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When we talk about why so many Hawaii residents are leaving the state, we usually think about young people just starting out.

But those aren’t the only ones we are losing. The “brain drain” also has hurt us when it comes to critical professions.

For example, the Healthcare Association of Hawaii says in a new report there are about 2,200 job openings in the state’s hospitals and health care facilities. These are non-physician jobs, ranging from nurses to patient service representatives and physical therapists.

But there also is a doctor shortage. Experts say the state needs nearly 800 doctors, with the neighbor islands suffering the most. On Hawaii Island, it can take four to five months to see a specialist or primary care doctor.

Why do we have these shortages? Partly it is because of a lack of local training and educational opportunities. Of the non-physician roles that have gone unfilled, about one-fourth require training that’s not available in-state. The University of Hawaii John A. Burns School of Medicine tries to keep graduates in Hawaii through local residency programs, but that’s not always possible. And when JABSOM graduates leave the state for their residencies, only half come back.

But there’s another factor, the same thing that causes Hawaii to lose lawyers, new graduates, entrepreneurs, and so many others: the state’s cost of living. Earlier this year, Wallethub ranked Hawaii one of the worst states to practice medicine, thanks partly to it having the lowest average wages for physicians when adjusted for cost of living. Hawaii also scored poorly in the categories of “Medical Environment” and “Opportunity and Competition.”

Interviewed three years ago by the Grassroot Institute of Hawaii, internal medicine physician Dr. Kyle Varner put it bluntly when he noted that doctors can make 50 percent more if they work on the mainland instead of in Hawaii.

“The sad and simple fact is that recruiters in Hawaii cannot compete in terms of salary, in terms of benefits, and in terms of practice environment,” said Varner, who now works on the mainland.

Dr. Jerris Hedges, dean of JABSOM, similarly cited Hawaii’s “chronic underpayment for physicians” as a reason for the shortage.

“Physicians here in Hawaii sort of are dealing with a difficult situation,” Hedges said. “You have lower reimbursement than you do on the West Coast and much of the rest of the nation, and you also have a higher cost of living.”

JABSOM and other organizations are working to increase training opportunities for physicians and other health care workers. However, unless we do something about the economics of living in Hawaii, those efforts won’t end the shortage. Making Hawaii an attractive place for doctors and health care workers will require the same basic approach as making the state more attractive to other professionals. It means lowering the cost of living, by cutting taxes, making more land available for housing, and reducing red tape.

We also should repeal or reform Hawaii’s restrictive certificate of need laws, which limit the expansion of health care services and create unnecessary barriers to innovation. And we could pursue more public-private partnerships for our state-run hospitals, such as we did on Maui, which would help revitalize the industry and improve health care access where it’s most needed.

Just as in every other industry, health care workers will vote with their feet when it comes to finding the best job. But Hawaii can fill those vacant health care jobs, if we just work on making our state affordable again.