RIVERSIDE, Calif. — In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.

Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems. The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000.

Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans. It typically takes a decade to train a doctor.

“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”

Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult. In Riverside, it has left residents driving long distances to doctors, languishing on waiting lists, overusing emergency rooms and even forgoing care.

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The United States will need 5.6 million new healthcare workers by 2020. The study, by researchers at Georgetown University’s Center on Education and Workforce, also found that 4.6 million of those new workers will need education beyond high school.

“In healthcare, there are really two labor markets — professional and support,” Anthony P. Carnevale, the report’s lead author and director of the Center on Education and Workforce, said in a news release. “Professional jobs demand postsecondary training and advanced degrees, while support jobs demand high school and some college.” There is “minimal mobility” between the two, Carnevale said, “and the pay gap is enormous — the average professional worker makes 2.5 times as much as the average support worker.”

Among the study’s findings:

• In 2008, 80% of entry-level RNs had at least an associate’s degree, up from 37% in 1980.

• Rising degree requirements in nursing may be crowding out disadvantaged minorities, according to the authors: 51% of white nurses under age 40 have bachelor’s degrees, compared with 46% of Hispanic nurses and 44% of African-American nurses.

• Healthcare has the largest number and proportion of foreign-born and foreign-trained workers of any industry in the U.S. Among healthcare workers, 22% are foreign-born, compared with 13% of all workers nationwide. Most foreign-born nurses come from the Philippines, India and China.

• Only 20% of healthcare professional and technical occupations earn less than $38,000 a year, and almost 50% earn more than $60,000.

• More than 70% of healthcare support workers make less than $30,000 per year, but that percentage is still better than most available alternatives for workers of that skill and education level, according to the report.

• Healthcare successfully competes for science and engineering talent. Because the healthcare, science and technology fields tend to require similar skills, healthcare programs at the associate and bachelor’s level often are appealing alternatives for science and engineering students.

• One difference between the fields: People in healthcare jobs tend to value forming social bonds, while people who gravitate to science, technology and engineering occupations place a greater emphasis on achievement and independence, the researchers found.

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For decades, the attempts at health care reform have aimed to increase access. The United States is one of the few industrialized nations in the world that does not provide universal health care to its citizens. And repeatedly, those who oppose it have been forced to argue that access isn't the problem some make it out to be. Why?

That, of course, is not true.

It's not even close. Let's start with the idea that emergency rooms must provide you care.

What's important to remember is that you can't be refused emergency care. That's because the Emergency Medical Treatment and Active Labor Act (EMTALA) requires that any hospital that takes Medicare or Medicaid must check you for emergent conditions and treat them if they exist. Since nearly every hospital in the country takes federal funds from one of these programs, nearly all hospitals are subject to EMTALA.

But "emergency medical condition" has a pretty narrow definition. It includes active labor for women and acute conditions that would cause death, serious bodily organ harm or serious bodily function impairment if they were not treated right away.

If politicians are meaning to say that women have universal access to delivery care, then I suppose there's an element of truth to that. But there's no guarantee of prenatal care in the emergency department. If they are saying that we have universal access if we're acutely having a heart attack, then I suppose there's truth to that as well. But there's no such access for lipid panels, stress tests or prescriptions for cholesterol medications that might help you avoid the heart attack in the first place. If you're acutely obstructed by massively advanced colon cancer, it's likely you can get emergency surgery to end the blockage. But your cancer is likely too far advanced to cure at that point. Moreover, you're not going to get chemotherapy in the emergency department nor could you have gotten the colonoscopy that might have detected the cancer far earlier.

You can't get preventive care in the emergency department. You can't get screened for a host of disorders. You can't get treatment for your depression there or really for any chronic mental disorders. You can't get help with your child's autism, ADHD or developmental delay. And even if you could, it wouldn't be free.

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