With tens of millions of uninsured people likely to get coverage over the next few years thanks to health care reform, who is going to perform all the additional medical services, and how will costs be controlled if demand quickly races ahead of supply?

We already face a shortage of primary care doctors, according to The Physicians Foundation (www.physiciansfoundation.org), which has been circulating an op-ed piece on this subject raising issues that should concern not only health insurers and employee benefit managers, but workers' comp and auto carriers as well.

In 2008, the foundation surveyed U.S. primary care physicians and uncovered some very disturbing trends:

o 76 percent said they were at "full capacity," or are "overextended and overwhelmed."

o Nearly half said that over the next three years they intend to cut the number of patients they see, or to stop seeing patients altogether.

o Fewer than 6 percent assessed their colleagues' morale as "positive."

Add 30 million more insured patients to that mix, and you have a recipe for disaster, marked by long wait times at best, and rationing at worst.

These trends are likely to be exacerbated by cost-control pressures, as health insurers–denied the ability to pick and choose patients based on their medical conditions–must compete on their ability to negotiate the lowest reimbursements, and perhaps delay or even deny services to those not seen as having an immediate or critical need.

Workers' comp insurers, while not directly mentioned in the reform legislation, will not be immune to its impact. It's likely that all else being equal, occupational health patients may have a tougher time seeing a doctor or physical therapist, or getting quick diagnostic tests, if the country doesn't grow the medical care system.

And with health insurers under the gun to control expenses–and having far more leverage than their workers' comp counterparts in negotiating fees–look for more cost-shifting.

Of course, workers' comp insurers will see some benefits, too. For example, today an uninsured patient might be tempted to file a comp claim, whether or not their injury or illness is work-related. The reform law may ease the likelihood of such fraud.

With millions more insured, we'll also have a healthier population, which means workers' comp carriers should have an easier time getting those who do get hurt back on the job more quickly.

But the bigger picture isn't pretty. What can we do to alleviate this shortage?

o We'll need a public-private campaign to encourage more people to become doctors–with incentives to do primary care rather than specialties. More scholarship money for medical students–or perhaps even medical malpractice subsidies for new doctors–would help. Perhaps insurers could kick in some funding, or even lead the charge.

o We also need medical malpractice reform so that doctors don't waste precious resources on defensive medicine.

o Immigration reform must make allowances to recruit more skilled medical students and doctors from around the world.

o We'll have to consider expanding the use of non-M.D. health care practitioners to handle the more routine cases and relieve the burden on full-fledged doctors.

Whatever we do, we need to move quickly. The shortage of skilled doctors is already a big problem. If we wait for 30 million more people to line up with their brand-new insurance ID cards to adapt, we'll have a crisis on our hands.

What do you folks think we should do?