The head of the Association of American Medical College's new Center for Workforce Studies says that a variety of healthcare trends are combining to create a likely shortage of doctors in the coming years. In a report presented to policymakers on Capitol Hill recently, Edward Salsberg said that "we could be facing some very undesirable conditions and fewer options" unless steps are taken soon to bolster the number of med students being trained in the United States. A combination of factors is driving the predicted shortfall, Salsberg tells Medical News. On the demand side, Salsberg and his colleagues noted that 78 million baby boomers are headed for retirement, an age when demand for physician services climbs sharply. At the same time, enrollment at medical schools has been growing only slowly while new graduates have been seeking lighter work schedules and many doctors retire early from practice. "What we do see is a definite trend of younger workers working fewer hours," notes Tim Dall of The Lewin Group, who participated in the Washington forum. In part, that's because a growing number of women are taking places in medical school (see chart), including many who have no great interest in pursuing grueling schedules after graduation. But many young male doctors fit the same mold, he says, and meanwhile a growing group of aging physicians have indicated that they're also less and less likely to volunteer long hours. Any changes in medical school enrollment will be needed quickly, notes Salsberg. The surge in medical demand is expected to become particularly noticeable around 2012, says Dall, when the largest number of baby boomers have retired. But Salsberg says that it can take years to influence the number of doctors in the workforce. "To begin to move the system you need to add capacity now," says Salberg, pointing out that four years of med school are followed by three to five years of training. "You're not going to see an increase until 2015, and then it's only marginal." There are already some signs of a physician shortage in some specialties, says Dall. "In cardiology, urology, and surgical specialties, demand is growing faster than supply," he says. "For those that serve the non-elderly - obstetrics, gynecologists and so on - supply is growing faster than demand. Of course, our healthcare training system can change course to some degree," especially if doctors can determine now if demand is likely to fall for their specialty 10 years down the road. Salsberg recently surveyed medical schools in the United States to get a better idea of how likely they are to expand the number of students in school. While many are planning to boost enrollment, it's likely to be by only a modest 5 percent to 6 percent, he says. That number needs to be closer to 15 percent. To get the number of doctors needed, he says, medical schools will likely need to expand more quickly and some new medical schools may be needed. In addition, he says, the country needs to do a better job at addressing the needs of professionals, to encourage doctors to extend their years practicing medicine. We need to find ways to better utilize their time, he adds, and boost the number of nurse practitioners, physicians' assistants, nurses and social workers while employing better information technology to make doctors more productive. Not everyone agrees with Salsberg's conclusion, a Johns Hopkins University researcher Jonathon Weiner concluded earlier this year that a more efficient use of physicians - including requiring new grads to spend time practicing in underserved areas - would help address much of any shortage likely to develop. The key problem with physicians isn't how many are practicing, says Weiner, but how accessible they are to patients. In an earlier report from March of this year, Salsberg noted overall employment in health care - already growing at a torrid pace - was expected to mushroom from 11.5 million jobs in 2002 to 15 million in 2012.