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My friend Frank died on a recent Friday night. Our Big Island doctor shortage is now 231.

Dr. Frank Hammer came here straight from the Army, 1976. Two years ago, age 70, anesthesiologist Dr. Hammer won the powerlifting championship masters division world record deadlift and came in second in bench press.

He said, “I was thinking I’d just grab the bar and push my f**king feet through the floor!”

And man, oh, man, did he ever.

His heart attack started during a surgicenter case.

“I didn’t feel quite well,” he told me later.

Obstetrics and gynecology surgeon Dr. Fred Nitta (no spring chicken himself) told him to get subbed out.

“No way!” Frank said, finishing the operation before Dr. Nitta could get an EKG on him. “No, Frank, you’re not driving yourself to the ER.”

He went by ambulance, bypassed the emergency room and straight into the Hilo Medical Center cardiac catheterization lab. They saved his life that day.

“Maybe I’ll quit hospital call, staying up all night, when they let me back next month,” he said.

“Good idea, Frank,” I said. “Rest up.”

But it wasn’t enough. A week later he was gone.

‘Losing Money’

A few years ago, after 40 years in Hilo, my friend Djon died. The Queen’s Medical Center program director said Dr. Djon Lim was “the best cardiologist the fellowship program ever had.”

He was from Medan, Sumatra, just down the road from Banda Aceh where my grandmother was born. He and my dad, his patient, chatted about old Indonesia days — very cool.

I remember him once crawling off his sickbed, coming in coughing, looking like crap to help my ER fracture patient, seen in the dead of night.

Then one day Djon said, “Ed, I can’t continue losing money every year. I’m closing my practice, changing to hospital employee.”

Even a fully booked world-class cardiologist couldn’t make money practicing in Hilo.

They’ve been through about six-plus cardiologists since then, they come and go, none in private practice.

My friend Ben quit last year. Dr Ben Ono was my personal doc, the only fellowship-trained pulmonologist on the Big Island. Superb. Busy.

He said insurance company constraints, “payment transformation program,” forced computerized scrutiny and extra requirements all resulted in losing money. He wanted to keep going, tried, but he quit.

After two of his kids were born here, my neighbor, Dr. Steve Lazaro, an anesthesiologist, took his family and moved away.

“It’s never going to change, and it’s getting worse,” he said.

Dr. Danny Chaung, another anesthesiologist, left last year, too, with his wife and newborn kid. The Hilo Community Surgery Center started cutting back on my operating room time because it was short on anesthesia docs. Now it completely shuts an OR some days.

The Hilo Endoscopy Center went from three to one-and-a-half gastroenterologists, and soon it will be just one. It has been unable to recruit anyone in six years of trying. But no one wants to come here.

Why is that? Very simple: Our docs get worked way too hard, and get paid way too little. As in any abusive relationship, eventually one leaves.

Medicare pays Hawaii docs near the bottom of the scale despite our highest cost of living in the nation. Alaska docs get 50% more, and even New York and California get more.

Then our state takes 4.2% of that for the general excise tax, which we are forbidden to charge the patients. So Hawaii docs actually get paid net the lowest rates in the nation. Ditto for Medicaid, Quest.

No other state taxes medical care. None. The counties voted an extra .5% to pay for the Honolulu train-to-nowhere, so a 4.7% hit is comin’ atcha, docs!

Our docs get worked way too hard, and get paid way too little.

The Centers for Medicare and Medicaid Services began penalizing us an additional 4% “negative adjustment” for not meeting “Meaningful Use Stage II” electronic heath record requirements. (It’s more like “Meaningful Abuse.”)

In two years this becomes a 9% hit. Many practices, including urgent care, can in no way meet those extra requirements without losing money. They’re already penalizing eight of our hospitals 0.3% for having too many re-admissions, due to collapse of primary care provider back-up in the community.

The Big Island is experiencing a critical physician shortage currently at 44%, worsening with demand climbing and our docs leaving, getting old, quitting, retiring and dying.

Docs are channeling their inner Rambo: “I love my country! I just want it to love us back.”

Last year 152 docs .