Neurology Services in Rural Hawaii: A Survey of Primary Care Physician Perspectives on Kauai
Nicole Hada1, J. Douglas Miles2
1John A. Burns School of Medicine, University of Hawaii, 2The Queen's Medical Center
Objective:
The objective of our study was to survey primary care physicians (PCPs) on the rural island of Kauai, Hawaii to identify physician reported experiences, needs, and barriers to caring for patients with neurologic conditions.
Background:
For patients living in rural Hawaii, the growing physician shortage exacerbates the burden of health disparities this population already experiences. According to the Hawaii Physician Workforce Report 2025, there is a 24% physician shortage in Kauai County, which is equivalent to 43 full-time physicians. Zero full-time adult and pediatric neurologists on Kauai contribute to this statistic. PCPs are one of the main providers for patients with neurologic conditions. Despite the growing role for PCPs in providing neurologic services, there is limited data on PCP reported experiences of treating patients with neurologic conditions.
Design/Methods:
A Google Form survey was administered to PCPs (Family Medicine, Internal Medicine, Pediatrics, and Obstetrics-Gynecology) on Kauai (n=14) in August 2025. PCPs completed questions about their experiences managing patients with neurologic conditions.
Results:
On a scale from 1-5 [1 = not comfortable at all, 5 = extremely comfortable], only two PCPs (14.3%) indicated “4”, five (35.7%) indicated “3”, five (35.7%) indicated “2”, and two (14.3%) indicated “1”, on how comfortable they feel managing neurological conditions. The wait time for patients on Kauai to get an appointment with a neurologist on Oahu ranges from 2-8 months. PCPs stated inadequate patient access, communication, and support from neurologists to be the leading barriers.
Conclusions:
Our study defines the direct impact a shortage of neurologists on Kauai has on PCPs and the patients with neurologic conditions they care for by identifying needs and barriers for services. Identifying the most important barriers based on PCP perspectives could be valuable for PCPs hoping to establish or improve care for patients needing neurology services in rural Hawaii.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.