Raleigh, N.C. — Physician shortages in North Carolina could grow in the coming years, according to a new study, as population growth and increased numbers of aging patients with chronic diseases put more pressure on the health care system.

The North Carolina Institute of Medicine conducted a far-reaching study on the shrinking supply of doctors and determined that the  shortfall in the number of needed primary care physicians will reach 25 percent statewide over the next 20 years.

"It's going to be very serious if nothing changes," said Pam Silberman, president and chief executive of the Institute of Medicine, an independent, nonprofit organization that provides analysis and advice on issues related to health and health care statewide.

"There are already almost 40 counties in this state that already have physician shortages," Silberman said.

Dr. Barbara Rowland, medical director for Piedmont Health Services, which runs clinics in many under-served areas of the state, already sees the impact of doctor shortages and said it's becoming very hard to recruit primary care physicians

"It's frightening," Rowland said. "At several of the sites, by the middle of the day, we're turning people away.

"I have never experienced this in my 18 years."

The problem results from a combination of more physicians nearing retirement and the difficulties medical schools have had to produce enough family doctors to meet the growing demand.

The Institute of Medicine has made various recommendations to head off the doctor shortage:

• The University of North Carolina system is looking at expanding medical schools in Charlotte or Asheville with a focus on recruiting more primary care docs.

• More physician assistants and nurse practitioners could be used.

• Programs could ensure more medical residents stay in North Carolina for their careers.

Several students at the UNC School of Medicine in Chapel Hill told WRAL they were interested in specialties like oncology, sports medicine and anesthesiology, rather than family practice medicine.

"I have family members that are in primary care. That's one of the (people) telling me don't go into family medicine because you're working really hard for the amount of money you get," medical student Lea Harrell said.

"Primary care is at the bottom end of the pay scale," student Matt DeAugustinis said.

"With insurance, they're trying to pay them less and get more out of the doctors," student Rob Thompson said.

Silberman called the growing shortage of primary care physicians a matter of economics, noting many medical school students are more than $100,000 in debt when they graduate.

"You can get a lot more money if you go into a specialty than if you go into primary care," she said.

In some cases, surgeons are also in dwindling supply, and shortages are also projected in psychiatry and obstetrics, according to the Institute of Medicine study.

"This is an issue. We can't wait until we're in a crisis to solve because medical training takes a long time before you produce the doctors who are going to be out on the street," Silberman said.