50 million new patients? More primary doctors a must

BOSTON — When Dr. Robert Flaherty launched a private practice in 2001, he soon found himself cramming in as many patients as possible to make ends meet, leaving little time to discuss with them the steps they could take to prevent future health troubles.

"I constantly felt that conflict of going faster than I should," said Flaherty, 40, of Mashpee, who gave up his practice after four years for a hospital post. "Everyone knows if you want to make a decent living, become a specialist; if you want to be banging your head, go into primary care."

Among the many hurdles facing President Barack Obama's plan to revamp the nation's health care system is a shortage of primary care physicians — those legions of overworked doctors who provide the front line of medical care for both the sick and those hoping to stay healthy.

As Massachusetts' experience shows, extending health care to 50 million uninsured Americans will only further stress the system and could force many of those newly insured back into costly emergency rooms for routine care if they can't find a primary care doctor, health care observers said.

Massachusetts, home of the nation's most ambitious health care law, has seen the need for primary care doctors shoot up with the addition of 428,000 people to the ranks of the insured under a 2006 law that mandates health care for nearly all residents.

To keep up with the demand for primary care doctors, the country will need to add another 40,000 to the existing 100,000 doctors over the next decade or face a soaring backlog, according to Dr. Ted Epperly, president of the Kansas-based American Academy of Family Physicians.

"It's like giving everyone free bus passes, but there are only two buses," he said.

The need for more primary care doctors comes as the country's shortage of all doctors is expected to worsen, according to a study by the Association of American Medical Colleges, which found the rate of first-year enrollees in U.S. medical schools has declined steadily since 1980.

If current patterns persist, the study shows the country will have about 159,000 fewer doctors than it needs by 2025.

A raft of ideas has been proposed to ease that pressure — from boosting loan repayment programs for medical students studying primary care to narrowing the salary gap between primary care doctors and specialists like brain surgeons and cardiologists.