduates of the University of Hawaii John A. Burns School of Medicine (JABSOM) who paid in-state tuition to serve as physicians in Hawaii for at least two years following completion of their residency or fellowship.

The committee heard from Sam Shoemaker, dean of the John A. Burns School of Medicine, who testified in opposition and stood on submitted written testimony. "The role of JABSOM is to produce the physician workforce for the state of Hawaii," Shoemaker said, and described the school's enrollment and retention patterns.

Shoemaker told senators the Manoa medical school enrolls 77 students per class. He said about half of graduates complete residency training in Hawaii in some years, while a questionnaire of entering students found that 81 percent of accepted applicants indicated an intention to practice in Hawaii. "The more important statistic…is the number of our graduates who do their residency in Hawaii who then wind up practicing in the state of Hawaii, which is over 80 percent," Shoemaker said.

Sen. Hashimoto pressed for precise retention figures and questioned whether the bill might deter applicants. Hashimoto noted a published figure that 31 percent of the class of 2023 stayed in Hawaii for residency and contrasted that with the school's higher-year averages. Shoemaker said year-to-year variation is possible and emphasized the stronger retention among those who complete residency in Hawaii.

The committee also heard from Candace Park, deputy attorney general, who recommended indicating that the law is a matter of statewide concern.

Lawmakers and the school discussed strategies the university is pursuing to increase physician retention: expanding residency training slots in Hawaii, developing neighbor-island rotations, increasing scholarships and loan-repayment programs, and considering larger class sizes if clinical placement capacity and accreditation requirements can be met. Shoemaker said creating more residency positions requires substantial financial commitments from health systems.

Several senators asked for numeric goals. Shoemaker suggested a multi-pronged approach and estimated an achievable improvement: "I think we can increase it by at least 10% over the next 5 years." Senators pressed the university for a written plan and additional retention data.

At decision making, the committee recommended passing SB101 with amendments, adding an SD1 and a statement of statewide concern, and deferring the effective date to July. The measure was recommended to go to the Senate Committee on Ways and Means (WAM). The committee roll call on SB101 recorded Chair Kim—aye; Vice Chair Kidani—aye; Sen. Fukunaga—aye; Sen. Hashimoto—aye; Sen. Fevella—excused. The committee report will include the committee's recommended amendments and any funding placeholders.

Why it matters: Hawaii reports a multi-hundred–physician shortage across the state; committee members and the medical school debated whether an admissions-linked service requirement, expanded residency training, or larger scholarship and loan-repayment programs will best increase the number of physicians who ultimately practice in Hawaii.

The committee asked JABSOM to supply additional data on scholarship uptake and retention after loan-repayment commitments and requested a written plan for increasing in-state retention and residency capacity.