It's doubtful anyone asked about the availability of healthcare when Horace Greeley's advice was printed in the New York Tribune to "go west, young man." Today, it's a valid concern, particularly in Wyoming. With only 5 people per square mile, it's an understatement to say that Wyoming is a very rural state. With only 2.2 doctors for every thousand people, it's no wonder why state residents need to gravitate toward one of the state's few urban centers to find internal medicine in Wyoming. Most Wyoming residents have visit medical centers in Cheyenne, Casper or Jackson Hole to find a specialist. Serious or complicated treatments require a trip to Salt Lake City in neighboring Utah.

Compounding an already serious deficit in medical care, Wyoming is facing the same recruiting dilemma found in most areas of the country. According to the Wyoming Department of Health, over one third of practicing physicians, internists or specialists, are over 50 years of age. The majority of these are planning to retire within the next five years. All fifty states are finding that they'll require millions in recruiting dollars in order to entice young doctors to commit to their geographical area. Many states offer assistance with medical school loan repayments, relocation expenses and huge signing bonuses, so Wyoming medical recruiters have already found themselves to be at a disadvantage. Unless a prospective physician is interested in living with only the basic necessities, likes to spend a lot of time in natural surroundings and isn't worried about an extensive social life with first class cultural or athletic events to choose from, Wyoming is going to come up short on filling the anticipated openings from the upcoming graduating classes of the nation's medical schools.

Another trend giving most states reason to be anxious about projected shortages of practicing doctors of all specialties is the impending passage of the nation's "baby-boomers" into their geriatric years. The youngest of the boomers are now hitting Medicare age, with legions to follow over the next ten to fifteen years. With a third of Wyoming's population over age 50, the need for medical intervention can only be expected to rise as well.

How do residents of Wyoming cope with the difficulty in finding internal medicine in Wyoming? Many communities have turned to physician assistants (PAs) or nurse practitioners (NPs). Pursuit of both of these professions can be achieved with a master's degree and can serve as a means for all states, particularly Wyoming, of dealing with the shortage of doctors both now, and the foreseeable future.