Whatever final form the new health-care legislation takes in the coming reconciliation of the House and Senate versions, one likely outcome will be refocused attention on the longpredicted demise of the primary-care physician.

With as many as 30 million Americans joining the ranks of the insured over the next few years, an already overburdened primary-care system will certainly be swamped.

As with most health-care problems there are no simple solutions. Based solely on numbers, there are more physicians per capita than ever. But the flight from primary care, both among practitioners and among medical students who flock to surgical and specialty practice, is undeniable. The Department of Health and Human Services estimates that there are 17,000 fewer primary-care doctors than needed in inner-city and rural areas today. Others have estimated that by 2025 there will be a shortage of as many as 150,000. The emergence of physician extenders, nurse practitioners and physician assistants and the like has failed to bridge the gap, as these graduates too are increasingly drawn to subspecialty and surgical practices.

One attempt tied to the current legislation to alleviate the shortage is stirring both attention and controversy. It would add 15,000 residency slots to the current total of 100,000. Whether this would increase the number of primary-care physicians is at best a leap of faith.

Other proposals under Congressional consideration would:

• Remove primarycare reimbursement from the strictures of the sustainable- growth-rate system of containing costs, which pools and caps all reimbursement, resulting in robbing Dr. Peter to pay Dr. Procedure.

• Provide debt forgiveness to medical school graduates entering primary care.

• Provide greater funding and priority to implementing health information technology that would enable a new model of primary-care practice to evolve that not only takes full advantage of technology but coordinates the skills of every member of the primarycare team.

None of these steps alone will provide the necessary relief. But reshaping the health-care system to restore primary care will undoubtedly affect every stakeholder, including subspecialties and surgical specialties.