A string of bills allowing the state to join different industry compacts will be heard in the Senate on Friday, with lawmakers hoping that their passage will expand medical access.

Hawaii’s pool of available medical workers may expand soon, a dire need considering the state’s well-documented shortage.

Most notably, this would be through a system of interstate compacts, where workers licensed to practice in one state could then practice in another state without having to immediately wait to complete a lengthy and arduous process of relicensing.

“The idea is to support existing health care professionals, yet try to get even more here,” said Sen. Joy San Buenaventura, who chairs the Senate Health and Human Services Committee and introduced several bills related to interstate compacts for different medical professions.

These compacts are designed to streamline the process for licensed professionals who want to move states. 

Rep Joy San Buenaventura cesspool info forum.
Sen. Joy San Buenaventura, chair of the Senate Committee on Health and Human Services, introduced a string of bills that would put Hawaii into different medical interstate compacts. (Cory Lum/Civil Beat/2018)

For example, if a physician licensed to practice in New Jersey decides they want to practice in Hawaii, the current setup can take months for them to receive approval from the Hawaii Medical Board.

Under a proposal that would add Hawaii to the Interstate Medical Licensure Compact, Senate Bill 674 and House Bill 666, physicians could be approved in just a few days, according to written testimony by the Hawaii Medical Service Association.

Other medical professions grapple with this dynamic too. 

Jackie Barry, associate director for the Hawaii chapter of the American Physical Therapy Association, said that physical therapists who move states – like military spouses often do, for example – have had to wait months to get their new licenses to practice. 

“Employers don’t always want to wait that long,” she said. 

When Washington state joined the Physical Therapy Compact in 2017, it and nine other states suddenly had access to their collective supply of physical therapists, allowing practitioners to more fluidly move between states without worrying about the bureaucratic delays that would come with having to be relicensed, along with expanding telehealth options. 

On Friday, the Senate Health and Human Services Committee is scheduled to consider a string of bills that would make it easier for out-of-state medical workers to practice in Hawaii

Some of these compacts already contain dozens of states, while Hawaii is notable for its lack of participation in compacts even outside the medical field.

Nurse hold signs protesting fronting the Kapiolani Womens and Childrens hospital.
Another factor in Hawaii’s short supply of medical workers might be poor working conditions. Nurses in 2020 were burned out from double shifts and mandatory overtime under stressful conditions, union representatives said. (Cory Lum/Civil Beat/2020)

This wouldn’t be the first time interstate compacts are explored. A bill to enter the nurse interstate compact was introduced in 2019 by then-Rep. Roy Takumi, though it was quickly amended to just put together a task force for consideration. The bill ultimately died. 

It probably didn’t help that the Board of Nursing opposed the bill, writing in its testimony that it was concerned about the compact overriding its own authority, or at least blurring it. 

These sovereignty hangups came up during Washington’s deliberations too, said Barry, who in addition to her status as associate director of Hawaii’s APTA chapter is also heavily involved with the physical therapists group’s Washington state office. 

Ultimately, she said, a compromise was reached that Washington’s Board of Physical Therapy would have to approve compact changes.

“I think they did a great job of going through the process,” she said.

But Barry also pointed out that different medical professions might weigh the pros and cons of an interstate compact differently.

Erik Abe, Public Affairs and Policy Director of the Hawaii Primary Care Association, made the same observation. While his organization recently testified in support of a House bill that would bring Hawaii into the Interstate Medical Licensure Compact – a compact for physicians – he said that the issue might be more controversial for nurses. 

“You need to look at an interstate compact as basically the minimum licensing standards for a profession,” he said.

This minimum might not be so controversial among physicians, but among nurses, their ability to prescribe medication varies by state. State boards probably wouldn’t be keen to change their standards to reconcile this.

But Abe does believe that joining interstate compacts would do more good than harm, referencing Hawaii’s lack of medical care – especially during the pandemic, and especially on neighbor islands.

Maybe medical professionals will use these compacts to leave for other, more affordable locales – but “that’s what’s happening currently,” said Abe. 

Joining interstate compacts is not the only lever of power the legislature holds for increasing the availability of medical care. Last year, lawmakers boosted funds to the University of Hawaii’s nursing program to expand training capacity; on Friday, another bill being considered would expand which types of professionals could practice respiratory care.

“The trend is to make medical care more accessible,” said San Buenaventura.

Interstate compacts are a significant piece of this, she said. And she’s hoping that out-of-state workers might see the deal as a win-win.

“Who would want to not come to Hawaii?” she said.

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