PHOENIX - Arizona's chronic shortage of primary-care physicians is likely to get worse when hundreds of thousands of new patients begin to seek out medical care under the federal health-care overhaul.
The state expects to absorb nearly 800,000 newly insured people in the coming years, an influx from the Affordable Care Act that threatens to crush the existing health-care system.
As it stands, Arizona ranks 43rd in the nation for its share of primary-care doctors, according to the Association of American Medical Colleges. Experts and health-care professionals agree the coverage expansion will strain the system, but how much is yet to be seen.
Medical schools in the state are increasing their output of doctors in an attempt to meet shortages, but experts still predict things will get worse before they get better since many new doctors leave the state for resident training and never return.
Of Arizona's 6.7 million residents, about 1.2 million are uninsured. An expansion of the state's Medicaid program for the poor pushed through the Legislature this month by Gov. Jan Brewer is expected to cover 300,000 people starting next year. Another 470,000 people are expected to get coverage though a new federal insurance exchange.
Many of those people currently receive treatment either in emergency rooms or clinics, but with insurance comes the regular care President Obama's health-care overhaul is designed to provide, which experts worry will exacerbate the doctor shortage.
The problem comes down to preparing new doctors, according to Dr. Conrad Clemens, a primary-care pediatrician who runs the graduate education department at the University of Arizona College of Medicine.
"What we're seeing is the inability to train more physicians because the number of spots that we have among the state to train physicians, called graduate medical education slots, have been pretty constant from the federal government since the mid-1990s," Clemons said.
The federal government has identified nearly 400 designated health-professional-shortage areas statewide, many in rural areas. Of those, 140 areas are short of primary-care physicians, while the rest are split among dentist and mental-health professionals.
The Arizona Department of Health Services says the state now needs a minimum of 300 primary-care physicians, 250 dentists and 130 psychiatrists to eliminate those official shortage areas. There are about 14,500 physicians in Arizona, including about 5,100 primary-care doctors.
The state Health Department runs programs that help retain new physicians by paying their student loans in exchange for a minimum of two years' commitment to work in underserved areas, according to Ana Lyn Roscetti, who oversees the work. Another program helps foreign doctors get visa waivers if they agree to work in those areas for three years.
But those programs have only 286 health professionals participating, including midlevel providers like nurse practitioners.
Although the new law worries many, others think it might not be that bad.
"I think everybody's knee-jerk response is: We're already short of physicians, and it's going to get worse. But I don't know if that's going to be the case," said Jon Ford, communications director for the Phoenix-based St. Luke's Health Initiatives, a foundation that has studied the shortage.
There's a chance that the new patients will be gradually absorbed into the system since it isn't clear whether there will be a stampede to the doctor's office or a slow, steady increase. Also, it's unknown how much care the new patients will need.
Ford, however, said there's absolutely a need for more Arizona doctors. Without improvements, he said, the health-care overhaul will cause that need to become more pronounced over time.
Clemons is more worried.
"Even without this, we're already suffering now," he said. "And then if we're not expanding our pool of physicians and primary-care docs and specialists, we're really going to be in trouble."