Even if President Barack Obama is successful in revamping the health care system to cover the nation's 46 million uninsured, Texas and the rest of the nation still face a shortage of primary-care doctors to treat them.

Since 1997, U.S. medical school graduates in family medicine and general internal medicine programs have fallen by nearly 50 percent, according to the American Academy of Family Physicians.

"It pays less, and it's harder to do," said Dr. Bill Walton, a Dallas family doctor.

This year, the average salary offered to pediatricians is $171,000 vs. $480,000 for orthopedic surgeons, according to a study from Merritt Hawkins & Associates, an Irving-based physician placement firm.

Six-figure medical school debt, the desire for a better lifestyle and regular work hours persuade an increasing number of students to specialize.

"I work 65 hours a week," Walton said. "If I worked 55 hours I wouldn't make any money."

Walton, who sees 23 patients a day, said much of his time is spent away from patients studying their medical records for better care and handling business-related matters.

Salary isn't the only reason medical students shun family practice medicine. General practitioners tend to see a larger percentage of Medicaid patients, requiring more paperwork for reimbursements. North Texas physicians have reported that in many cases Medicaid, the government health plan for the poor, reimburses only 40 percent of what private insurers will pay.

The state Legislature in May approved a $2.5 billion increase in general revenue funds to cover Medicaid's projected cost increases and caseload growth, but no money was allocated for payment rate increases for physicians or dentists.

In the United States, specialists outnumber primary-care doctors 2-to-1. However, mortality rates are lower in counties where there are more primary care physicians, according to a national study funded by the U.S. Department of Health and Human Services.

The 2005 study did not find lower mortality rates in counties with a higher concentration of specialists.

Researchers at Johns Hopkins School of Public Health, which conducted the study, concluded that increasing the supply of specialists will not improve the country's health care in comparison to other industrialized countries, and it will likely lead to greater disparities in health status.

Dr. Doug Curran, a family doctor in Athens, experiences daily testimonies of how health care costs could be better contained if more patients had a family or primary-care doctor.

He said he recently had a longtime patient who asked for a magnetic resonance imaging test on his knees.

Because of his relationship with the patient, Curran said he spoke frankly. "Listen, your knees are worn out, partner," Curran recalled saying. "The MRI is not going to help us. Now we can do some other things to make your knees feel better."

Said Curran: "It took me less time to offer that advice than to go around the corner and order the tests."

General practitioners and specialists alike have been blamed for driving up health care costs by doing unnecessary procedures and ordering extra tests. As a result, physician quality incentives are being discussed as apart of the Obama administration's plan for health care reform.

Solutions for covering the uninsured far outweigh solutions for increasing family care doctors, but efforts are being made.

In March, lawmakers expanded the state's physician loan repayment program. The measure increases the amount of medical school debt that Texas will repay for a physician who agrees to practice in an underserved community, from $45,000 over five years to $160,000 over four years.

Walton recommends that doctors be paid for their time, not for the number of procedures, as is done currently.

Dr. Ernie Buck, a Corpus Christi family doctor, said virtual medicine may be the answer, including technology like home-based blood pressure readings synced with the doctor's office.

"I don't see where all these people are going to get their primary care," Buck said. "There aren't enough of us in the pipeline. Everyone won't have a chance to be able to look at a doctor in the face."