The US is facing a shortage of physicians which is expected to get worse in the near future. The American Association of Medical Schools says the country could face a deficit of 50,000 physicians by 2020.

The shortage is most acute when it comes to primary care physicians, the ones many patients see on a periodic basis, especially for annual checkups. "If you look at an average class in medicine of 120 students, probably less than one-third will go into primary care," says Dr. John Vitariello, the President of the Frederick County Medical Society and a local cardiologist. "There's less prestige in it. I think some family physicians feel slighted, which is unfortunate. My father was a primary care physician. And they're underpaid."

He says many medical students go on to be specialists, which pay more. Dr. Vitariello says most young doctors when they attended medical school borrowed money to pay for tuition, books and other supplies, and now they're saddled with debt as they start careers in medicine. Dr. Vitariello says he would favor partial or complete debt forgiveness in return for working in underserved areas, such as Western Maryland or the Eastern Shore. "Allow the debt that accrues over four years to prolong the time to pay off their loans," he says. "They should give incentives to physicians to stay in Cumberland or Hagerstown and give them debt forgiveness."

In addition to that, Dr. Vitariello suggests that residents, particularly those in underserved areas, help attract physicians to their communities by assisting them with setting up their practices. "They, the communities, should chip in and use some of their finances to help subsidize the office, give them lower rents, give them lower interest for their physicians, so these physicians will go there," he says.

Other ideas include increasing the number of medical school students. Dr. Vitariello says the State of Maryland should also look at opening up a new medical school, such on the Eastern Shore. Right now, the University of Maryland and Johns Hopkins University are the only medical schools in the state.

One of the most debated issues regarding the medical profession is malpractice suits. Doctors say many physicians who are trained in Maryland leave after they complete their education, and set up their practices in states where malpractice coverage isn't as costly. "Here in the United States, the lawyers get a contingency. It's kind of like a finder's fee. So greed gets involved it. They want to make a lot of money so they push a $4-million-dollar award, an outrageous award. And they take home 30% of the kitty. It's like a lottery," he says.

And that, plus the fact that they can make more money in other states, encourages a lot of doctors trained in Maryland to take their skills to other states. "I'm going to earn less now, pay more for medical malpractice. And why should I stay in Maryland," says Dr. Vitariello. "So 60%, approximately, of our graduating classes are Maryland residents, leave our state and go elsewhere. So we're training these kids to stay with us, but they leave."

He admits that physicians do make mistakes, and patients have suffered. Dr. Vitariello suggests several states adopt a European system of boards with magistrates who listen to malpractice claims and decide on an award, if any. He also says laws should be put in place in Maryland, like in Texas and California, to cap medical malpractice awards. "Maryland, unfortunately, has a legislative body that's very pro-trial lawyer. They get a lot of money from them. And they're somewhat antagonistic toward physicians," says Dr. Vitariello.

The Affordable Care Act, known sometimes as "Obamacare," which goes into affect in 2014, requires all Americans to have health insurance coverage so they don't have to use hospital emergency rooms as their primary care physicians. Dr. Vitariello says 800,000 citizens who are not insured  are expected to have coverage when the law kicks in. But 350,000 will be left out, many of whom are undocumented immigrants. Dr. Vitarieillo says these people need to be covered as well. "We need to have some community approach to take care of the uninsured after the Affordable Care Act kicks in, meaning illegal immigrants, need health care as opposed to going to the ER, and overwhelming the ER," he says.

Right now, many of them get free medical care from Mission of Mercy, which has a mobile clinic which is parked at various locations around Frederick County. The physicians, nurses and other medical professionals volunteer their time, and don't ask a patient's immigration status before they provide treatment. But Dr. Vitariello says Mission of Mercy is running out of money to keep its clinic in operation.