State insurance exchanges will open for business next week, offering millions of uninsured Americans access to affordable healthcare coverage. In response, the healthcare community is bracing for the influx of new patients, but the strain these patients place on the system could be more than simply an increase in volume. Kevin Sexton, president and chief executive officer of Holy Cross Health, told Bloomberg the previously uninsured population who will begin to seek primary care services will likely be sicker than the average patient. A report by the Urban Institute and the University of Maryland found that almost half of all uninsured, non-elderly adults had a chronic condition, and one in six with hypertension reported no visits to health professionals in a year. After years of not having access to primary care services, many of the uninsured have poorly controlled chronic conditions, such as diabetes, and other undiagnosed conditions, including cancer. When such conditions go undiagnosed or untreated, patients can develop additional conditions that further complicate their treatment. To deal with this influx of potentially sicker patients, Holy Cross Hospital and others are considering adding staff and hours; however, there is a problem. The United States has a shortage of more than 15,000 primary care physicians according to the US Department of Health and Human Services, making recruiting new physicians a challenge. The problem will be even more difficult for providers in rural areas, who already have a hard time recruiting and retaining medical professionals. The increased demand for primary care services along with the lack of supply will cause many hospitals, practices, outpatient clinics, and other organizations to turn to locum tenens professionals to supplement their existing staff in order to avoid long wait times and turning away patients. Many hospitals, practices, and companies use locum tenens physicians to hold a position until they can find a permanent provider. Others, especially in rural areas, use a steady stream of locum tenens providers to ensure they can provide care to their patients.