KAILUA — The number of doctors working in Windward O'ahu is on the decline, worrying people that a shortage of physicians that was once primarily a Neighbor Islands problem is festering here.

In the past two years alone, eight doctors — including a family doctor, an internist, a spine surgeon, a vascular surgeon and several orthopedic surgeons — have closed their practices or left for the Mainland, said Dr. Linda Rasmussen, a Windward orthopedic surgeon and legislative co-chair for the Hawaii Medical Association.

Most often doctors blame the high cost of malpractice insurance coupled with a continuing decrease in reimbursement from medical insurance coverage, Rasmussen said.

None of those who left has been replaced, affecting thousands of patients and placing a burden on remaining physicians who try to take up the slack, Rasmussen said.

A panel, including Rasmussen, a state representative and a specialist on medical reform, discussed the issue last night at Castle Medical Center. About 50 people turned out for the forum.

"In Windward (O'ahu), there's no neurologist, no neurosurgeons, very limited OB-GYN, and orthopedic surgeons went from seven to three and a half," she said before last night's meeting.

Two general practitioners alone had a combined patient load of 6,000 people and the patients they left behind are struggling to find a replacement or doing without, she said.

A Kahuku orthopedic surgeon has quit and a Kahuku OB-GYN is considering closing, Rasmussen said, adding that other rural areas on O'ahu are facing similar problems. It won't be long before Honolulu suffers a similar fate, she said.

"I really feel like the whole system is just ready to collapse," Rasmussen said.

She blames the rising rates of insurance and reduced reimbursements. She said surgery reimbursement is down 26 percent since 1995 and her malpractice insurance was up $8,000 in the past two years. Still, she considers her increase low because other doctors had to pay $20,000 more.

Doctors cannot pass on the cost to patients, so it comes out of their income and some of them are making less than nurses, she said. So they leave because the risk is too high, the hours are long and the workload necessary to make ends meet is overwhelming, Rasmussen said.

Patients have felt the loss, including Joan Ryan, a Kailua resident and panelist. Ryan said her family has lost six doctors in the past 20 months, limiting access to medical care sometimes when they most needed it.

"The bottom line for us is healthcare in Hawai'i is being rationed," she said before last night's meeting. "You cannot get healthcare that, in some cases, you desperately need on a timely basis."

She has been lobbying legislators to solve the problem and urged people at the forum to lobby as well before Hawai'i reaches a point of no return.

"We need to carry the message," Ryan said. "We need to say, 'You're killing our docs. You're overworking them and putting our kids at risk.' "

Dr. Mark Stitham, a psychiatrist, said insurance companies have bullied doctors for years. Stitham said he's lobbied legislators for change but hasn't had success.

Dr. Raymond Fodor, an ear, nose and throat specialist, said he's given up financial security to keep his business open, using his retirement and savings. He said doctors are frustrated that insurance carriers try to decide what they may charge and how much they should get paid; it's gotten so bad that some doctors give up private practice to work in a hospital clinic, Fodor said.

"This is a disgrace," he said. "Here in this great state of Hawai'i, highly trained physicians, an asset to our community, are being kicked around by insurance carriers."

State Reps. Josh Green and Cynthia Thielen, who were on the panel, said they are working to pass medical liability reform this session. Green said he will call for a state attorney general's investigation of HMSA, the state's largest medical insurer.

"We're not going to allow an insurance company to get in the way of taking care of people and at the same time I would like to see some kind of medical malpractice reform," said Green, D-6th (N. Kona, Keauhou, Kailua), a Big Island doctor and chairman of the House Health Committee.

Reach Eloise Aguiar at eaguiar@honoluluadvertiser.com.