Keeping Physicians at the Center of Care in an AI Era

A central focus was the rapid expansion of artificial intelligence (AI) in healthcare. The AMA adopted policies emphasizing that AI should support—not replace— physician judgment. Policies call for transparency, accountability, the use of evidence-based data, and physician oversight in both clinical care and insurance coverage determinations.

For patients, this helps ensure that care decisions remain individualized. For physicians, it reinforces their role as leaders in clinical decision-making.

Addressing Payment and Access to Care

The AMA reaffirmed Medicare physician payment reform as a top priority and emphasized protecting Medicaid programs. These issues influence access to care, particularly in regions facing workforce shortages and geographic barriers, including Hawaiʻi.

Ongoing payment challenges and administrative complexity continue to place pressure on physician practices and negatively impact patient access to timely, local care—especially in underserved and neighbor island communities already experiencing physician shortages.

Reducing Administrative Barriers

Delegates also addressed prior authorization and insurer decision making. New policies call for greater oversight of coverage decisions— especially when AI tools are used— and emphasize that determinations should be based on current medical evidence and include physician review.

These issues directly affect both physicians and patients, particularly when delays in care occur due to administrative processes.

Strengthening Public Health and Workforce Capacity

Policy actions also focused on expanding maternal health services, supporting maternal mortality review efforts, and addressing healthcare workforce shortages. These priorities align with ongoing challenges in ensuring access to care in rural and underserved communities.

Selected Specific Actions by the AMA Supported by the HMA

At the 2026 AMA Annual Meeting, the House of Delegates adopted several policies with direct relevance to Hawaiʻi and the physician community. These included Resolution 239, Medicare Administrative Contractor Policy Modification, adopted as amended; Resolution 310, Increasing Capacity and Access to Maternal Health Services in Rural Areas, adopted as amended and co-sponsored by Hawaiʻi; and Resolution 315, Expanding the Native Hawaiian Health Scholarship Program Eligibility, adopted as amended, co-sponsored by Hawaiʻi. Together, these actions advance HMA priorities around Medicare administrative accountability, rural and neighbor island access to care, maternal health capacity, and strengthening the Native Hawaiian health workforce.

The American Medical Association (AMA) House of Delegates (HOD) typically considers 200 to 250 combined reports and resolutions. For more information on a specific report or resolution, and other news at the annual meeting, please visit the AMA annual meeting webpage at ama-assn. org/house-delegates/annual-meeting.

Engaged and Learning

Dr. Ignacio and Marc Alexander attended multiple meetings of importance, including the Scope of Practice update, the AMA Litigation Center session, CEOs/EDs of the State Medical Associations with the AMA Executive Vice President and CEO, Dr. John J. Whyte, and general business and educational sessions. Of particular note was the meeting of the Organization of State Medical Association Presidents (OSMAP) and The Physicians Foundation, which included a panel discussion with AMA Executive Leadership and a special panel.

The featured topic was “Organized Medicine, Meet Organized Labor: Amidst Increasing Physician Unionization, Where Does the State Medical Association Fit In?” This panel presentation was moderated by Molly Reese, JD, Lead Attorney of the AMA Advocacy Resource Center, and panelists, Richard H. Levenstein, Esq., Shareholder and Leader of the Healthcare Practice Group, Nason Yeager, Richard Long, JD, General Counsel for the Pennsylvania Medical Society, and Jeff Howell, JD, Executive Vice President of the Missouri State Medical Association. This panel addressed the growing reality that physicians are organizing, and it is happening outside organized medicine. As physicians increasingly become employees and workplace grievances mount, more are turning to unions as a tool for governance and professional agency. For state medical associations, long a voice and source of support for physicians, the question is no longer whether this trend is real, but what to do about it. This panel explored opportunities and threats as physician unionization continues to grow.

Looking Ahead

The 2026 AMA Annual Meeting highlights a continued focus on evidence-based care, physician leadership, and patient access. As these national priorities inform federal and state policy, they will continue to shape healthcare delivery across the country—including efforts in Hawaiʻi to strengthen the physician workforce and improve access to care for all patients.

Over the past month, the Hawaiʻi Medical Association has continued to strengthen its role as the trusted, thoughtful voice of physicians and patients across our state. Through our Conversations at HMA, policy engagement, and public presence, we are not only participating in the dialogue—we are contributing to it. Our recent discussions with healthcare leaders and legislative experts have informed ongoing conversations about key issues facing Hawaiʻi’s healthcare system.

