I moved here in 2009 (and am moving back to the mainland next month). The pay is bupkus - the group for which I worked covered 2 hospitals - one saw about 40K per year, but was the worst run ED I'd ever seen, and the hospital had IM hospitalists - they didn't even have general surgery 7 days a week. Of other specialists, they were all handshake agreements, and, as such, spotty (like, if you were the new guy, and wasn't an "old friend", good luck - since they weren't on the call schedule, the nice guy but old as dirt orthopod wasn't available). That was $120/hr, and I said that that was underpaid. I worked at the other hospital downtown, and that was stealing money at $100/hr.
My hospitals shut down, lights off, power off, doors chained, in December 2011. The downtown hospital is going to be changed totally to a hospice facility. The other hospital is in a strategically located position. It may be a year from now before it reopens. Who is going to staff it is a closely guarded secret. There are 3 possibilities, and also possible for a dark horse to come out of the shadows (but much less likely, because, as Ben Franklin said, "three people can keep a secret if two of them are dead). An interesting wrinkle is that there is "Hawai'i Pacific Health", which composes Straub, Kapi'olani Women's and Children's, Pali Momi, and the hospital on Kaua'i. However, EM docs work for Straub, whereas the docs at Pali Momi and on the adult side at Kap are staffed by EMP - and EMP hired on 3 more docs in February that are finishing residency in June. So, EITHER EMP OR Straub could staff the hospital, or Queen's is another option. And, with the Queen's Health Network, or the HPH network, either one is situated to have virtually every specialty available, so surgeries and referrals don't get farmed out.
The low I found was $85/hr on an outer island. The most was $160/hr, but that was for part-timers not shooting for full-time.
The jewel in the crown is Maui Memorial. They have the perfect storm over there. First, even thought the hospital is state-owned, and the docs work for the hospital, the EM docs opted out of all insurance programs, so all insurers have to pay out-of-network. But there are no other hospitals on the island, so there's nowhere else for the insurers to tell patients to go. And the people on Maui are, on the whole, more affluent. There are poor people, but the rich, by money, raise the bar much higher, so HMSA (BC/BS here in HI) and Kaiser can't disenfranchise their subscribers. Putting these all together, you get $200/hr+, but, as the guy in charge of recruiting told me, "We can give you one shift a month, but, even if we like you, it could be 4 or 5 years before a spot opens up". But that is to be expected - people don't leave good jobs, and, for EM, like other medical specialties, lifestyle, location, and pay - pick 2. On Maui, you get all three. And people on SDN have posted about places on the mainland that didn't have a doc leave in 8 years.
There was a survey two years ago about doctors in HI. Overall, the state is down 25% for staffing (believe it or don't, we don't have enough plastic surgeons here), but, for EM, we're staffed for 104%. That means that, for places that are hiring, it's because they can't keep people when there are too many. To paraphrase Marx (Groucho, that is), I would not work at any place that would hire me.
To summarize, the weather is great - every damn day is a beautiful, sunny day (except for a week in March on Maui - they had the worst rain since Hurricane Iniki in 1992). Right now, looking out my window at 11:15am, it is sunny and the sky is cloudless. Every day is 85 and every night is 70. White people from the mainland often will leave, saying "I want 4 seasons". I don't - give me a summer day every day. I don't want to leave. I just have to.
And, if one is a vagrant sleeping on the beach (all beaches, by law, in HI are public), one doesn't freeze to death. However, for my 1000 sqft apartment, I pay $1500/month. Comparatively, 10 years ago, in Queens, NY, I paid $675/month for less than 200 sqft. Buying a house was out of the question.
A better option would be a "busman's holiday" - fly in to work 5 or 7 shifts over 2 or 3 weeks (like have your mainland schedule maneuvered to be done by the 20th of one month, and start the 10th of the next month, giving you 3 weeks off), and you get your time off the do whatever. I can think of 2 people that did that (and my sample space is quite small).
Any ?, feel free to PM. There are a number of other folks that have!
