Large population centers like Las Vegas and Detroit are feeling the effects of the nation’s physician shortage, Bloomberg News reports, which is no longer limited to rural areas. Patients in populous urban areas are waiting weeks—or even months—or traveling to find the care they need.

Many factors are contributing to the shortage, including an aging physician workforce that is reaching retirement, and not enough new doctors in the pipeline to replace them and care for an influx of patients with increasingly complex health care needs.

Doctors also tend to stay near where they train, the story reports, creating poor distribution in states like Nevada that don’t have large medical schools or training hospitals. Census Bureau data shows that Nevada has the fifth-lowest ratio of doctors to patients in the country, behind Wyoming, Mississippi, Oklahoma and Idaho.

One possible solution: other health care professionals. “In a bid to address the shortage, the medical community has embraced the greater use of nurse practitioners and physician assistants, who can prescribe medicines and diagnose and treat many illnesses,” the story reports.

What do you think? What steps will convince physicians to practice in underserved areas? Register below to leave a comment.

Read the Bloomberg News story.

Natasha Dow Schüll, PhD, MA, is a cultural anthropologist and associate professor at the Massachusetts Institute of Technology's Program in Science, Technology and Society. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2003-2005). Her recent book, Addiction by Design: Machine Gambling in Las Vegas, examines the ways that the gambling industry has designed gambling machines that encourage addiction.

Human Capital Blog: In your book, you describe how electronic gambling machines—the modern equivalent of slot machines—are designed in such a way that they encourage addiction. Tell us about that, please.

Natasha Dow Schüll: If you have never actually been in a Las Vegas casino and your idea of it comes from a James Bond movie, you'd be surprised by what you'd find. Of course they still have card games and roulette wheels, but most of the money casinos make is from electronic gambling machines, which are amazingly sophisticated versions of the classic three-reel slot machine. Every aspect of their design—the hardware, the software, the math, even the seating components—is carefully designed to keep players at the machine, playing game after game. Play is simple and amazingly fast—it takes only three to four seconds per spin. The machines are programmed so gamblers win every now and then, and they give audiovisual feedback to encourage them to continue. They induce players to gamble quickly and repeatedly, developing a sort of rhythmic flow that can sweep them away. Gamblers talk about getting into a "zone" where everything but the game just drops out of their awareness. After a while, they crave the zone itself, so it stops being about beating the machine and becomes instead about staying on the machine for as long as they can so they can be in that zone. They're addicted, and they develop all the behaviors of an addict as a result.

My point is that it's no accident; the machines are designed to drive the kinds of behavior—playing faster, longer, and more intensively—that turns gamblers into addicts.

RWJF Health & Society Scholars program alum (2003-2005) Natasha Schull, Ph.D., M.A., was interviewed by Lesley Stahl for the January 9, 2011 edition of “60 minutes” on CBS. Her topic: a new generation of slot machines that is contributing to gambling addiction. With gambling now legal in 38 states, the latest breed of slots relies on flashing lights, noises, rapid and multiple bets, and other stimuli to lull players into a trance-like state that Schull calls, “the zone.”

Schull is a cultural anthropology professor at MIT and a documentary filmmaker. She has recently finished a book based on her research in Las Vegas among compulsive gamblers and the designers of the slot machines they play. Addiction by Design: Machine Gambling in Las Vegas is scheduled for publication by Princeton University Press later this year.

Watch the 60 Minutes story.

For an overview of RWJF scholar and fellow opportunities, visit www.RWJFLeaders.org.