Equally important, we are building trust through consistency. From social media engagement to podcasts and public forums, HMA is showing up with a clear message: physicians Pu‘ulu Lapa‘au Caring for Hawai‘i’s Medical Community August 19, 2026 5:30 p.m. on Zoom Our next episode of Conversations at HMA welcomes back the leadership from Puʻulu Lapaʻau. Joining us is Executive Director Geri Young, MD, and Medical Director Angela Gough, DO. In 1983, The Hawaiʻi Medical Association established a Committee on Physician’s Health (CPH). For over 20 years, CPH consisted of a dedicated group of volunteer must be at the center of decisions that impact patient care. As one member recently shared, “HMA brings physicians together in a way that is thoughtful, respectful, and focused on what truly matters—our patients.”

Our advocacy reflects that same approach. Whether working collaboratively with health plans on payment transitions or engaging policymakers, we are guided by respect, credibility, and a commitment to solutions. This includes our recent engagement with the Governor regarding SB 847—a bill that would allow psychologists, under a pilot program, to prescribe certain medications, including controlled substances. In coordination with the American Medical Association, HMA raised concerns about patient safety— particularly around prescribing authority, training, and safeguards— while also recognizing the shared goal of expanding behavioral health access (letters are available online for members). Even in complex situations, we have demonstrated that it is possible to advocate clearly and firmly while maintaining a constructive, partnership-oriented tone.

This is what physician leadership in Hawaiʻi should look like: strong, steady, and grounded in aloha.

Call to action: I encourage each of you to stay engaged—participate in Conversations at HMA, share our resources, and invite your colleagues to join. This is also an election year. It is critical that physicians are visible, informed, and engaged so that candidates understand that physicians vote, they pay attention, and they care deeply about the future of healthcare in Hawaiʻi. Together, we will ensure that physicians and patients across our state are heard—and well served.

It’s been a busy month as just last week, HMA hosted a Conversations at HMA entitled, “A Conversation with HMSA Leadership: Shaping Hawaiʻi’s Healthcare Future.” Co-sponsored with the Hawaiʻi Medical Foundation, our guests were Dr. Mark Mugiishi, CEO of HMSA and a surgeon; Ms. Jenny Smith, HMSA’s first woman President and COO, with moderator, Dr. Nadine Tenn Salle, HMA President and a practicing internal medicine and pediatrics physician. The recording is available on the HMA YouTube channel. While the target audience for these programs is first physicians, patients and anyone interested in Hawaiʻi’s healthcare landscape will find these offerings useful.

These kinds of events underscore the importance of collaboration, and respectful, even if at times difficult, discussion of complex healthcare issues.

Just prior to publication, one of our physician leaders brought to our attention a recently released national report, Moral Injury in Medicine: The Human Costs of Practicing in a Profit-Driven System (Physicians for a National Health Program, March 2026). The report explores the concept of “moral injury” among physicians—describing the distress that can arise when clinicians feel unable to provide the care they believe is most appropriate due to broader system constraints—and offers one perspective on how structural factors within the U.S. healthcare environment may contribute to this experience.

Drawing on surveys, interviews, and focus groups involving more than 1,200 physicians, the report suggests that administrative and operational requirements—such as prior authorizations, coverage limitations, productivity expectations, and documentation demands— can, at times, create challenges for physicians seeking to deliver timely, evidence-based care. Many physicians reported experiencing varying levels of professional distress, and some indicated that these pressures had influenced career decisions. The report also notes potential implications for patient care, including delays, access challenges, and the possibility of widening disparities in already vulnerable populations.

The report emphasizes that these concerns may be rooted in broader systemic dynamics and suggest consideration of policy, organizational, and practice-level approaches. Their recommendations include exploring ways to better support clinical judgment, streamline administrative processes, and examine the role of various stakeholders in shaping care delivery.

In referencing this report, it is important to acknowledge that reasonable perspectives may differ regarding both its framing and conclusions. Hawaiʻi is fortunate to have a healthcare community grounded in mutual respect and a shared commitment to the well being of our residents. Even when viewpoints differ, we continue to value thoughtful dialogue and collaboration. Recent Conversations at HMA reflect this spirit of engagement and openness.

HMA looks forward to fostering a constructive, locally informed discussion around the issue of moral injury—beginning with listening to and learning from our physicians here in Hawaiʻi.

For many practices, this represents more than a payment change. Over the last decade, physicians redesigned staffing models, workflows, quality reporting systems, care coordination infrastructure, and patient access strategies around HMSA’s population health framework. Abrupt operational shifts create uncertainty, particularly for small and independent practices already facing workforce shortages, rising overhead costs, and administrative burden.

