From Rural ER Doc to the Governor’s Mansion: How Hawaii Gov. Josh Green Is Rewriting the Rules of Public Health

Dr. Josh Green is one of the few people in America who’s worn both a trauma gown and a governor’s sash - sometimes at the same time. A longtime rural emergency physician on the Big Island of Hawaii, he treated patients through nights, weekends, and pandemics, even while serving in elected office. Now as Governor of Hawaii, he’s bringing a clinician’s mindset to the business of running a state and applying the lessons of triage, teamwork, and time-sensitive decision-making to crises like homelessness, healthcare access, and climate change.

On this episode of How I Doctor, Dr. Graham Walker talks with Josh about why physicians belong in public office and how medicine prepared him better than any policy degree ever could. They dive into what it’s like to govern during crises and workforce shortages, how Hawaii is proving that housing is healthcare, and why the time is now for doctors to take leadership roles beyond the bedside. If you’ve ever wondered how to make a bigger impact or what medicine could look like if physicians were the ones writing the rules this episode offers both a blueprint and a call to action.

Governor Josh Green brings an ER doc’s urgency and problem-solving mindset to the highest office in Hawaii. In this conversation, he shares why physicians are uniquely equipped to lead, how clinical experience can drive smarter policy, and what it takes to turn frustration into lasting change.

Triage Thinking in Politics: How ER Training Helps Leaders Make Faster, Better Decisions During Crises

“In the next hour, we’re going to look at all the data and we’re going to make a decision, and if the decision needs to be adjusted later, we’ll adjust. Which is very much an ER doc approach.”

In the ER, delaying a decision can mean losing a life—and Gov. Green applies the same logic to governing. He explains how the time pressure and uncertainty that define emergency medicine trained him to act decisively in high-stakes political situations, including during wildfires and housing crises. While others debate endlessly, Green gets stakeholders to the table, makes a call, and adjusts as needed. His approach may seem unorthodox in government, but he argues that acting early—even imperfectly—is often the best way to save lives and resources.

Housing Is Healthcare: A Clinician’s Case for Rethinking Public Health

“We see people use and abuse substances far less… they don’t go back to the hospital almost at all when they have a roof over their head.”

Gov. Green has seen firsthand how lack of shelter fuels ER overuse and worsens chronic disease. In Hawaii, 30% of ER visits were from unhoused individuals, driving up costs and straining limited resources. His response? Build tiny home villages—an intervention that’s led to dramatic improvements in health outcomes, reduced substance use, and fewer hospitalizations. For Green, treating housing as healthcare isn’t radical—it’s just what works.

Why Doctors Should Run: Making the Case for Physician Leadership in Politics

“Literally walk door to door in your scrubs… being a physician absolutely sets one apart, and it’s almost always in a positive way.”

Green shares how his identity as a physician not only helped him win elections but also shaped how constituents saw him—as a healer and problem-solver, not just a politician. He encourages more clinicians to run for office and is working with groups like 314 Action and his own HEAL PAC to make that happen. Doctors already have the communication skills, work ethic, and systems knowledge needed to lead. What they often lack is the push to believe their voice belongs in politics—and Green wants to change that.

Clinical Instincts, Policy Impact: How to Lead Without Losing Your Humanity

“A ton of what we do is interpersonal reassurance, expectation management, and of course sometimes a serious surgery… It’s the same in government.”

Despite stepping into the political arena, Green insists he hasn’t left medicine behind. He talks about carrying clinical instincts into public service—listening carefully, diagnosing root problems, and knowing when to escalate. Whether he’s walking his neighborhood or testifying before Congress, he sees his role as an extension of patient care. The tools of medicine, he argues, are exactly what government needs more of: empathy, clarity, and action grounded in human connection.

Find out more about Josh here and connect with him on Instagram at https://www.instagram.com/govjoshgreen/

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Transcript