Healthcare Recruiting
Hawaii PA License 2026: Physician Assistant Requirements, Process, and Salary
Hawaii physician assistants are licensed by the Hawaii Medical Board (under the Department of Commerce and Consumer Affairs). The state requires a supervision agreement and has longer processing times than most states — 10–14 weeks is a practical planning horizon. Hawaii's extreme cost of living means that PA salaries, while nominally higher than many mainland states, often represent lower purchasing power in practice. Outer island positions (Maui, Kauai, Molokai, Lanai) carry genuine shortage premiums that partially offset the COL burden.
Practice Model: Supervision Required
Hawaii PAs must have a written supervision agreement with a licensed Hawaii physician. The agreement defines scope of practice and prescriptive authority. No on-site physician presence is required for routine PA practice.
- Supervision agreement: Required before clinical practice
- Prescriptive authority: Schedule II–V with DEA registration under the supervision agreement
- Outer islands: PAs often practice with significant practical independence on outer islands where physician availability is limited
Application Requirements
- Active NCCPA certification
- Graduation from ARC-PA accredited program
- Hawaii Medical Board application and fee (~$275)
- Supervision agreement
- Background check
- DEA registration (if prescribing controlled substances)
Processing Timeline
The Hawaii Medical Board processes PA applications in 10–14 weeks — one of the longest timelines in the country. Begin the application immediately after accepting a Hawaii position. Total time to practice-ready including DEA: approximately 12–16 weeks.
PA Salary in Hawaii (2026)
| Setting | Median Base | Typical Sign-On |
|---|---|---|
| Hospital / Inpatient (Oahu) | $138,000 | $10,000–$20,000 |
| Emergency Medicine | $142,000 | $10,000–$20,000 |
| Outer Island (Maui / Kauai) | $148,000–$165,000 | $15,000–$30,000 |
| Primary Care / Outpatient | $126,000 | $8,000–$15,000 |
| Kaiser Hawaii (integrated) | $135,000 | Minimal (internal scale) |
Top PA Employers in Hawaii
Queen's Health Systems (Queen's Medical Center — Oahu, and facilities on Big Island) is the state's largest non-profit health system and primary academic PA employer. Hawaii Pacific Health (Pali Momi, Kapiolani, Straub, Wilcox Medical Center on Kauai) operates the state's most geographically diverse system, with the Kauai campus creating outer-island PA opportunities. Kaiser Permanente Hawaii operates an integrated health plan with its own PA career track. Outer island positions — particularly Maui Memorial Medical Center and Hilo Medical Center (Big Island) — recruit for primary care, ER, and hospitalist PA roles with hardship-adjacent premiums.
What We See at Ava Health
Hawaii PA candidates must plan for the long licensure timeline — 12–16 weeks from application to practice-ready is not unusual. The most successful Hawaii placements start the Medical Board application concurrent with signing the employment offer. Outer island positions are genuinely competitive nationally for PAs who want adventure, clinical autonomy, and above-average compensation; the Kauai and Maui markets are the most active for sign-on competition.
Related: NP License Hawaii 2026, PA Salary by State 2026, Healthcare Recruiting in Hawaii 2026.
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