State lawmakers are continuing to wrestle with how to attract more physicians to rural areas where primary care is limited.

Senate Bill 665 and its House companion, HB 1383, would give the University of Hawaii John A. Burns School of Medicine a total of $1.86 million to bring more Hawaiians and Pacific Islanders into the medical school program, expand the number of residency students in primary care and continue loan repayment for doctors who practice in rural communities.

"Young people coming out of medical school (nationwide) are not choosing primary care. They are choosing specialities because it pays more," said Keawe Kaholokula, chairman of the Department of Native Hawaiian Health at the medical school. "We’re losing them to surgery (and other specialties). And we’re losing a lot of primary care physicians as they age. It’s very critical because primary care doctors are the safety net."

The state is short an estimated 635 physicians, both in primary care and specialty areas, according to the school’s Hawaii Health Workforce Assessment. Slightly more than a quarter of the state’s practicing doctors are already at retirement age, the study said.

What’s more, while Native Hawaiians have among the highest rates of diabetes, cancer, heart disease and obesity, they are underrepresented in all health professions, according to testimony Monday from the medical school. Only 4 percent of the state’s licensed physicians are of Hawaiian or Pacific Islander ancestry, though 26 percent of the population is of that heritage.

Kaimana Chow, 25, a second-year medical student who received support for tuition and living expenses through the Imi Hoola program, a 12-month boot camp for students from disadvantaged backgrounds, plans to eventually return to his native Molokai to work in primary care.

"I definitely want to move back," he said. "Those kind of rural communities have higher rates of (chronic disease), all things that can be addressed through primary care."

Perhaps the most pressing need the bill seeks to deal with is new funding for the Native Hawaiian Center of Excellence, which encourages more than 2,500 students annually from kindergarten through college to consider health careers. Roughly $700,000 in federal money expires in June, threatening its sustainability.

"Without these funds we won’t have staff and resources to pay for activities and to provide the pipeline of promising students to the Imi Hoola program," said Winona Mesiona Lee, program director.

The measures come as the federal government begins to implement the Affordable Care Act, which largely focuses on increasing the primary care workforce in America.