What happens if you break your leg on the Big Island on a weekend? Chances are you, get airlifted to Honolulu. Ditto for many other serious but, in most cases, not lifethreatening problems. The Outer Islands have long struggled to attract physicians and specialists. They get roughly 25% less pay than colleagues on the Mainland and pay cost of living that's roughly 25% more, plus there is a higher demand for on-call services.

That means less down time. It all adds up to a very unpleasant environment for docs. Which explains why, well, there aren't many of them on Kauai, Maui, or the Big Island. At a conference attended by many docs, one participant said, straight-up, (I paraphrase but...) "I sure wouldn't want to get in a car crash on the Big Island." Gulp. The upshot of all this? In reality, outside of Honolulu Hawaii is essentially a Third-World country in terms of health care facilities. Even in Honolulu, things can be tricky. Sometimes the hospitals have been unable to get a qualified neurosurgeon to take call. There are also only two orthopedic surgeons on call on Oahu at any given time (for a population of over 800,000). So if you are compound fracture number three then you are plain outta luck.

—Alex, 02/07/07