Physicians throughout Hawaiʻi are requesting additional clarity regarding the transition. Questions remain regarding fee schedules, including MAC (maximum allowable charge) rates, the future of physician organization administrative fees, reimbursement for telehealth, non-face-to-face patient care such as MyChart communications, and ongoing support for patient care coordination activities that have become integral to modern primary care delivery.

Importantly, many physicians are also asking whether patients and employers fully understand that this transition is occurring and what its downstream impact may be on access, staffing, and practice sustainability across the islands.

The Hawaiʻi Medical Association is encouraging a thoughtful transition plan that recognizes the operational realities facing practices, particularly those serving vulnerable populations, rural communities, and neighbor islands. Hawaiʻi cannot afford further destabilization of primary care access at a time when physician shortages remain a critical statewide issue.

More broadly, these developments underscore the need for Hawaiʻi to establish a long term healthcare strategy that reflects our state’s unique geographic, workforce, and community realities. Payment reform, healthcare consolidation, access, affordability, and workforce sustainability cannot be addressed in isolation.

The 2026 Hawaiʻi legislative session has now concluded. HMA remained actively engaged throughout the session on issues impacting patient safety, workforce sustainability, behavioral health access, and healthcare delivery statewide, including advocacy regarding SB 847 and patient safety safeguards. Comments on SB 847 can be submitted through the following link: https://governor.hawaii.gov/comments-on legislation/

We encourage physicians and community members to watch the HMA Public Policy Committee Year-End Update on the HMA YouTube channel.

Key bills with ongoing conference committee activity, include, HB1970 (tumor registry), SB2969 (Maui Wildfire Exposure Study and health registry), SB847 (Kauaʻi psychologist prescriptive authority pilot), and HB1546, which would establish a health coverage continuity pilot. Other measures such as HB1574 (HELP service requirement adjustments), HB1591 (expansion of the physician preceptor tax credit), SB2816 (expansion of enterprise zones to include healthcare services), and HB1898 (alignment of vaccine guidelines), have all had conferees appointed, signaling continued negotiations in process. A bill like SB3133 (DOH, prevailing medical standard) has only received notices of disagreement, signaling it is unlikely to move forward.

Several HMA-supported bills have already passed the Legislature and been transmitted to the Governor, including HB1573 regulating FDA-approved vaping products, HB1858 modernizing fetal death registration and certification procedures, and HB1875 protecting providers delivering gender-affirming and reproductive care from legal and insurance retaliation. In addition, GM745 confirming the reappointment of Dr. Elizabeth Ignacio to the Hawaiʻi Medical Board was approved unanimously by the Senate, marking a completed legislative action.

Together, these measures reflect substantial progress on HMA priorities, with final outcomes for conference bills expected imminently.

For Hawaiʻi, physician leadership is essential. Our geography and workforce realities demand models of care that emphasize clinical judgment, continuity, and accountability. This is particularly true for neighbor island communities and private practitioners, where disparities in access to specialty care, workforce shortages, and resource limitations are felt most acutely. Any future system — including potential affiliations — must address these gaps directly.

As part of this broader discussion, Hawaiʻi must advance models of care that thoughtfully balance when patients should be triaged to Oʻahu for higher levels of care and when communities can and should be resourced to care for patients locally. This requires intentional investment in workforce, infrastructure, and telehealth-enabled coordination, ensuring that care is delivered in the right place, at the right time, for each patient. Without this balance, disparities across islands will persist or worsen.

HMA also seeks to reframe the broader healthcare conversation. While national and local discussions often focus on dysfunction — cost, access, administrative burden, and workforce strain — Hawaiʻi has an opportunity to focus on solutions. The question is not only what is broken, but what we must build: a system that improves access, supports physician practice across settings, and delivers equitable, high-quality care for all communities. HMA will be hosting a healthcare roundtable this summer.

As of April 24, the Legislature has entered conference committee, where House and Senate are reconciling differences before the April 29 Final Decking deadline for non-fiscal bills. HMA continues to actively engage across priority areas including access to care, behavioral health, and quality initiatives, with multiple supported bills advancing through conference (e.g., health coverage continuity, preceptor tax credits, tumor registry, and Maui health studies), while maintaining opposition to prescribing scope expansion for psychologists. Several measures have already progressed, with key public health bills transmitted to the Governor. Overall, HMA remains actively involved in shaping outcomes during this critical final phase of session.

HMA looks forward to celebrating the extraordinary contributions of physicians across our state on Saturday, September 26, 2026. Each year, a committee selects recipients for a Lifetime Achievement Award and an annual physician award, recognizing individuals whose work has meaningfully advanced healthcare in Hawaiʻi. We encourage members to submit nominations so that we may continue to recognize the many ways physicians contribute to the well-being of our communities.

