Hawaii has long grappled with various shortages of physicians and other health care providers. Right now, though, the state is about 700 physicians short of what a similar community has on the mainland — and, according to concerning projections, the deficit could more than double within a decade.

At the same time, there’s no chance of a drop in demand for services. To the contrary, it’s poised to rise dramatically in coming decades. Driving demand, in part, will be geriatric needs of the so-called silver tsunami. By 2045, the age-65-and-older bracket will account for nearly 24 percent of Hawaii’s resident population.

In response to the looming threat of curtailed access to prompt services, the medical community is rightly stepping up efforts to expand and fortify its statewide workforce. According to a recently released survey by the University of Hawaii, the islands lost 51 full-time doctors from 2017 to 2018.

Among the top factors contributing to the loss is low pay compared with mainland counterparts, when wages are adjusted for cost-of-living issues. Also, the Baby Boomer generation is aging out of the profession: half of the state’s practicing physicians are now in the age-55-and-older bracket.

Efforts to replenish their ranks are imperative — and include a focus on recruiting and retaining young doctors, with a special emphasis on addressing the largest single shortage area: primary care physicians. On Oahu, the shortage increased from 142 to 187, in 2016 and 2017, respectively. For most on-island residents, this type of physician serves as our vital first contact for undiagnosed concerns and other matters. Fewer docs, of course, means longer waits for appointments, and treatment.

On neighbor islands, which typically have fewer resources to serve a more rural population, longer waits as well as flights to Oahu for some medical care have long been part of the country-living picture. Now compounding valid worries about increasingly longer waits are state projections for coming decades that show residential growth on neighbor isles moving at a faster click than Oahu.

By county, Hawaii island has the worst shortage at 41.2 percent, followed by Maui County at 33.8 percent, Kauai at 32.9 percent and Oahu at 16.5 percent. While nearly 10,000 physicians are licensed in the state, only about 3,400 are practicing, according to the UH survey.

Among those taking a hard look at the state’s health care problems are several hundred professionals — in areas such as primary care, rural health, oral health, telehealth, geriatrics, and public health — who convened earlier this month for an annual workforce summit. Among solutions in the works — identified by summit participants as interventions — are expanding the pathway to health careers, and expanding rural training opportunities.

Smartly folded into summit discussions was this question: What can be done to improve health care provider happiness? For many doctors, happiness could be boosted by starting their careers without crushing student debt. According to the Association of American Medical Colleges, the average medical-school graduate left campus with more than $190,000 of debt in 2017.

It’s encouraging to see that about one-third of the incoming Class of 2022 at UH’s John A. Burns School of Medicine will not have to worry about such debt as more than $3.6 million has been committed to fund full scholarships for nearly two dozen Hawaii residents who started their medical school education in July.

Virginia Weinman, one of the philanthropists pitching in, has underscored the funding’s importance: “With so many of Hawaii’s doctors retiring … and the cost of a medical education rising annually, Hawaii’s well-being will remain precarious unless more doctors can afford to be educated and then practice here.”

Indeed. Critical to an effective health care future here will be more homegrown doctors and other health care professionals.