It’s no secret that Hawaii faces a significant and growing shortage of doctors.

The latest study from the Hawaii Physician Workforce Assessment Project reported that by 2020 the state would have a shortage of 800 full-time physicians — and that’s the best-case scenario. The worst case: a shortage of 1,500, just four years from now.

Further complicating matters is the trend of more physicians leaving private practice to work for hospitals, raising concerns that a critical pool of independent practitioners who provide primary care is shrinking further.

As reported Sunday by Star-Advertiser writer Kristen Consillio, the percentage of Hawaii physicians employed by hospitals rose from 22 percent in 2012 to 30 percent in 2015, according to a new study by Physicians Advocacy Institute Inc.

The Queen’s Medical Center has increased the number of doctors on its staff by 15 percent to handle a growing number of patients.

“With that growth we need to hire up to meet the need,” said Dr. Kuo-Chiang Lian, medical director of the Queen’s medical group and hospitalist program.

And hire up it does: Queen’s offers a salary of $300,000 for its West Oahu campus, nearly double what a typical primary-care physician in private practice would make.

There are pros and cons associated with this migration, and the effects can be difficult to discern. Both public and private health policymakers need to track this trend closely, as part of larger ongoing efforts to ensure that people in every corner of the state, especially the poor and those living in rural areas, have ready access to quality primary health care.

Studies confirm that the Hawaii trend mirrors a national one. More doctors choose to become hospitalists — full-time employees of a single hospital — because of higher pay, access to state-of-the-art equipment and other resources, regular work hours and no overhead expenses such as office leases and salaries for nurses and staff. Low reimbursements from Medicare and Medicaid also drive doctors to the shelter of a big employer.

Dr. Scott McCaffrey, president of the Hawaii Medical Association, told Consillio of a collateral effect: It’s harder for independent physicians to hire and retain medical assistants and other professionals, who get paid a lot more to work for hospitals like Queen’s.

How this trend benefits patients is not so clear. A hospitalist at a large medical facility has better access to training and resources, which could benefit the patient.

However, medical decisions may be driven by hospital policy as much as the doctor’s own good judgment. The bureaucracy of hospital administration can decrease the doctor’s flexibility. And corporate physicians may not have the same professional and emotional connection to their patients as independent practitioners.

In Hawaii, the problem of getting quality affordable care is exacerbated by a shortage of primary care physicians, especially in rural areas where hospitals don’t reach.

“The hospitals are paying so well for inpatient work, it is drawing doctors out of primary care. It is draining the labor pool of primary care doctors that are easily accessible to the public,” McCaffrey said. Such a trend can’t continue unabated.

What is needed is a greater commitment by both the state and private providers like Queen’s to work together to invest more in ongoing efforts to expand health care where it’s needed most.

That could include more support for community health centers; expanding programs for advanced practice registered nurses, who can provide primary care; incentivizing rural medical practices through loan forgiveness; and offering more opportunities to enter the health care field (see ahec.hawaii.edu).