HONOLULU (AP) - Hawaii’s supply of doctors is the lowest since 2015 as older physicians retire and younger practitioners move outside the state for higher pay, reports said.

Workforce data shows there are now 2,819 active physicians in Hawaii, a decrease of 108 full-time doctors over the past year, news organizations reported Tuesday.

A survey by the University of Hawaii Burns School of Medicine indicates the state needs at least 3,481 doctors. The school’s Hawaii/Pacific Basin Area Health Education Center found a quarter of the state’s doctors are 65 and older.

“It’s the hassles of medicine and the low pay in Hawaii,” said Basin Area Center Executive Director Kelley Withy.

A system of “payment transformation” was implemented in 2017 by the state’s largest health insurer, Hawaii Medical Service Association, which now reimburses doctors a fixed monthly rate for each patient regardless of how many times a patient is seen.

“We only have between 200 and 300 positions open because physicians used to open their own offices, but now it’s too expensive, and payment transformation makes it very challenging,” Withy said.

Almost three-quarters of 156 doctors who responded to the university survey said they are unhappy with the new per-member, per-month payment model, while more than half reported they earn less than in 2016.

“I think payment transformation has scared people out of state,” Withy said.

Democratic Lt. Gov. Josh Green, an emergency room doctor, disagrees.

“The physician shortage is not due to payment transformation. We are short on providers because it is difficult to train enough docs to keep up with retirements and people going to the mainland,” Green said. “We are in the middle of the evolution of our health care system.”

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