HMA remains committed to supporting physicians and advancing a healthcare system that is patient-centered, physician-led, and accountable to the people of Hawaiʻi. 

Other Key Measures
HMA supports SB2816, which expands the enterprise zones program to include “medical and healthcare services.” Both the University of Hawaiʻi John A. Burns School of Medicine and the University of Hawaiʻi Cancer Center could benefit from this legislation. HMA also supports GM745, which is the re-appointment of Dr. Elizabeth Ann Ignacio, HMA’s Immediate Past President, to the Hawaiʻi Medical Board.

The Hawaiʻi Medical Association has not formally endorsed nor opposed the proposed affiliation. HMA’s responsibility is to ensure that any significant system change — whether through consolidation, partnership, or broader reform — is evaluated through clear, patient centered principles.

Meaningful healthcare reform must begin with the patient. In Hawaiʻi, aloha, pono, and mālama remind us that health is shaped by family, culture, and community. Policies must be judged not by how they shift financial risk, but by whether they improve outcomes, protect access from Ka‘u to Kalihi to Kaua‘i’s North Shore, and strengthen continuity of care through physician-led, team-based models.

If this affiliation proceeds, important questions must be asked: Will it measurably stabilize the workforce? Reduce administrative burden? Transparently reinvest efficiencies into frontline care? Improve Medicaid access and equity across islands?

HMA’s public policy team continues active engagement at the 2026 Hawaiʻi State Legislature. HMA is currently tracking approximately 65 priority bills and has submitted more than 60 testimonies to date. Members can follow and engage the 2026 legislative session, review Advocacy Updates, and access extensive policy resources — including past testimonies from 2023–2025 and materials for the current session — through the HMA member portal.

In parallel, HMA is convening physicians through specialty-based and natural group meetings to discuss system changes and shared concerns. If your group would like to meet, please reach out.

HMA’s strength depends on physicians collaborating. A unified voice ensures Hawaiʻi’s healthcare future remains patient-centered, physician-led, sustainable, and accountable to our communities.

HMA provides timely, trusted resources to support informed engagement, including special webpages dedicated to the proposed HMSA–HPH alliance, and broader healthcare policy issues – with many resources available to the public. In addition, our members-only pages offer updates, analysis, all HMA testimonies, and resources/opportunities for physicians to stay informed, learn about the process, and ensure the physician voice remains central in Hawaiʻi’s health policy decisions.

Hawai‘i’s healthcare system faces ongoing challenges, including workforce shortages, high costs, and significant health disparities. The Hawai‘i Medical Association (HMA) provides physicians with a unified, effective voice to influence state policy and strengthen care across the islands.

HMA advocates for reforms that support both patients and physicians - such as higher Medicaid reimbursement, streamlined prior authorization, expanded telehealth, and stronger loan repayment programs. Recent legislative successes include increased Medicaid rates and the passage of a General Excise Tax exemption for medical services, reducing overhead costs for practices and improving access to care.

As rising costs and funding pressures threaten services statewide, especially on neighbor islands, physician engagement is essential. Through collaboration with the American Medical Association, HMA ensures Hawai‘i’s priorities are also represented nationally, and that HMA has access to the most up-to-date practice and policy resources.

Joining HMA provides timely legislative updates, advocacy resources, and opportunities to influence health policy. Add your voice - join HMA today at hawaiimedicalassociation.org and help shape the future of healthcare in Hawaiʻi.

With the large grant from the RHTP, combined with the new GET tax exemption, we’re hoping to see better health outcomes for Hawaiʻi’s most vulnerable populations. Notes HMA member Kelley Withy, MD, Director of the Hawaii / Pacific Basin Area Health Education Center, “My hope is that we can provide enough training, scholarships and incentives to rural healthcare workers to fully staff the rural areas of Hawaii.”

The five-year plan seeks to transform the rural health care delivery system in a sustainable manner that will improve healthcare access, quality, and outcomes for the rural population that comprise 40.8% of the state (all neighbor islands and rural parts of Oahu).

