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of the University of North Dakota School of Medicine. The shortage is expected to grow to 300, or about 150 primary care physicians, in the next decade as an aging population requires more medical care, many doctors retire and a booming economy in North Dakota's oil fields and elsewhere swells the state's population, he said.
• The federal Affordable Care Act will put more patients in doctors' offices, but it will have less effect in North Dakota than in many states because North Dakota has a relatively small number of people who have no insurance or Medicaid coverage, Wynne said.
• "The robust economy has enabled a lot of people to get health insurance through their employment," Wynne said.
• Gary Hart, director of UND's Center for Rural Health, said it's difficult to predict how many people who have avoided care until they were seriously sick will get insurance under the new federal law and start seeing family doctors regularly.
• "There's no way of knowing until we get through some of this. We aren't doing great to begin with. We're short to begin with," Hart said.
• The South Dakota State Medical Association estimates the state's shortage of primary care doctors is now somewhere around 100. The shortage of family doctors could reach 200 in the next decade, meaning an additional 20 a year need to be recruited to replace retiring doctors, care for an aging population and cover those who gain coverage under the federal health care overhaul, said Dr. Daniel Heinemann, the association's president.
• Both Dakotas are expanding the size of medical school classes and residency training programs, offering financial rewards to new doctors and others who agree to practice in rural areas and helping small communities recruit doctors.
• The North Dakota Legislature this year approved spending more than $120 million to build a new medical school facility and support an ongoing effort to expand the number of doctors and other health workers. The Medical School's class size expanded from 62 to 70 two years ago and will now expand to 78.
• Wynne said North Dakota has to train more doctors, keep more graduates in the state, encourage people to lead more healthy lives, and develop a system that uses physicians' assistants, nurse practitioners and others to work with doctors in rural areas.
• South Dakota also expanded its medical school class size from 52 to 60, and an effort is under way to boost it even further. Residency programs and other efforts encourage graduates to work in rural areas.
• Heinemann said it's difficult to recruit doctors to rural areas because they can make a lot more money as specialists in large cities. The state needs to increase

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