Want to Be a Nephrologist in Hawaii? This is What It’s Like!

We talked to Hawaii Kidney Specialists Executive Director Charlotte Dixon to ask what it’s like living and working in one of the most beautiful and unique locations in the world.

What do you like most about living in Hawaii?

Honestly, it is the climate and the ability to really enjoy your environment all year round. It’s never so hot or so cold here that it is oppressive.

What are the challenges of being so remote?

Cost is the first challenge most people will bring up. Because everything needs to be shipped in, things are more expensive here. You also don’t have the same amount of variety that most people are used to. You may only have ten options for salad dressing or three options for pizza. 

Convenience is another factor. There is no such thing as Amazon same-day delivery when you are thousands of miles from the mainland. Living here requires a big adjustment from how you’re used to doing things as opposed to how the island dictates you do them.

Hawaii Kidney Specialists is the largest nephrology practice in Hawaii — how has it grown and evolved over the years? 

When I joined the practice it had six doctors and the staffing situation stayed relatively static for a while. The nature of the nephrologist landscape here on the island is that there are a lot of individual doctors practicing and some group practices. Since I arrived in 2020, we’ve had one physician retire, but we’ve hired four and have two more starting next year.

Generally speaking, there is a serious lack of providers in Hawaii. There are significantly more people needing to see physicians than there are practitioners to provide that care. That is especially true for the smaller outer islands. One of the things we’ve worked towards is getting more providers here to help relieve that pressure. Patients should be able to be seen when they need to be seen, but there are only so many hours in a day.

On that note, J-visa holders may be interested in the fact that Hawaii almost always has slots that go unfilled. Of course, the other side of that is that some practices are cautious about hiring a physician that may leave in three years.

Can you speak to the transient nature, visa or not, of physicians in Hawaii?

For most people, after a year of living here, you are either ready to stay forever or you are ready to leave as soon as possible. It takes at least five or six hours by plane to get anywhere that isn’t Hawaii. For some people, this feels confining. 

It’s not that there isn’t plenty to do in Hawaii. The natural beauty of the islands is unparalleled. And Oahu is an incredibly busy metropolitan area. It has all the luxury, shopping, and dining you could want from a city.  The test is simply the idea of living on an island that is so far from everything else.  It’s either for you or it isn’t.  

How is the Hawaii medical landscape unique?

It’s a diverse landscape. We have a high rate of turnover, some of which is expected but some isn’t. A physician may love living in Hawaii, but if their spouse doesn’t, staying here isn’t an option. 

Private schools are expensive and highly competitive because there are so few of them. The entire private school landscape is in Honolulu, so a doctor with kids, or who is planning to have them, has to navigate the school system.  Like anywhere, some of Hawaii’s public schools are good, but some aren’t.  So, this becomes a recruiting issue for us, especially on the outer islands.

There is a pretty diverse mix of background for the physicians practicing here as well. They come from the islands – but from everywhere else as well.

What would you say to nephrologists considering relocating to Hawaii?

I would ask them “Have you been here”?  It sounds silly, but lots of people have an idea of Hawaii based on what they’ve seen on TV and in movies, but that’s not the reality. To really understand Hawaii, you have to visit and you have to get out of Waikiki when you do it.  

My best advice is to talk to people who have moved here. Consider where your family and your ties are. Because you can’t just pop down and see grandma whenever you want.  Getting to most places takes between five and twelve hours depending on how many flights you have to catch.  

This is a challenge for those with family in the United States, but it is great for people who have family in Japan or the Philippines because we’re much closer to them. 

Finally, I would ask if they are ready to be here for a while. Moving to Hawaii is a commitment. It’s not easy to move here and then change your mind to go somewhere else.

I would also ask them if they are ready to practice a little differently. The concepts of ohana and malama are big here and they really do influence the practice of medicine, I think in a good way.

How does your group handle work/life balance? 

Work/life balance is one of the most important things here and it is one of the main reasons I took this job. I think the idea of balance is baked into the culture here in Hawaii more so than it is on the mainland. 

There is a pervading idea here that you work to live, you don’t live to work. Everyone wants you to spend time with your family and enjoy the beautiful place you’ve chosen to live. We don’t want physicians working 4 am-10 pm every night.   

A lot of places on the mainland expect that nephrologists should have 24/7 availability for all the time, no matter what. Here on the island, we tend to respect people’s time more, especially their private time.   

What would you say your team of nephrologists enjoy most about working in Hawaii?  

It’s working in Hawaii! They all enjoy what all the islands have to offer. For example, I go snorkeling every single weekend in one of the most beautiful bays in the world. One of my doctors takes his kids bodyboarding every weekend, another hikes every weekend with their family. And several of them are very involved in the outreach projects of their kid’s schools.

Another thing is that our doctors enjoy a real sense of camaraderie as a group. We’ve worked hard to foster an environment where they are a group of physicians, not a group of individuals that just so happen to share expenses. They are a genuine support for each other.

What unique opportunities exist here?

The population in Hawaii is very different from anywhere else in the world. There is the native Hawaiian population as well as a large East Asian population —  Indian, Malaysian, Filipino, Japanese, etc. Every unique ethnic population has its unique medical concerns specific to it.  And practicing medicine in a remote place brings its own unique challenges. It is an underserved area so you get to really feel and see the difference you make and how much it is appreciated.

Also, Hawaii is the perfect place for home dialysis. People are spread out here, there aren’t great places for central dialysis clinics in any areas. Transportation can be an issue both on-island and inter-island. Home dialysis allows patients to get the care they need. The heavy tourism.retirement element here means there are unique opportunities for innovation.  We’ve discussed the possibility of having home dialysis machines prepared by dialysis companies set up in hotel rooms for travelers. 

Why do you believe physicians should consider Hawaii as a viable option for a long-term career? 

First and foremost is the weather. Climate change is a real thing, but it is mitigated here on the island in a way that it just isn’t in other places. I grew up in Texas and it has definitely gotten hotter in the summer and colder in the winters there. 

Hawaii is also a wonderful place to raise a family. You can eat outside all year round. You can hike, you can boat, you can swim — any time you want. Many people don’t realize this, but Hawaii has virtually every kind of natural environment you would want to explore. We’ve got volcanos, rainforests, dry deserts, and even snowy mountains.  

I think my favorite thing about it, though, is that the people here tend to look out for each other in a way you don’t get in many other parts of the world. It really is a community.