A hallmark of national health-care reform - cutting the number of uninsured Americans - could cause major headaches for doctors and their offices.

Industry experts say there won't be enough doctors to treat the 32 million patients who will be newly insured under the Patient Protection and Affordable Care Act.

And those left to handle the influx also will have to comply with the new reimbursement rules and invest in electronic office systems.

The apparent solution - boosting the nation's physician supply - will take many years and much funding. But portions of the act are rolling out this year. How well the industry addresses its needs in the short term depends on innovation. Health care will need to be more creative than ever about the distribution of work, experts say.

"You can't move in 30 or 40 million new patients without having an impact on doctor supply as we presently constitute the delivery of care, which is one-on-one delivery of care," said Daniel Scully, CEO of Buffalo Medical Group.

The Association of American Medical Colleges predicts that in the next 15 years, the nation will need 130,600 more physicians, mostly primary-care physicians who serve a larger role under the law to coordinate care for each patient.

Some say the new law encourages more students to enter medical school, but it worsens a bottleneck by not restoring funding for medical residencies that was cut by Congress several years ago. Residencies give medical school graduates three years of training in hospitals and clinics before they enter the profession.

"If medical school enrollment is increased 30 percent, the funding that needs to follow that is not in place," said Dr. David Dunn, vice president for health sciences at the University at Buffalo medical school.

Further stressing the supply of primary-care doctors: Many more medical school students, facing a postgraduate debt load of $150,000 or so, are choosing to go into specialties because the pay is better than primary care. Dr. Ronald Santasiero, a Hamburg family physician, said about 40 of the 100 graduates in his medical school class of 1975 chose primary care.

In last year's class, just 10 did.

Facing an inundation of patients with few doctors in practice and few in the pipeline, the health-care industry is experimenting with some new care-management models. Examples:

• Independent Health is assigning case managers, who once worked out of the health plan's headquarters, to physician offices and is expanding the program to include pharmacy and behavior health, said Dr. Thomas Foels, chief medical officer. The health plan also is expanding primary care coordination of the Patient-Centered Medical Home pilot project to include specialists, he said.

• At the Buffalo Medical Group, patients may be connected to the practice through monitoring systems, instead of being seen in person. And if they do make the trip to the doctor's office, patients might visit a nurse practitioner or a licensed practical nurse instead.

"It doesn't have to be doctors all the time," Scully said.

The new law also changes the way doctors get paid. Payments will be based on the results of the care, not the number and kind of procedures they perform. This focus on quality of care, not the steps it takes to get there, is a major shift for doctors and Medicare, according to industry experts. Insurance forms, codes and billing procedures will be standardized under the new law. There also is an expectation that doctors will adopt electronic health records to facilitate sharing of patients' files between practitioners. It's an expensive proposition.

"A small physician practice won't be able to spend $100,000 on an electronic health record, without knowing the impact. There's no immediate return on investment," said Nicole Miller, director of the health information technology program at Trocaire College.

Though health reform is looming, doctors and their office staffs have more pressing concerns in complying with the national upgrade of medical coding. By 2013, U.S. health-care providers will have to code injuries, diseases and procedures using a more detailed format according to an international standard. Known as ICD-10, the coding helps to track disease and determines how it will be treated and how much money will have to be applied to its treatment. The United States lags behind 110 countries that have adopted ICD-10 since it was developed 18 years ago.

There's new software to purchase or update, and coding personnel will have to be retrained. Miller said the impact will be "enormous."

"This is placing quite a burden on medical offices," particularly those still using paper records, she said.

Annemarie Franczyk is an associate professor at Buffalo State College and a regular contributor to the Buffalo Law Journal.