Fewer medical students are choosing to go into primary care at a time when demand for their services is expected to increase as more people gain access to care through the federal healthcare overhaul. Eighty percent of Missouri, including all of southeastern Missouri, has been designated a Health Provider Shortage Area by the U.S. Department of Health and Human Services. That means one in five Missourians is without access to primary healthcare, according to the Missouri Foundation for Health. The problem is worse in rural areas, said Thomas McAuliffe, policy analyst with the foundation. Only about 12% of Missouri medical school graduates went into family medicine in 2009, according to the Missouri Primary Care Association. Declining reimbursements from insurance companies and the hundreds of thousands of dollars in medical school debt doctors graduate with are both contributing to the shortage of primary care physicians, she said. Primary care doctors earn about half what specialists do, according to the Medical Group Management Association.