EWA, OAHU (HawaiiNewsNow) - Hawaii has the dubious distinction of being the third worst state in the nation to practice medicine, according to a recent study.
WalletHub sites physician wages and lack of opportunity as hurting the state.
Doctors who stay say they practice in the islands because they're dedicated to their home and their communities.
Dr. Scott McCaffrey practices family and emergency medicine. Like many Hawaii doctors, he feels the financial pain of practicing in Hawaii: Lower pay, high costs and medical school debt.
"All those factors are together in a perfect storm that makes it a difficult place to start a practice particularly if you are going to have a private practice as a solo practitioner," said McCaffrey, medical director and CEO of Workstar Injury Recovery Center in Ewa.
For smaller operations, it's difficult to keep up with paperwork requirements, he said.
"The great diversity of people that we have here can only attract doctors to a certain point beyond that we have to get revenue and resources to bear on this problem," he said.
Meanwhile, younger doctors say financial aid and other assistance has helped them cut down on debt.
"I'm really fortunate that I have scholarships that are supported by the community," said Michael Brigoli, a University of Hawaii medical school graduate.
"As medical professionals, we've heard a lot of disgruntling things, but it doesn't really stop us. It helps us want to make it better," added Leimomi Kanagusuku.
While medical opportunities may be more enticing on the mainland, these fledgling doctors want to practice in Hawaii and in their hometowns.
"Working as a physician in Hawaii is a lot more than financial reimbursement. This is my community this is my home," said Brigoli, who hopes to practice internal medicine on the east side of Hawaii island.
Kanagusuku hopes to practice family medicine on Oahu's Leeward Coast.
"That's where my heart is and that's always been the dream," she said.