A primary problem: more patients under federal health reform with fewer primary care doctors spell trouble.

• Author: Tobler, Laura

By 2019, 32 million of those currently uninsured will have health care coverage.

But insured or not, they're going to have trouble finding a doctor.

Passage of national health reform elevated the problem of the primary care doctor shortage that must be solved if federal health care reform is going to work, says Dr. Lori Heim, president of the American Academy of Family Physicians.

"If current trends continue, there will be a shortage of about 40,000 family doctors by 2020," she says.

Primary care is delivered by physicians, nurse practitioners and physician assistants practicing family medicine, general internal medicine and general pediatrics. They provide care to prevent disease, maintain health, manage chronic disease, diagnose medical problems, refer patients to specialists and coordinate all medical care for a patient population.

Primary care has been described as the backbone of the nation's health care system. A strong primary care system provides accessible, cost-effective, high-quality care. Primary care clinicians work to keep people healthy, use fewer tests and spend less money than specialists, according to a large body of research.

Those with regular primary care receive more preventive services, are better at complying with their treatment, and have lower rates of illness and premature death than those without such care, research shows.

They also use emergency rooms and are hospitalized less often than those without primary care.

When Massachusetts enacted health reform legislation in 2006 that included coverage for the state's 550,000 uninsured, it was among the states with a very high ratio of total physicians to residents. Yet even with legislation in 2008 to address primary care physician shortages, the number of primary care doctors is still inadequate. A 2009 survey found 40 percent of family physicians no longer were accepting new patients, up from 30 percent before reform.

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When patients were able to find a doctor, the average wait time for an appointment was more than 44 days, 29 days longer than in 2005. A report from the Massachusetts Medical Society concluded "current and long-term shortages in the physician labor markets will continue to deteriorate if not addressed."

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"We will have the same problem in Florida, only worse," says Senator Durell Peaden, a retired general practitioner. "All 67 of our counties lack access to primary care."

There are not nearly enough primary care doctors graduating in Florida to meet the projected need, he says, and the situation is similar in most states.

SHRINKING SUPPLY

Fifty years ago, about half the doctors were in primary care practices. Today, the number has declined to about 31 percent. In 2000, only 14 percent of U.S. medical school graduates entered family medicine. Five years later, the number dropped to 8 percent and continued to fall until last spring when the number rose to 9 percent.

"This was the first time there has been an increase in this number in decades," says Heim. The increase, however, is not "even close to what is needed to meet the demand."

Not only are new medical graduates choosing specialties more often, but those currently working in primary care are retiring, or thinking about leaving the profession and advising others to steer clear of it. The Massachusetts survey found nearly 25 percent of responding physicians indicated they were contemplating leaving the profession.

Why? A major factor is the growing income gap between primary care and specialties.

"Compared to other countries, the United States has not valued primary care," says New Jersey...