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The national shortage of primary care doctors is no small problem.

For physicians, it means overbooked schedules and less time for follow-ups.

For patients, it means difficulty getting a timely appointment.

And for the health system as a whole, it means more costly and less efficient care.

"The concern is that when you need a doctor the most, there are no appointments available," said Dr. John Rugge, CEO of the Hudson Headwaters Health Network. "You end up in a more expensive setting where co-pays are higher and you see someone who can't put to use all that background knowledge ... that comes naturally when a doctor knows someone."

According to the Association of American Medical Colleges, the number of U.S.-born physicians expected to become primary care practitioners - internal medicine, family practice and pediatrics - decreased 31 percent from 2000 to 2010. And the group expects the shortage to get worse.

Behind the problem are some strong financial forces.

Specialties are generally more lucrative, and new doctors are exiting medical school with heavier debt loads.

In addition, industry groups say the reimbursement system undervalues primary care services. This not only widens the income gap, but it creates a perception of prestige or status among specialties.

Other factors driving the shortage include a pervasive belief that generalists face heavier workloads, less flexible schedules and more stress than specialists.

Meanwhile, the population is growing and aging, creating more need for primary care doctors to manage multiple and complex chronic conditions, the association says.

Dr. Robert Reeves, one of 10 physicians at Irongate Family Practice in Glens Falls, said he is still accepting new patients, but in limited numbers.

"We're not at 100 percent capacity, but we have very busy schedules," he said.

Reeves believes there are fewer new primary care doctors because medical school debt has increased dramatically, and young doctors feel pressure to pay off the loans faster by ensuring a higher income.

But the job of a family practice doctor is no less important than a specialist's. They are often the first stop for illness and routine checkups, the starting point for referrals, and they tend to know their patients best.

"You need somebody to kind of be the quarterback to manage everything," Reeves said of patient care.

Hudson Headwaters is also experiencing high demand for primary care services. The network of Adirondack health centers opened its 14th location last month in Queensbury to relieve pressure on its other high-traffic clinics.

"We were absolutely at capacity," said Rugge, the CEO.

While primary care physicians have benefitted in the past decade from advances such as the widespread use of electronic medical records and new ways to measure and track results, a lot of work is left to attract the best candidates, he said.

Rugge advocates for loan forgiveness for doctors who choose primary care, especially in rural areas. And he feels low reimbursement rates for basic procedures should be addressed.

"We need to make the health system more accessible and more affordable, and the key to that is primary care," Rugge said.

Paul Scimeca, vice president of physician practices and community health at Glens Falls Hospital, said the greater Glens Falls area hasn't struggled as much with the shortage as other places because of a strong primary care infrastructure through the hospital, Hudson Headwaters and Irongate. But he sees a lag in new physicians establishing or joining practices to meet the growing need.

He pointed to health

care reform and said newly insured patients are going to need access to a doctor's office.

For its part, the hospital has added outpatient centers throughout the region to reach new communities. Its 13 primary care practices and health centers, along with two in-school centers, reported 140,000 patient visits in 2011.

"Ultimately, it does come down to access," Scimeca said. "How easy is it to find a new physician?"

Health care providers are increasingly turning to nurse practitioners and physician assistants to fill gaps. These medical professionals,

who work under the supervision of a physician, are especially critical in rural areas, where it's harder to recruit new doctors.

Irongate, Glens Falls Hospital and Hudson Headwaters said expanding their medical teams takes pressure off the physicians while ensuring a consistent level of care and attention.

Still, experts say major changes are needed going forward to fix the growing primary care problem. If left unchecked, they argue, everyone stands to lose.

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