The shortage of family doctors isn't just a rural problem.

Even in Colorado's larger cities, including Denver and Grand Junction, people can struggle to find a primary-care physician — particularly one that accepts Medicare or Medicaid.

Nationwide, the number of new American doctors choosing primary care has dropped to 25 percent from 34 percent in 2001, according to the Association of American Medical Colleges. The plunge is likely to dip even lower, though, because many doctors end up sub-specializing during their residencies.

At the University of Colorado School of Medicine, about half of graduates choose primary care, though only a fraction of those eventually become family doctors.

The major reason for the shortage, doctors say, is low pay relative to specialties such as surgery or oncology or neurology. The average pay for a family doctor in the Denver area in 2008 was $157,430, while the average in Fort Collins was $106,180, according to the Colorado Health Institute.

Compare that with a medical school graduate's average debt in 2008: $155,000.

At CU's medical school, the class of 2008, with 124 students, had a cumulative debt of more than $17.1 million. The average per-person debt was $138,352 for medical school, plus $26,000 for undergraduate education.

It is tough to encourage new graduates to become family doctors when so many primary-care physicians are struggling to make it, said Dr. John Bender, a Fort Collins family doctor with Miramont Family Medicine and president of the Colorado Academy of Family Physicians.

By his count, 32 primary-care doctors in Larimer County have "washed out." Many others have retired, Bender said.

One physician was making less money at age 50 than he was at 40, so he went to work for the Medicaid office in Wyoming. Another doctor's office shuttered after the bank showed up and seized its computer system, and along with it, all of its patient records. A third doctor left family practice for sports medicine.

"Primary care? That's major brain damage," Bender said. "People aren't going into it."

Bender has managed to keep his practice open and take home about $120,000 annually by doing away with paper and investing in computer technology. Miramont Family Medicine took over clinics in the past year in Wellington and Red Feather Lakes after one was running $500,000 in the hole and the other was bankrupt.

Without the clinic, Wellington residents would have to drive 40 miles round trip to see a doctor. Folks in Red Feather Lakes would have to drive about two hours.

Miramont is a "medical home" that coordinates appointments with specialists for patients, does lab work on site, has night and weekend hours, and focuses on prevention rather than sick care. To stay afloat, the office skips things such as getting pre-authorizations from insurance companies.

"I can't pay someone $30,000 to sit on the phone and talk to someone in New Delhi," Bender said.

Like many doctors, Bender argues that the only way to encourage more physicians to go into primary care is to reimburse them more for doing family medicine.

Proposals in Washington call for expanding "medical home" projects similar to some in Colorado, where insurance companies and the government pay doctor's offices more for coordinating care and keeping convenient hours.

"We have to make the patient-centered medical home the centerpiece," Bender said. "Each one of my practices needs an extra $100,000."

Jennifer Brown: 303-954-1593 or