When many new doctors graduate from medical school--most with more than $100,000 in student loan debt--they intentionally choose not to practice in Arizona.

"We are headed toward a perfect storm because of the doctor shortage over the next few years," says Robert P. Goldfarb, a neurosurgeon at the Carondelet Neurological Institute in Tucson who has spent some time studying why.

"Just as an example, one-third of physicians who are currently practicing will be retiring over the next ten years," Goldfarb says. "We train in the residencies approximately 20,000 to 22,000 new physicians a year, but we need about 40,000 a year."

Goldfarb says some of the serious challenges particular to Arizona include rising educational costs, decreasing support for post-medical school training, higher malpractice insurance costs than other states, and lower Medicare reimbursements than in other parts of the country.

Given those conditions, "we can turn out more and more physicians in this state, but we'll be training them to go to other parts of the country," Goldfarb says.