Nothing spells impending disaster the way this does: an aging population in need of health care with an existing shortage of doctors growing worse, day by day.

That is the state of health care in Hawaii, and despite alarm bells going off for years and some initial steps taken, it seems clear that countermeasures have not offset the decline.

As the legislative session begins its first full week, lawmakers have to redouble efforts to build a more robust foundation for the next generation of physicians, especially in Hawaii’s rural areas.

There’s no shortage of data underscoring the severity of the problem. The Physician Workforce Assessment is an ongoing research effort by Kelley Withy at the John A. Burns School of Medicine’s Area Health Education Center (AHEC) — and the word from Withy is not good.

The gap between doctor need and availability has widened by 20 percent over the past year. Updated figures from Withy’s work indicate that Hawaii is short by 890 doctors, a deficit that could shoot up as high as 1,500 in the next five years.

There are many reasons for this, but one is simple math. The baby boomers, comprising the largest generation, are retiring — physicians along with their patients. Withy projects that one-third of its practicing doctors will reach retirement age in the next five years, while those already 65 or older represent 18 percent of the workforce.

Other problems may be fueling the dash for the exits. One is the rapid change in the medical field, including the pressures exerted by the Affordable Care Act.

Some trends, including making payment hinge more on health outcomes than the number of procedures performed, already were beginning within the private medical insurance industry, but the regulations of Obamacare accelerated them.

In addition, the federal law is pressing for better coordination of care among various providers, and for the conversion to electronic medical records that make this coordination possible.

These shifts are essential, if health costs are ever to be controlled, but documenting such factors under federal rules has added to the administrative burdens of medical practitioners.

The younger generation of doctors, native to information technologies and schooled in the new, team-focused approach to care, should adapt readily.

The question is, will Hawaii have enough of them willing to stay and practice in this state, especially in the more remote and rural island communities, where shortages are the worst?

The approach with the greatest potential for attracting and retaining doctors in Hawaii is to "grow" them right here.

Initiatives such as the health education loan-repayment program provide an incentive to those committing to serving two years in areas with the most acute shortages; eligible physicians, physician assistants and nurse practitioners will receive tax-free funds to pay off their student loans.

Lawmakers this year should consider a proposal crucial to keeping this federally funded program viable: providing matching funds. Last year the state was unable to access more than $100,000 of the $300,000 available to the state because the state didn’t provide the required match.

AHEC also has been working to raise private donations to provide more of the match, which should help bolster the program, too.

Beyond such efforts, there should be more outreach into Hawaii schools to encourage island students to pursue medical careers. Extending the reach of physician assistants and nurse practitioners to the limit of their licenses should be explored, offsetting clinical shortages.

And the private sector has an opportunity to fill a needed niche in the field: Physician support services are springing up to provide administrative backup to doctors, enabling easier management for solo practitioners and small groups.

It’s going to take all of these measures, and more, to overcome a shortage already nearing crisis proportions. The health of this state depends on swift and continuing action.