It's 8:15 a.m. on a warm July Wednesday, and the parade of patients is already lining up for Mary Fey, a family nurse practitioner on the front lines of health reform in this rural community 100 miles south of Portland, Ore.
There's the 32-year-old guy with a Hobo spider bite and high blood pressure, the 61-year-old with a sore shoulder from a tractor accident, the 9-year-old with allergies, the 91-year-old with dementia.
They all come to Fey, the sole primary care provider for nearly 30 miles in this region where doctors are in short supply—and the January launch of Obamacare is expected to make it worse.
"I'm pushing 1,500 patients now and that's going to increase," said Fey, 58, who refers to the coming changes as "the onslaught."
Like nurse practitioners across the U.S., Fey is girding for the onset of reforms put in place by the 2010 Affordable Care Act, which offers some 32 million Americans new access to health insurance—but no guarantee of access to care.
"It will be better, but it's painful to get to something better," said Fey.
Experts estimate the U.S. is already short more than 9,000 primary care physicians, a number expected to rise to 65,800 by 2025, according to the Association of American Medical Colleges.
If newly insured Americans are going to get care under the federal health overhaul, it's Fey and her colleagues who will have to help fill the gap, analysts say.
'Huge, huge solution'
"To me, nurse practitioners could be a huge, huge solution to this problem of primary care shortage," said Dr. Thomas Bodenheimer, a professor of family and community medicine at the University of California, San Francisco, School of Medicine.
NPs, as they're sometimes known, are registered nurses who hold graduate degrees and can perform virtually all of the functions of front-line family doctors—depending on the laws of the state they're in.
"They can do 90 to 95 percent of what the docs can do," said Bodenheimer, a medical doctor who practiced primary care himself for three decades.
More patients are recognizing that: Between 1998 and 2010, the number of Medicare patients treated by NPs increased 15-fold to more than 450,000 people, University of Texas Medical Branch researchers found recently.
But advocates say that many of the nation's 106,000 nurse practitioners, including about 56,000 who practice primary care, are hamstrung by state laws that limit their authority.