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Retiring doctors, low Medi-Cal reimbursement rates, and the federal health care reform law are exacerbating California's shortage of primary care physicians, Bay Area health care providers and medical associations say.

Already, only a quarter of California's counties meet the recommended ratio of 60 to 80 primary care doctors for every 100,000 residents, according to the California Medical Association. (In the Bay Area, there are 78 primary care physicians for every 100,000 residents.)

“We are very much worried about the shortage in general,” said Callie Langton, health care workforce policy expert at the California Academy of Family Physicians. “Twenty years ago, a lot more physicians were going into primary care, and the replacement rate is not high.”

Nearly a third of doctors are 60 or older and are close to retirement, but only 42 percent of medical students are going into primary care. According to the California Medical Association and the California Healthcare Foundation, the number of young doctors pursuing primary care decreased over the past decade because the it's one of the lowest paid medical specialties.

Family practitioners earn an average of $143,000, while anesthesiologists and surgeons can earn well over $200,000, according to the Bureau of Labor Statistics.

While the number of primary care doctors is shrinking, the demand for the care they provide is about to soar, thanks to the federal health care reform law.

Under the law, known as the Affordable Care Act, as many as 6 million more Californians will be able to obtain health insurance coverage, with nearly half eligible for coverage under Medi-Cal. Many of the newly insured will try to seek treatment from primary care physicians and family practice doctors, who provide the kind of cradle-to-grave, coordinated care that emphasizes preventive medicine, which can help reduce health care costs.

But fewer physicians than ever — just 57 percent — say they are now willing to accept new Medi-Cal patients, according to the California Healthcare Foundation. Many doctors say the reimbursement rate — that is, the amount of money the state pays them for treating patients — is too low. California sets the rate, which is the fourth lowest among all 50 states, according to the California Medical Association.