Hawaii’s doctor shortage is worsening, except on the island of Kauai, according to the most recent data by the University of Hawaii Physician Workforce Assessment.

By county and specialty, the total shortage has grown to 769, compared with 707 in 2016.

Maui resident Mila Miyashita was diagnosed in 2001 with rheumatoid arthritis, a chronic disease that causes the immune system to attack the joints, and has since had to travel to Honolulu several times a year to be treated by a specialist.

“There’s a shortage of rheumatologists to begin with in the state,” said Miyashita, 56, who lives Upcountry. “When I was diagnosed in 2001, a lot of rheumatologists were pretty much at their max capacity.”

Oahu needs 381 physicians, up from 339 last year, while the Big Island is short 196 providers, compared with 183, the latest study shows. Maui County has a deficit of 139, up from 125, while Kauai needs 53 doctors, down from 62.

Primary care providers are the largest group in short supply, followed by infectious disease specialists on Oahu and Kauai, colorectal surgeons on the Big Island and geriatric doctors in Maui County.

“Our population is growing and aging, and this compounds the situation. We need to train more, recruit more and make it the best place to practice in the country,” said UH professor Kelley Withy, who conducts the annual study, adding that Hawaii Pacific Health, the parent company of Wilcox Health on Kauai, has made a “concerted effort” to recruit and retain more doctors.

Even though there are more than 9,000 licensed physicians, only 3,551 are practicing in the islands. The latest data show that the shortage of primary care doctors has grown to 282.5 from 228 a year ago.

That’s largely due to the state’s high cost of living and lower pay for medical providers compared with the mainland, among other social issues such as quality of schools, Withy added.

“We still have no neurosurgeon. Any head or spinal trauma is immediately medevaced to Oahu,” said Dr. Edward Gutteling, an orthopedic surgeon in Hilo. “We haven’t had a neurosurgeon in 15 years or more. One of our top cardiologists died; one cardiologist actually had a heart attack. We have hard time keeping them here. But the bottom line is, Why is it so hard to keep doctors here of any specialization? We work too hard and get paid too little, compounded by rules and regulations, which have become increasingly onerous.”

The health care industry for years has struggled to recruit doctors, particularly to rural communities on the neighbor islands.

“Many have given up practices to work for hospitals, and many private practices have closed because of that,” Gutteling said. “Other doctors that are coming out are scared of private practices. They all want to get jobs and have a paycheck, so private practice is dying.”

Gutteling added that the state should invest in an emergency medevac system and designated referral center that has the capability to take patients around the clock.

“The community as a whole thinks they can go to Hilo Medical Center and they will be taken care of. That is their assumption but it’s not true,” he said. “They pretend to have a trauma system. If we are short of specialists … we should put people on a helicopter or plane and get them out of here, instead of pretending that the community hospitals on the neighbor islands can take care of anybody at all times, because they can’t and they never will because we don’t have the population to support it.”