North Carolina's rapidly growing population and rising number of older residents will overburden the state's physicians if steps aren't taken to increase their numbers.

The N.C. Institute of Medicine, which studies the health- care work force, released projections Thursday that suggest the state could face as much as a 21 percent drop in the number of doctors per 10,000 residents by 2030. That would make it harder for people statewide to get primary and psychiatric care, schedule surgery and find doctors to deliver babies.

For now, North Carolina is not in bad shape. As of last year, the state had 20.7 physicians for every 10,000 residents, which is about average among all 50 states. But North Carolina doctors are not evenly distributed. Eleven of the state's 100 counties and parts of 40 other counties are experiencing physician shortages.

Problems are expected to worsen because a large chunk of the state's doctors will reach retirement age even as North Carolina continues as one of the nation's fastest-growing states, demographic data show. Also, North Carolina is now the nation's fourth most popular state to retire to, so more new residents are older people with greater needs for medical care.

Physicians, health policy experts, hospital administrators and others gathered Thursday in Raleigh to discuss ways to preserve North Carolinians' access to care. A task force convened by the nonprofit Institute of Medicine presented several recommendations, including:

* Increasing enrollment at the state's four medical schools by 30 percent, or asking the General Assembly to pay for a fifth medical school.

* Boosting enrollment at training programs for "physician extender" positions such as nurse practitioners and physician assistants, and at East Carolina University's nurse midwife program, by 30 percent.

* Establishing care delivery models that use physicians more efficiently, possibly by delegating work to nurse practitioners and physician assistants -- professionals who diagnose patients and prescribe medication.

* Providing millions of state dollars to establish more residency training opportunities in areas that most need physicians. Doctors often set up practice near where they complete their residencies.

Some efforts are under way at the state's medical training programs.

The School of Medicine at UNC-Chapel Hill and private Carolinas HealthCare System in Charlotte said earlier this month that they will study creating a satellite UNC medical campus in Charlotte. Such a program would increase the medical school enrollment at UNC-CH by 50 students, for a total of 210. That is a 31 percent increase.

"This is, to be sure, not a full solution," Dr. William L. Roper, dean of UNC's medical school, said at Thursday's meeting. "If we do head down this road, it will be a help."

He said the idea is to have all students attend the first two years of medical school in Chapel Hill. Then, 50 would complete the final two years of training in Charlotte. Leaders at UNC-CH and Carolinas think developing a satellite campus in Charlotte will prove less costly than expanding in Chapel Hill or establishing a new medical school.

Duke University's School of Medicine weathered criticism this year when it announced it would no longer enroll residents seeking to train in family medicine -- one of the core areas of primary care. But Dr. Victor J. Dzau, Duke's chancellor for health affairs, said Duke will be part of the solution to provider shortages.

Duke hopes to establish a family medicine residency program that will emphasize outpatient treatment -- in particular care for people with chronic disease -- and training family doctors to work in teams that include nurse practitioners, physician assistants, nutritionists, physical therapists and other non-MD providers.

If approved by the national body that oversees residency training, the program could enroll four residents as soon as this summer, said Dr. Lloyd Michener, chairman of Duke's department of community and family medicine.

Meanwhile, Duke is expanding enrollment in its physician assistant program by about 60 percent, for a total of 180 students, and increasing enrollment in its physical therapy training program by 25 percent, for a total of 225 students.