The plan is built around six interconnected initiatives:

• Rural Health Information Network (RHIN) - A statewide digital backbone connecting rural hospitals, clinics and health centers through interoperable electronic health records, secure wireless networks, referral systems and shared data platforms.
• Pili Ola Telehealth Network - A statewide telehealth system expanding virtual care by deploying access points in schools, libraries, workplaces and community centers, supported by telehealth navigators and remote patient monitoring.
• Rural Infrastructure for Care Access (RICA) - Expansion of emergency medical services, mobile healthcare, community paramedicine and behavioral health capacity, including a real-time statewide emergency and trauma coordination center.
• HOME RUN: Rural Healthcare Workforce Pipeline - New rural training sites, residencies, nursing transition-to-practice programs, high-school healthcare certificates, scholarships and incentives to recruit and retain healthcare professionals.
• Rural Respite Network - Five new medical respite centers in Kauaʻi, Maui, Kona, Hilo and Waiʻanae to reduce preventable hospital stays and support recovery for patients experiencing homelessness or post-acute medical needs.
• Rural Value-Based Innovation and AHEAD Readiness Fund - A competitive fund helping rural providers adopt value-based care and population health models, preparing Hawaiʻi for the CMS AHEAD payment system.

For the latest updates and details on RHTP, please visit the Engage Hawaii website by clicking here.

Across the nation - and here in Hawai‘i - healthcare is changing rapidly. Consolidation, workforce shortages, rising administrative burden, and shifting models of care are no longer distant policy discussions. They show up every day in how we care for patients. Decisions that affect our practice are being considered quickly and at a high level, often without enough physician input.

Recent headlines read: Hawai‘i Pacific Health and HMSA announce plans to move forward with an affiliation. The premise underlying this and other industry changes is clear - healthcare in Hawai‘i is on an unsustainable path.

But that headline should not end the conversation. It should begin a broader one.

As physicians, we must ask: What discussions should be happening alongside these structural changes? What perspectives need to be heard from different specialties, from neighbor islands, from hospital-based physicians, private practices, rural clinics, and safety-net settings? What is working - and what is not - depending on how and where we practice?

The Hawai‘i Medical Association exists for moments like this. HMA is not a decision making body. It is a container - a place where physicians can come together to listen, build relationships, and speak honestly about the realities of practicing medicine in Hawai‘i. It is where we can ask hard questions together, grounded in lived clinical experience.

Physician colleagues, I invite your thoughts:

• What changes need to happen now to make practicing medicine in Hawai‘i sustainable?
• How do we meaningfully reduce administrative burden?
• What would it take to eliminate or reform prior authorization?
• Is there a role for more uniform or universal billing structures?
• How do we improve Medicaid administration so it better supports patients and clinicians alike?

The physician voice is strongest when it is collective. Organizing that voice begins with showing up - to meetings, forums, and conversations with colleagues across islands and specialties.

I encourage physicians to consider committing to HMA membership for at least two years. Give yourself time to listen, engage, and understand the breadth of perspectives within our profession. This is how trust forms. This is how alignment begins. Hawai‘i’s healthcare future should not be shaped without the voices of those who practice medicine here. Together, we can help ensure that care in our state remains equitable, patient centered, and grounded in the values that brought us to medicine.

I invite you to be part of that work.

Your colleague,

Nadine Tenn Salle, MD

President of your Hawaii Medical Association

Advocacy for Hawai‘i physicians is the main function of HMA, and to prepare for each new legislative session, we poll our membership to discover the priorities they find most important. From that, HMA designs its legislative priorities for the session, and shares these priorities with every legislator.

Meet our HMA Public Policy Committee for 2026:

• Elizabeth Ann Ignacio, MD - Chair
• Robert Carlisle, MD & Christina Marzo, MD - Vice Chairs
• Linda Rosehill, JD - Government Relations
• Marc Alexander, Executive Director

Our team will be working diligently to ensure our legislative priorities are known to all members of the House and Senate, and will track the bills and resolutions that affect healthcare in Hawai‘i.

You can read the legislative priorities report shared with each legislator by clicking here.

Now called Act 47, the tax exemption is set to go into effect on January 1, 2026. We want our members - and all healthcare professionals - to take full advantage of this new tax law.

HMA canvassed our membership and collected questions regarding Act 47, and working in conjunction with the Hawaii / Pacific Basin Area Health Education Center (AHEC) and JABSOM - those questions were posed to Garrison Kurth, from the Hawaii Department of Taxation. The conversation was recorded, and we encourage all members to view the recording on the HMA YouTube Channel by clicking here.

This was evident during HMA’s December 18 panel examining the proposed HMSA–HPH affiliation. The discussion brought together health system leaders with differing perspectives, yet a shared premise: Hawai‘i’s healthcare system is under significant strain and cannot continue under business as usual. Rising costs, workforce shortages, deferred care following COVID, administrative  burden, and the realities of geographic isolation and cost of living are converging in ways that threaten access, affordability, and sustainability.

