The U.S. Department of Health and Human Services is projecting a shortfall of 20,400 primary care physicians by 2020. The agency notes in a study that the shortage could be eliminated if nurse practitioners and physicians assistants were fully integrated into the health care system. Linda Rounds, professor of nursing at UTMB, said she believes the growth of nurse practitioners is a response to the shortage of primary care physicians. She said many physicians opt to go into a specialty medicine instead of primary care, enabling them to make enough money to repay the greater amount of student debt they incurred. Rounds said, in her opinion, that an average patient would not be able to notice a difference in a nurse practitioner's diagnosis from a doctor.