Many physicians are worried the family doctor will go the way of the house call without healthcare reform and more encouragement to students to enter the field.

Dr. Christopher Linden of Hilo said he became a family physician for philosophical reasons. He describes himself as a "generalist" who believes "that a broad understanding of medicine is the most appropriate way to take care of people."

But Linden said he and many other Big Island physicians are no longer accepting new patients because of the hassles of dealing with insurance reimbursements and Medicaid and Medicare's "complicated bureaucracy."

"I didn't go into family medicine for the money, but if I had to do it over again, I'm not sure I'd do it," he said yesterday from Washington, D.C.

Linden and hundreds of other doctors are participating in today's "Vote for America's Health Rally," calling for the next Congress to make healthcare issues as important as the Iraq war and the fight against terrorism.

A report released today by the American Academy of Family Physicians, a rally sponsor, states that the number of family physicians in Hawai'i would need to increase by 35 percent over the next 15 years to meet the state's future primary-care needs. The reports said there are 393 family physicians in the state, with 530 needed by the year 2020.

Family physicians treat all sorts of ailments in patients of all ages, often providing care for multiple generations of the same family. They also provide the majority of care for America's underserved and rural populations. Nearly one in four of all office visits are made to general and family physicians, according to the academy.

Nationally, the report said, the number of family physicians must increase by 39 percent by 2020, with fast-growing states such as Nevada and Arizona needing to increase numbers of family doctors by 70 percent or more.

"We need a Congress that finally fixes our troubled healthcare system, and we can't wait any longer. As America's population ages and chronic disease increases, we face a serious shortfall in the number of family doctors needed in every state. Already, one in four U.S. counties is designated a primary-care shortage area," said a statement from Dr. Larry S. Fields, president of the American Academy of Family Physicians.

The need for family physicians is greatest in rural areas of Hawai'i, but most of the family physicians are concentrated in Honolulu and other urban areas, said Dr. Neal Palafox of the Department of Family Medicine and Community Health at the University of Hawai'i's John A. Burns School of Medicine. He said he's seen a decline in interest in the field of family medicine for reasons that include those mentioned by Linden.

"Sadly to say, it's also the economics: You can make much, much more being a urologist, cardiologist or surgeon than you're ever going to make as a family physician," Palafox said.

The two Hawai'i doctors said family physicians have an image problem, with medical specialties seen as more prestigious, even though general practitioners are required to possess a greater breadth of knowledge that will help them deliver babies, conduct cancer screening and treat the elderly, for example. Linden said that family medicine wasn't even recognized as a specialty when he was attending medical school at Northwestern University.

Palafox said medical schools should be doing more to enroll students interested in family medicine, not just selecting those headed for careers in medical research and other high-profile fields.

He said he prefers family medicine's "holistic" approach and tells his students they'll be able to find work anywhere.

Palafox spent his first few years as a doctor in the Marshall Islands. "I wanted to be able to deal with whatever came at me and also was able to do a lot of public health and preventive health programs," he said.

To introduce students to the idea of working in rural communities, UH family medicine interns train at Wahiawa Hospital, and Palafox said arrangements are being made to allow students to complete their family medicine residency in Hilo.

Reach Christie Wilson at cwilson@honoluluadvertiser.com.