Panelists described both the promise and the risks of consolidation. One perspective emphasized the potential to reduce duplicative administrative costs, align incentives, and reinvest savings into bending the cost curve, strengthening services statewide—including neighbor islands—and supporting workforce and upstream social investments. Another perspective raised serious concerns about unintended consequences, particularly the fragility of safety-net services and how even modest shifts in commercial volume could destabilize care for Medicaid, behavioral health, trauma, and other essential populations. A third, integrated-system perspective reinforced that alignment and reducimg administrative waste—especially prior authorization—are critical, while underscoring the need for transparency, accountability, and demonstrable community benefit.

Importantly, the discussion surfaced unresolved questions: how regulatory safeguards would be enforced over time; whether “open system” commitments can truly prevent unintended patient steering; how safety-net providers would be protected structurally; and how any savings would be measured, audited, and equitably distributed. Yet there was also meaningful alignment. All agreed that the current system is unsustainable, workforce shortages are acute, administrative burden is harmful, neighbor-island access requires structural solutions, and Hawai‘i needs a strong, diverse provider ecosystem to serve its people.

As we look ahead to the 2026 legislative session, HMA will focus on fostering physician-inclusive policy discussions that are grounded in clinical experience and informed by those delivering care every day. Our role will be to convene and partner thoughtfully with health systems, insurers, and legislators—ensuring that proposed solutions are examined through the lived realities of private practitioners, rural and neighbor-island physicians, and those caring for our most vulnerable populations. Through respectful, evidence-based advocacy, HMA will work to elevate practical reforms in prior authorization, workforce stabilization, and access, while remaining mindful of Hawai‘i’s unique geography, communities, and shared kuleana.

HMA is not a decision-making body for the healthcare system. We are a trusted container for physicians—a place where difficult conversations can occur with integrity, nuance, and mutual respect. As we enter the new year, our commitment remains clear: to rebuild and strengthen the physician voice, to engage constructively across differences, and to help shape a healthier Hawai‘i for the next generation.

Mahalo for your leadership, your service, and your partnership. Encourage a physician colleague to join HMA in 2026

As we gather with loved ones, HMA celebrates a year of meaningful progress driven by you—our physician community. We secured prior authorization reform (HB250/Act 151), advanced continuity of care through transparent, datadriven standards, and countered national trends by growing membership across the islands. We launched the “Your Care is At Our Core” campaign to amplify the physician-patient relationship, and Ola Pono Ike 2025 delivered strong results— over 400 people celebrating our awesome physician leaders—fueling advocacy and education. We also stood up for fairness in contracts with our amicus brief and media presence following the Hawaiʻi State Supreme Court’s decision on Nitta v. HMSA, and deepened collaboration with HCMS while strengthening HMA’s longterm sustainability. HMA’s convening role was evident with our recent Conversations at HMA: Ensuring healthcare access, equity, and sustainability In Hawaii; understanding the potential HPH-HMSA Affiliation and its impact, with the CEOs of Hawaiʻi Pacific Health (Ray Vara), Queen’s (Jason Chang), and Kaiser (Ed Chan), moderated by HMA President Dr. Nadine Tenn Salle. Healthcare is in a tough place, but you can count on HMA to be on the frontline for physicians and their patients, in a spirit of collaboration and aloha with all stakeholders.

Mahalo for your advocacy, care, and aloha. May the season bring peace and renewed purpose as we keep moving forward— together.

With aloha,

Marc Alexander

Executive Director

It was an honor to speak with so many of you at our recent Ola Pono ike Gala and Officer Installation. That evening marked more than a transition in leadership - it marked a reaffirmation of our shared purpose.

We are living in a time of undeniable strain across our healthcare system. From rising costs and provider shortages to the very real burnout affecting our colleagues, especially on the neighbor islands, we know that patchwork fixes won’t carry us forward. What we need now is collective action - led by physicians, rooted in community, and sustained through collaboration.

That’s the foundation we’re building this year at HMA.

Our priorities begin with strengthening public policy and advocacy. But we won’t do this in isolation. True advocacy requires a shared voice - one that includes clinicians across all islands, leaders of our hospitals and health plans, and voices from the Department of Health and our medical schools.

We are also working to create more collaborative spaces for physicians - forums where we can gather to ask, “What do we need to practice medicine here in Hawaiʻi with integrity, equity, and joy?” This isn’t theoretical. It’s about shaping how policy is written, how systems are built, and how our profession is respected.

To do this, HMA must grow - not just in membership numbers, but in engagement. In the months ahead, you’ll see new opportunities for involvement across committees, events, and advocacy efforts. We invite not only practicing physicians, but also medical students and residents, to be part of this future. They are not just the next generation - they are part of the now.

