To stay patients, state will need more doctors.

• Author: Martin, Edward
• Position: HEALTH CARE

For most of 2006, Tar Heel health care appeared to be on the mend: Malpractice angst eased, physicians dodged a cut in government payments, and hospitals were building. Then as the year closed, a fresh wound opened. A study concluded North Carolina will run short of doctors within 25 years.

Besides obvious concerns--patients facing delays for care and medical practices trying to outbid one another for doctors--the report had regional and political implications. "There needs to be more medical students," says Darlyne Menscer, president of the 11,500-member North Carolina Medical Society. "North Carolina needs to decide how to deal with that. It's not going to be cheap."

One option surfaced in December when Charlotte-based Carolinas HealthCare System said it and the UNC School of Medicine in Chapel Hill were studying whether to start a satellite medical school in Charlotte. A new campus could increase the number of UNC med school graduates each year by 50, to about 210.

However, the last time the state started a medical school--at East Carolina University in Greenville in 1974--the money came only after a fight that pitted Charlotte, Greensboro and other urban sites against largely rural Eastern North Carolina. ECU won, but political scientists say the bitterness created still colors state politics.

What's clear is that North Carolina, with a population of nearly 9 million, is outgrowing its pool of doctors. It has about 18,000-21 per 10,000 residents, roughly the national average, according to the Cecil G. Sheps Center for Health Services Research in Chapel Hill. But a report by the North Carolina Institute of Medicine, a Durham nonprofit set up by the General Assembly to study health trends, concluded that the ratio will fall nearly a fifth by 2030.

The institute recommends increasing enrollment by a third at the four medical schools in the state and expanding programs that can relieve physicians--such as training more nurse midwives.

But those aren't the only gaps in the state's $60 billion-a-year health-care delivery system. Nurses already are in short supply. "A lot of people want to be a nurse, but there's not enough capacity at colleges and community colleges," says Stephanie Strickland, a spokeswoman for the 135-member N.C. Hospital Association. The 16-campus UNC system and the General Assembly last year started to fix that by expanding nursing programs at Fayetteville State University and UNC Pembroke.

On another front, doctors, who...