Despite frantic calls to nearly a dozen oncologists after her mother was diagnosed March 21 with advanced-stage cancer, the earliest appointment that Nicole Pagan could get was 2-1/2 months away.

Her 67-year-old mother, Poni Medeiros, died 16 days later.

“Those days were spent not only with me wrapping my head around the diagnosis not knowing what it meant, but also frantically calling anybody,” said the Maui resident, 47, who said she called cancer specialists locally and on the mainland.

Because her mother didn’t get a chance to see an oncologist, the family still doesn’t know where the root of the cancer was — either in the pancreas or colon, she said.

Pagan’s experience is becoming more prevalent in the islands as patients wait weeks — sometimes months — to see doctors, particularly specialists.

Hawaii lost 51 full-time doctors from 2017 to 2018, the first loss since 2014 when 92 left the workforce, according to the latest physician workforce survey by the University of Hawaii. The state gained 75 doctors last year, 97 in 2016 and four in 2015, the survey showed.

Factors contributing to the shortage include better pay on the mainland, frustrations over lower health insurance payments and increasingly onerous regulations to practice medicine, said UH professor Kelley Withy, who conducts the annual survey.

“This just makes it more challenging for patients to get the care they need when they need it, which could end in significant health impairments and patient suffering,” she said.

The survey is based on the national average for utilization of services, and the number of physicians in comparable populations on the mainland.

By county, Hawaii island has the worst shortage at 41.2 percent, followed by Maui County at 33.8 percent, Kauai at 32.9 percent and Oahu at 16.5 percent. Oahu is short 384 doctors, up from 381 last year, while the Big Island needs 213, up from 196; Maui County needs 141, up from 139; and Kauai needs 59, up from 53. While nearly 10,000 physicians are licensed in the state, only about 3,400 are practicing, according to the survey.

One Big Island neurologist is scheduling appointments a month out for existing patients and three months out for new patients, while a Maui oncologist is scheduling appointments for November. On Oahu, ear, nose and throat specialists are scheduling patients for February, and on Kauai the same type of doctors are taking patients in October, the Honolulu Star-Advertiser found.

Shana Laririt, 42, a clinical social worker on Maui, said the shortage affects mental health as well.

“We’ve gone through periods of time, particularly for geriatrics, when there is no geriatric psychiatrists. It has been as high as a two-month wait to get a psychiatry appointment. It’s pretty detrimental because then you’re looking at someone utilizing crisis resources — the emergency room. And it’s detrimental to the person, too. They’re suffering. They’re sometimes suicidal or homicidal. It’s definitely a danger for their safety. It’s a community safety issue, too.”

Laririt has personally been affected by the doctor shortage. When her 6-year-old son needed to see a gastroenterologist, specializing in digestive system illnesses, she had to pay out of pocket to fly to Oahu because insurance doesn’t cover travel expenses and Maui had recently lost its only pediatric gastroenterologist, she said.

“Even to secure that appointment took a month and a half,” she said. “Three hundred dollars out of pocket to take my kid to see pediatric GI. Now we’re looking at having to take him every six months, and now he needs to see a pediatric urologist — another $300 flight. It definitely can be anxiety-provoking.”

Dr. Edward Gutteling, an orthopedic surgeon in Hilo, said people with significant injuries end up in the ER, unable to see a specialist for weeks.

“The ER will put them in a splint and send them home, then they will call up (a doctor) and get the runaround,” he said. “The staff is so busy. They’re sent home from the ER with a problem that needs to be addressed within days, and when they call up (are) told they can’t be seen for months. The patient is left there twisting in the wind, unable to get the care they need. That’s a horrible thing if the patient’s just left in the cracks like that.”