When Ruth Anne Tomlinson, a Wyoming pediatrician, and her husband, David, an anesthesiologist, shopped around for jobs in Hawaii in 2006, the starting salaries for anesthesiologists were as much as $100,000 less than most places on the mainland.

And the costs of living and doing business here were significantly higher.

"If you’re going to move to an area where the cost of living is really high then the salaries need to compensate for that so that your overall quality of life is the same," she said. "Certainly in Hawaii, they don’t."

Those are the reasons that many physicians like the Tomlinsons decide to work and live on the mainland.

"Some think Hawaii’s so great you just have to suck it up, take the sacrifice, and in some cases that’s true, but it has to be within reason," Ruth Ann Tomlinson said.

Current projections show the state could be short 1,230 doctors and 2,669 registered nurses to care for an estimated 280,496 baby boomers who will be 65 or older by 2020, according to the Hawaii State Center for Nursing and the Hawaii/Pacific Basin Area Health Education Center at the University of Hawaii John A. Burns School of Medicine. By 2030, the physician shortage is estimated to grow to 2,071.

The insufficient numbers of physicians, nurses and other health care professionals — due to lower pay scales, higher cost of living and fewer choices for quality education, professional development and employment opportunities — have grave repercussions given the wave of Hawaii residents expected to retire in the next 10 to 20 years. The elderly will account for nearly 20 percent of the state’s total population in the next decade.

"There’s no way to import that many doctors or providers because the whole country is short, so that means we’re going to have very poor medical care if we don’t do something right now," said Dr. Kelley Withy, director of the Hawaii/Pacific Basin Area Health Education Center.

Hawaii’s physician work force is short about 500 doctors, Withy said. Meanwhile, an estimated 1,335 Hawaii physicians will turn 65 in the next decade, resulting in a loss of 134 doctors a year, she said. The shortages are based on trends nationwide and projected population growth and aging in Hawaii.

"We’re losing more doctors to retirement than we’re gaining every year," she said.

The state has the equivalent of 2,855 full-time nonmilitary physicians.

Meanwhile, about 43 percent of the 11,000 nurses working in Hawaii intend to retire in the next 15 years, according to a 2009 survey by the Hawaii State Center for Nursing.

"The work force is aging and unfortunately we can’t stop it," said nursing center director Gail Tiwanak. "The number of graduates we’re projecting is not going to meet the demand."

Physician and nursing groups are stepping up efforts to mitigate the shortages, including increasing the health care workforce through programs designed to attract students as young as middle school into medical training, and providing mentors, research experiences and other support.

There also are efforts to target training specifically for the specialties in short supply in specific areas.

"If we need more primary care providers on the Big Island, then we should train more students in primary care on the Big Island," Withy said. "Especially if you recruited them from the Big Island, their family is from the Big Island — that is our best chance of getting them to stay on the Big Island."

Other ways to fight a shortage of health care professionals include tapping into pools of younger workers in other parts of the world and keeping older employees working longer, said David Baxter, senior vice president of Age Wave, a California-based consulting firm that studies aging and retirement.

"People have been retiring a little bit later, extending their working years because they need to or don’t want to sit around for 30 years," he said. "There are ways to encourage and empower people to stay in the workforce in their later years."