And to our colleagues on the neighbor islands: your experience must help guide HMA. We hear the urgency in your voices and see the growing inequities in access. We are committed to ensuring you are at the center - not the periphery - of every statewide healthcare conversation.

We’re asking every member of our physician community to take a moment to show your support. Help us achieve these goals through an active membership. If you’re already a member, consider gifting a younger colleague a membership to encourage participation and mentorship. Join a committee. Lend your voice.

If there has ever been a time to step forward - it is now.

We want to hear from you.

Together, we can strengthen the future of medicine in Hawaiʻi.

Thank you for all that you do. I look forward to serving with you this year.

Warmly,

Nadine Tenn Salle, MD

President Hawaiʻi Medical Association

n.tennsalle@hawaiimedicalassociation.org

As we celebrate Thanksgiving, HMA extends heartfelt gratitude to you - our valued members. Over the past few years, your support has helped us achieve significant legislative milestones, including prior authorization reform and the General Excise Tax (GET) exemption, strengthening healthcare access and affordability for our community.

Looking ahead, we remain committed to moving important discussions forward - such as creating licensing pathways for international medical graduates, advancing quality care through telehealth, ensuring patient safety by limiting prescriptive authority, and making the practice of medicine easier and more affordable. These efforts reflect our shared vision for a stronger, more equitable healthcare system.

Thank you for standing TOGETHER in our shared mission to advocate for physicians and their patients. Wishing you and your loved ones a joyful Thanksgiving f illed with peace, gratitude, and hope for the future.

With aloha,

Marc Alexander

Executive Director, Hawaii Medical Association

Hawaii healthcare has met continued challenges including our significant clinical workforce shortages, the exacerbated physician and team burnout, the broken payment system, health inequities and access disparities. I know well that our HMA work is not done.

But I feel inspired and emboldened by our HMA successes achieved with aloha, and I look forward to continuing our work, empowering patients, leveraging data, fostering interdisciplinary partnerships, and improving communication to build a healthier future for all of Hawaii.

Mahalo nui loa and Salamat po for the honor of this term.

In a profession as demanding as medicine, comradery among physicians is not just a luxury—it’s a necessity. The support and understanding shared among colleagues provide a vital buffer against the stresses and emotional toll that come with caring for patients day in and day out, and the administrative burden which has become endemic to the practice of medicine today. HMA’s membership is very diverse, with employed and private practice physicians, those in urban and rural areas, leaders in government, healthcare, and the insurance industry, primary care and specialists of every stripe, those just starting their practice and physicians long-retired but active in the community, and the same range of political positions as found in the community at large. With this wonderful diversity, what unites physicians first and foremost is their shared profession as physicians, and the shared commitment expressed in the motto of our campaign with the American Medical Association, “Your Care is at Our Core.”

Events such as HMA’s Ola Pono Ike, and even smaller hybrid gatherings like Conversations at HMA, exemplify, foster, and celebrate the power of these connections, relationships, and fundamental raison d’être of the physician. Ola Pono Ike, which brings together healthcare professionals from around the state to celebrate and honor exemplary physician leaders, offers physicians a valuable opportunity to step out of the clinical and administrative environment and connect with each other on a personal level. These gatherings encourage open dialogue, mutual support, and the sharing of experiences that help physicians realize they are not alone in their challenges, and they can count on each other for support.

Ola Pono Ike is on Saturday, October 25, 2025, at the Hilton Hawaiian Village, Coral Ballroom, starting at 5:30pm. To host a table and register, visit the HMA website at hawaiimedicalassociation.org.

Founded in 1968 as a 501 (c)3 nonprofit organization, the Hawaii Medical Foundation supports charitable, scientific, educational, and literary needs in the medical community. Currently, major support is in the following areas:

• Geriatrics Fund for Department of Geriatrics, JABSOM
• Medical Education
• Patient Education
• Administrative / Fiscal Support for CME-approved medical education course
• White Coat Ceremony: JABSOM entering medical school class ceremony
• ‘Imi Ho’ōla Movie Project
• Future project: Annual Physician Leadership Academy

If you’d like to make a donation to support any of these important projects, visit hawaiimedicalfoundation.org.

This year’s meeting was held August 12-14 in Olympic Valley, California, and brought together over 130 participants from almost every state and many specialty societies. Key topics included prior authorization, the overdose epidemic, HR 1’s impact (e.g., Medicaid cuts, the Rural Health Transformation Program), physician wellness, scope of practice issues, and AI in healthcare. Materials from the meeting, including the agenda, presentations, resources, and references, will be posted in the HMA members-only section online. The opportunity to have frank discussions around strategy and to learn with colleagues fighting similar battles was invaluable.

