The Affordable Health Care Act will extend health care coverage to an additional 30 million Americans. Family doctors will play an essential role in keeping costs down. Routine visits to a general practitioner can facilitate healthful behaviors and prevent the chronic problems that require a specialist’s attention and have driven up the cost of health care. That is, if there are enough of them out there.

Bruce Japsen, a Chicago-based health care journalist, told WBEZ’s Alexandra Salomon that the shortage of family physicians, not to mention a number of other fields, has already been a problem, especially in rural areas of the country, and that the problem will only get worse in years to come. Excerpts from the conversation follow.

On the rise of specialists:

“Before costs went up, people said, ‘If I need to get an MRI, I’ll go see a radiologist. If I have a headache, I’m not going to go to my primary care doctor. I’ll go to the neurologist.’ Well, those folks are expensive.”

On the abundance of dermatologists and plastic surgeons:

“It’s an area they can do well because it’s credits cards. People are paying cash for those services. It’s not something insurance is going to cover.”

On what medical schools are doing:

“There are roughly 18 to 20 [medical schools] in development across the country. Generally, those are places where they’re going to train more primary care doctors. That is the trend right now. There are some teaching hospitals that cannot fill, say, their anesthesiology slots because certain states are letting nurse anesthetists to do more work because anesthesiologists are more expensive…and so you have a lot of dynamics changing.”