Two years ago, the University of Hawaii estimated that Hawaii’s statewide physician shortage was slightly over 1,000. Last year the shortage was calculated to be “at least 750 full-time providers.” There is no reason to think that it has gotten better since then. Many physicians are contemplating retirement, particularly those feeling overworked and underpaid.

People who go into medicine are not primarily motivated by the desire to get rich. However, they all want to start a family, live in comfortable homes, have their children get the best education available and pay off their substantial educational debt. According to Indeed Career Guide, Hawaii is 46th out of 50 states in average physician salaries, before adjusting for cost-of-living differences. We are lower than Mississippi and far lower than Alabama, where life and housing cost far less.

Most physicians who grew up here would prefer to stay here if the sacrifices involved in that choice are not too great. However, we must recognize that the market for medical school and fellowship graduates is a national one, and that physician salaries on the mainland are much higher than they are here, even before one considers Hawaii’s high cost of housing and cost of living. This makes it difficult to retain graduates who grew up here, and almost impossible to recruit graduates from the mainland. Hence, the doctor shortage.

What can be done? We must consider subsidizing, by way of educational loan forgiveness or housing subsidies, graduates who commit to practicing in Hawaii. We must also persuade our government and health care insurers to increase reimbursement rates for physicians’ services, and persuade our hospitals and clinics to find a way to increase physician pay. Some people may feel that doctors are already well-paid or overpaid. However, the physician shortage is proof to the contrary; Hawaii has been unable to attract and retain the doctors that it needs, especially on the neighbor islands.

Recently hospitals have recognized the need to pay nurses more in order to attract and retain them. This same need exists for doctors, but there has been much less effort in that direction, despite the shortage that should tell everyone that something needs to be done there, as well. The solution is difficult, because hospital budgets are also strained.

We all want good medical care. Sadly, we must face the fact that this costs money. Reliance upon the willingness of some physicians to accept lower pay to live in Hawaii goes only so far, but not far enough. Health care insurers, hospital administrators and government have to step up.

Adele Wilson is a retired Department of Education educator and mother of a medical practitioner who lives on the mainland.