Another featured topic was the national and state “Your Care is at Our Core” campaign. With all the demands placed on today’s physicians, people can forget that what drives physicians is trust, empathy, compassion, and a desire to spend time with their patients. This campaign seeks to highlight these values, and amplify the patient-physician relationship. HMA just launched Hawaii’s campaign on July 28, 2025, and already our digital postings have garnered hundreds of views. Visit the HMA website for more information.

The mission of this program is to improve quality and access to health care for those experiencing homelessness, while increasing student and physician awareness and understanding of this community and their healthcare needs.

The H.O.M.E Project currently provides free medical services to homeless individuals at the Pai‘olu Kaiaulu Shelter in Wai‘anae, the Onelauena Shelter in Kalaeloa, the IHS Men’s Shelter in Iwilei, and those that receive meals at the First United Methodist church in Honolulu. In addition, it also utilizes a mobile health van for medical outreach services to the unsheltered homeless individuals in the Kaka‘ako area.

A Student-Run Clinic
The Hawai‘i H.O.M.E. Project provides student-run free clinics, where medical students, pre-medical students, and other volunteers manage most of the duties of running the clinics. Students in all levels of medical training participate in seeing the patients, both as part of their educational curriculum and as volunteers. The students are supervised at all times by faculty physicians from the medical school and volunteer physicians from the community.

“I love the fact that I’m getting involved at this stage of my education. We provide care in a setting where it’s just two people; I learn so much from them while I treat them” said Christyn Mellor, second year JABSOM student. Says third year JABSOM student Mari Camacho: “It’s real world problem solving, and I have to be a doctor, nurse, and social
worker. We get close to patients, as we build trust and meet them where they’re at.” And third year JABSOM student Tracie Okamura says: “This experience will make me a better
doctor. I get to see patients as they are, not just as a diagnosis.”

The funding for clinic services comes mainly from donations, fund raising activities, and grants. The physician supervisors all volunteer their time to work at the clinic. (HMA supports the H.O.M.E. Project by making it a recipient of a nonprofit grant, awarded at our annual Ola Pono Ike Gala)

The H.O.M.E. Project provides management of acute and chronic health care problems, health maintenance / preventive services, vaccinations / TB testing, laboratory testing, minor surgical procedures, general physical exams, health counseling, medications for those without insurance, and oral health assessments.

To learn more and to donate to the H.O.M.E. Project, visit sites.google.com/view/hawaiihomeproject.

The United States faces a new kind of threat to public health - not a virus itself, but growing doubt around the tools used to prevent it. Since taking office as U.S. Secretary of Health and Human Services, Robert F. Kennedy Jr. has initiated a series of policy changes that depart sharply from established scientific consensus. He has disbanded key panels that guided national vaccine policy, altered membership on the U.S. Preventive Services Task Force, and revoked long-standing COVID-19 vaccination recommendations for pregnant women and healthy children.

Some of Secretary Kennedy’s concerns - such as the call for greater transparency in regulatory processes and emphasis on preventive health through nutrition and lifestyle - are not without merit. Public health should always strive to earn public trust through openness and responsiveness. But the danger lies in allowing ideology or conspiracy to masquerade as balanced debate. When scientifically vetted guidance is weakened or withdrawn without credible alternatives, the result is confusion - especially among parents trying to make informed decisions for their families.

This confusion carries consequences. Measles is often dismissed as a childhood illness, but it remains one of the most infectious diseases in the world. Up to 90% of susceptible people exposed to measles will become infected. Complications range from pneumonia to encephalitis, and death is still a very real risk, especially for children under five.

Here in Hawai‘i, low vaccination rates in some rural and neighbor island communities - combined with increased vaccine skepticism - place the state at real risk. Geographic isolation, limited pediatric access, and a long history of medical trauma among Native Hawaiian communities all contribute to today’s complex landscape. But these challenges should motivate more outreach, not less. They call for facts that meet people where they are, for education rooted in trust and dignity.

Measles may be the canary in the coal mine - an early warning that public health is being weakened not just by disease, but by the erosion of shared truth. The 2019 Samoa mission showed that with urgency and unity, outbreaks can be stopped. That lesson must guide us now.

This must remain a conversation - not a mandate. Personal choice should always be honored. But those choices must be informed by science, not speculation. Let us choose to protect each other, through compassion, clarity, and commitment to facts.