Molokaʻi native Misty Kahale completed her first year of medical school at the University of Nevada, Las Vegas on Friday. By the time she graduates, she expects to have $300,000 in student debt.
With final exams behind her and a mountain of tuition bills ahead, she plans to apply for a breakthrough new Hawaiʻi grant program that would cover the rest of her medical school expenses — a prospect that she said would instantly diffuse her financial stress.
There’s a catch: Grant awardees must pledge to work full time in rural Hawaiʻi for five years after graduation, a bid to entice healthcare workers to root themselves in areas where physicians, nurses and other professionals are in short supply.
Encouraging doctors to take up practice in remote areas is challenging. But state leaders are pushing the effort forward, setting aside $28 million in federal funds for an ambitious medical school tuition payment program.
Attending medical school will be free starting in September for awardees of the Hawaiʻi Outreach for Medical Education in Rural Under-resourced Neighborhoods (HOME RUN) workforce pipeline program.
The perk, funded by a chunk of a $188.9 million federal grant meant to revolutionize rural healthcare in Hawaiʻi, is available to students pursuing any career in healthcare or health information technology. It will cover tuition and fees for healthcare training at a university of the student’s choice.
By stepping up financial aid for medical training, the program could make a sizable dent in Hawaiʻi’s rural workforce problem, said Dr. Kelley Withy, a physician at the University of Hawaiʻi’s John A. Burns School of Medicine who leads an ongoing study of the state’s medical workforce shortage.
But she noted that a five-year future commitment to live and work in a rural area can be “a lot for twentysomethings” to make. The project defines rural Hawaiʻi as any of the neighbor islands and Waiʻanae, Wahiawā, Waimānalo, Hauʻula, Lāʻie, Kahuku, Haleʻiwa and Waialua on Oʻahu.
For Kahale, the requirement is really no concession. The 27-year-old aspires to become a family medicine doctor on Molokaʻi, where the supply of doctors needs to grow 83% to meet patient demand, according to Withy’s research.
Kahale knows she could earn more money practicing medicine elsewhere. But she said returning to her home island to help fill a longstanding doctor shortage is a calling more important than her own financial prospects.
“It’s almost a sense of duty and obligation because I know the needs of the island so well,” Kahale said. “But also it’s my home and I feel a draw to go back and help the people that raised me.”
None of the doctors currently practicing on Molokaʻi are from the island. Kimberly Svetin, president of family-owned Molokaʻi Drugs, said one solution to the physician shortage problem could be reversing this trend.
“In the rural parts of Hawaiʻi, we’re losing so many of our doctors,” Svetin said. “I’ve seen doctors retire. I’ve seen doctors only stay here for a couple of years because somewhere else the money’s better or they tire of the rural lifestyle. That’s why this program can be a game-changer because it would remove the cost of medical training as a barrier.”
‘We Have To Break The Cycle’
The annual cost of attending JABSOM, Hawaiʻi’s only medical school, is approximately $71,328, or $36,672 for Hawaii residents. Tuition for four years for a resident is roughly $146,688, not including books, fees and living expenses.
Gov. Josh Green, who helped write the federal Rural Health Transformation Program, said he wants to wipe out the state’s medical workforce shortage by 2030. The HOMERUN program is a crucial part of that effort.
“We have to break the cycle,” Green said. “Because housing is so expensive, it’s very difficult for someone to get a nursing degree and pay back $200,000 in education debt and also pay a down payment on a mortgage on a home.”
For Green, the issue is personal. He arrived in Hawaiʻi in 2000 after joining the National Health Service Corps, which stationed him as a physician in rural Kaʻū on the Big Island. The health service covered some of his medical school debt. He was 53 — and governor of the state — when he paid off the rest more than two decades later.
There have been 122 HOMERUN applications since the Hawaiʻi/Pacific Basin Area Health Education Center launched the award program in April. So far, the first 44 applicants have been approved. The center will continue to accept students who meet program criteria on a first-come, first-served basis.
The program has $28 million for fiscal year 2026, which ends Sept. 30. But Withy said it’s likely that some of the funds will roll over to the next fiscal year.
The scholarship’s first awardee is Katlyn An, a 27-year-old aspiring family nurse practitioner from Pearl City. An, who starts nursing school in the fall at the University of Hawaiʻi Mānoa, said it was easy to promise to spend the beginnings of her career in a rural area because she had already hoped to serve a medically under-resourced local community after graduation.
“Living in Hawaiʻi is so expensive and as I go through this program I am the primary income source for my family, both of my parents and my siblings,” she said. “It was going to be a really difficult situation for me if I didn’t get this scholarship. Now because of this award it’ll lessen the burden, definitely, and help me prioritize my education while also being able to continue to provide for my family.”
The award will save her roughly six figures of education debt, she said.
Another recipient, 25-year-old Jose Labrada, is a first-generation Cuban American who will relocate to Hawaiʻi from Las Vegas this summer to pursue a doctoral degree in occupational therapy at Hawaiʻi Pacific University.
Making an up-front commitment to launch his future career in a specified geography was not simple. Labrada has aging parents based on the U.S. mainland to consider. But he said the freedom to study without financial stress made it feel like a fair trade.
“Coming from a low-income household and living in a small two-room apartment with 10 family members, the opportunity to pursue my education without the burden of overwhelming student loans means more to me than I could put into words,” he said.
The new grant program mirrors a more targeted deal offered by JABSOM since 2022 for medical school students who commit to practicing on Kauaʻi. That program is funded by a six-year $10 million gift from Dr. Priscilla Chan and Mark Zuckerberg, who live part-time on Kauaʻi.
A separate statewide effort to repay medical loans for healthcare professionals who commit to working in Hawaiʻi has covered the partial education debt of more than 900 people in the state.
The push to make medical school more affordable comes at a time when changes in the way primary care doctors receive reimbursement from insurers threaten to destabilize small and rural practices already struggling to cover the cost of patient care.
It also comes as the statewide doctor shortage is on the rise. Hawaiʻi’s chronic shortage of physicians went from bad to worse in 2025. The gap in the state’s physician supply now stands at 833 full-time doctors when the state’s geography is factored in.
Hawaiʻi’s high cost of living and housing prices, coupled with lower salaries, deter physicians from practicing in the state.
Tuition grants are part of the state’s strategy to turn the tide, Withy said, but healthcare salaries in Hawaiʻi will also need to rise to dissuade medical workers from relocating to states with significantly higher-paying jobs and a lower cost of living.
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This story was originally published by Honolulu Civil Beat and distributed through a partnership with The Associated Press.
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