KAILUA (HawaiiNewsNow) - Doctor Raymond Fodor has a problem not found on any X-ray.
It's in his business's bottom line.
Fodor is fighting to keep his medical practice from failing under the strain of rising costs.
"Rent, overhead, malpractice insurance, endless paperwork, the hassles from government and insurers. It's just endless. It's horrible," he said.
Fodor is holding on but scores of other Hawaii physicians have closed up shop or left the state.
A survey by the University of Hawaii John A. Burns School of Medicine said Hawaii is 500 doctors short of where it should be.
"We're short in primary care. But we also have a lot of other areas such as cardiology, infectious disease, general surgery, orthopedic surgery," said Dr. Kelley Withy, who helped author the survey.
Reasons for the exodus are high malpractice insurance rates, low insurance reimbursement rates, and the high cost of living.
The shortage is affecting patient care. There are fewer doctors to tend to more patients.
"It's hard when you're being stressed to the max. You don't have time for your patients. You don't get to hear how their families are doing. That takes the fun out of practicing medicine," orthopedic surgeon Dr. Linda Rasmussen said.
Fodor said insurance reimbursements used to be fifty cents on the dollar -- now it's ten or twenty cents.
He used his life savings and retirement money to keep his practice going.
To cut costs, some physicians have lowered the levels of their malpractice insurance, decreased the number of surgeries they perform and cut back on patient services.
"It's as simple as that, dollars and cents," Fodor said.
He said better malpractice laws and higher reimbursement rates would help.
Until then, Fodor will continue to wallpaper his waiting room with newspaper stories of how doctoring in Hawaii is on life support.