When it comes to health care Utah has long been a state that has done more with less. According to the American Medical Association only three states have fewer physicians per capita than Utah. In terms of primary care physicians per capita Utah is last. Despite this, Utah is regarded as a state with excellent health care. Credit must be given, in part, to the unique care Utah's health care professionals provide their patients.

As a third-year medical student at the University of Utah, I am concerned Utah will face unprecedented challenges to health care in coming years. Increased demand on health care resources will result from Utah's rapidly expanding population and the aging baby boomer generation. Furthermore, pending health care reform, the state's uninsured population, numbering some 360,000 people, may soon have increased access to care. The end result is clear: Utah's need for physicians may soon be greater than ever.

Demand on primary care will increase disproportionately to other areas of medicine. It is estimated our nation will need 40,000 more primary care physicians by 2020. Meanwhile, the number of U.S. medical students entering primary care has dropped 52 percent since 1997. A factor driving this trend is escalating student debt for graduating medical students, often in excess of $200,000, which creates a powerful financial incentive to choose careers with greater income potential than primary care.

Since 2006 the Association of American Medical Colleges has called for all medical schools to increase class size by one-third to meet future physician demand. Unfortunately for Utah the class size at the U. School of Medicine recently reduced from 102 to 82 students.

Last year the Utah School of Medicine faced a 35 percent reduction in educational funding including a $10 million reduction from the Centers for Medicaid and Medicare and a $4.4 million reduction in state appropriations. Most of these budget cuts will be permanent. This is a disaster for the public.

Unlike most graduate programs, the cost of training medical students well exceeds student tuition (current in-state tuition at the School of Medicine is $24,343, which covers roughly 30 percent of the annual cost per student). With reduced funds administrators were compelled to cut the incoming class by 20 students and increase tuition by 15 percent across all four years. A smaller class and tuition increases will continue without new sources of funding.

This should be concerning to citizens of Utah. Increased tuition and student debt add incentive for students to choose careers other than primary care. Operating the School of Medicine at reduced size while on the brink of expanding coverage to a large uninsured population is not a viable option for the state.

Utah needs to plan ahead understanding the time required to train new physicians. It takes a minimum of seven years after starting medical school to train a primary care physician and 10 years or more to train a specialist.

If Utah is to meet future demand, class size and funding for medical education must increase now.

Innovative ways to encourage new physicians to enter primary care must also be considered such as tuition subsidies and expanded loan forgiveness programs for medical students who commit to practicing primary care in Utah.

As it stands now, the School of Medicine receives less than 5 percent of its funding from state appropriations, well below the national average of 13 percent for state medical schools. Utah cannot expect to maintain health care excellence without contributing its share to medical education. Making this happen should be a top priority for state leaders.

Matt Covington is a third-year medical student at the University of Utah School of Medicine.