CHEYENNE -- Wyoming is going to need a lot more family practice physicians over the next 14 years -- about one-third more than currently, according to a report out this week.

But Wyoming's expected shortage isn't going to be as dire as in many other states, the report by the American Academy of Family Physicians shows.

The outlook is even more grim in retirement havens including Nevada, Arizona and Florida; Wyoming ranks about in the middle for how many family physicians it will need.

Wyoming currently has 159 family practice physicians. Because of the state's growing and aging population, 211 will be needed by 2020, according to the report released Wednesday.

"I'm concerned that if some things don't change, then we may have some issues with access," said Dr. Gregory McCue, a family practice physician with the Billings Clinic in Cody.

McCue said not only are rural populations aging and in need of more medical attention, but also the doctors caring for those populations are getting older and preparing to retire.

"There are fewer people choosing to go into general medicine," he said. "This is largely because younger physicians realize this can be a more demanding lifestyle the way it is currently practiced. But also the reimbursement is significantly less than other specialties."

There are several other reasons why Wyoming has a shortage of physicians already, according to Susie Pouliot, executive director of the Wyoming Medical Society.

Another is the fact that Wyoming's rural physicians rely heavily on reimbursement from Medicare and Medicaid. That doesn't help their bottom line -- and physicians nationwide are facing steep Medicare cuts next year, Pouliot said.

Pouliot also pointed to Wyoming's medical malpractice insurance rates. In Wyoming, she said, those rates are quite a bit higher than in states that have enacted tort reform.

Wyoming family physicians on average pay $43,800 a year for medical malpractice insurance, compared with about $30,000 a year in Colorado, according to Pouliot.

All states neighboring Wyoming have imposed caps on medical liability payments, but Wyoming voters rejected caps in 2004. "Our liability climate remains a big hurdle for recruiting physicians to the state," Pouliot said.

Five of the state's first nine graduates from the WWAMI program -- which helps students from Washington, Wyoming, Alaska, Montana and Idaho attend the University of Washington medical school -- have begun practicing in Wyoming. The list includes two family practice physicians at Community Health Center of Central Wyoming and a pediatrician in Laramie.

In Wyoming, WWAMI graduates are forgiven nearly all their medical school debt in exchange for returning to the state to practice at least three years.

Also, Wyoming's two community health centers, in Cheyenne and Casper, host 18 to 20 family practice residents at any given time. Pouliot said national statistics show that residents are more likely to go into practice where they finish their training.

"Some of the residents do stay, some end up leaving the state," she said of the community health center residents. "So I think whatever we can do to make our state as attractive as possible for new physicians to stay here, we need to take those steps."

The report predicted that Nevada would have the nation's biggest demand for family practice physicians, with 79 percent more needed by 2020. Arizona ranked second (76 percent), followed by Florida (63 percent), Texas (52 percent) and Idaho (51 percent).

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