KONA >> When people come to see Dr. Anthony DeSalvo at Kona Community Hospital, they’re usually pretty sick, and they usually have more than one medical problem.

The oncologist said his patient load is massive compared with the population and that his patients’ cancers are oftentimes in advanced stages when they begin treatment.

He sees 28 to 32 people a day at the hospital, which primarily serves a rural area spanning from South Kohala to Pahala.

Part of the problem, he said, is the dearth of health care options for people in many areas of Hawaii island: Patients might drive up to two hours to get even basic treatment at the Kona facility. The lack of access to physicians means many people don’t get the regular screenings needed to catch problems early.

The issue is one of increasing urgency, given the massive population growth on the island which is only forecast to continue.

A 2011 report to the Legislature from the Hawai’i Physician Workforce Assessment Project estimated that Hawaii island needs about 174 more doctors just to serve its current population.

By comparison, Oahu — whose population is five times larger than Hawaii island’s — is short 331 doctors.

Complicating the shortage, Hawaii island residents are worse off on just about every health indicator, compared with statewide averages. They have higher rates of cancer and cardiovascular disease, and have lower life expectancies.

At the same time, nearly one-fifth of Hawaii County adults smoke (compared with 13 percent on Oahu), and 24 percent are overweight or obese.

And poverty rates are higher on Hawaii island: About 20 percent of residents live below the poverty line, double the percentage on Oahu.

"When you factor in the social determinants of health — education, economics, all those factors, all those social conditions — they are exacerbated here, which complicates the treatment of diseases," said Richard Taaffe, executive director of the West Hawaii Community Health Center.

THE CENTER OPENED in 2005, and that year saw about 900 patients. Today it has three clinics and about 11,000 patients.

The center serves an expansive area, from Kawaihae to Ocean View.

"We’re filling in the pukas having to do with primary care," he said. "There’s a tremendous need."

In addition to primary care physicians, the clinic offers behavioral health and pediatric dental services.

Taaffe said a lack of access to specialty care — from dermatologists to neurologists — is another hurdle for residents. The clinic has had to send some of its patients to Honolulu for care.

Hawaii County Councilman Greggor Ilagan said the shortage of health care services is also acute in his district in Puna, which has seen the biggest population increases on Hawaii island over the last decade.

Puna, now home to about 45,000 people, has a handful of small clinics and private practices, some of which aren’t open daily.

"We are really lacking in medical help," said Ilagan.

To access most services, he said, people have to drive about 30 minutes to Hilo.

Back at Kona Community Hospital, population growth has translated into higher patient counts at the 94-bed facility, which was designated as a trauma center in 2011 along with Hilo Medical Center.

The hospital’s emergency room saw 16,924 people in fiscal year 2012, up 44 percent from 2003.

Kona Community Hospital spokeswoman Judy Donovan said the facility, which is under the publicly funded Hawaii Health Systems Corp., is on track to see even more growth this year.

In March the hospital averaged about 60 emergency-room visits a day, up from about 50 in the same period a year ago.