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Because of health reform, the U.S. healthcare system is bracing for the overnight influx of an estimated 20 million or more newly insured patients on Jan. 1, 2014. Balancing supply and demand will be tricky because as millions clamor for health services, there will be an estimated 200,000 fewer physicians nationwide to provide them. That’s why so many people are counting on telemedicine to be the Great Equalizer.

Here’s the demographic challenge: most of the fastest growing states in the U.S. are in the northern plains, an area that isn’t exactly a doctor magnet. (North Dakota is our fastest growing state because of the Bakken shale oil fields.) Meanwhile, populations in some eastern states like Rhode Island and Michigan are actually declining. With telemedicine, physicians who might be twiddling their thumbs in Providence and Kalamazoo can help care for some of those drillers in the Dakotas.

A report by the U.S. Census Bureau has revealed the top 10 states that have seen a population boom in 2012, seen in red, along with the worst, seen in blue.

States in the western U.S. and New England are the most “Obamacare-ready,” so they’re likely to see the biggest surge in demand. They could get help, however, from doctors in the 16 states that currently oppose Medicaid expansion (and probably won’t experience an immediate avalanche of new patients).

As Nirav Desai noted in a recent Hands On Telehealth post, matching healthcare supply and demand will depend in large measure on how well we utilize nurse practitioners and physician assistants. According to the Agency for Healthcare Research and Quality, there are about 56,000 NPs and 30,000 PAs practicing in the U.S. As Nirav points out, telemedicine could connect these mid-level practitioners with a physician in a central location. They could examine most patients on their own, and consult with the physician on more complicated diagnoses.

No other industry has ever faced a more daunting task than what awaits the healthcare field next year. If you sell tires or toothpaste, no one has ever thrown a switch and handed you 20 million new customers instantly. But telemedicine gives our overtaxed healthcare system a decent chance of being able to connect practitioners with patients, from Pawtucket, Rhode Island to the boom towns of North Dakota.

We’ve all seen Clint Eastwood westerns where the sheriff says, “We can’t treat him here…the closest doctor is in Dodge City.”

Without telemedicine, that’s the future we’re all facing. In little more than a year, some 30 million new patients will enter the U.S. healthcare system – the equivalent of every man, woman and child inVenezuela. Meanwhile, the Association of American Medical Colleges (AAMC) predicts that the physician shortage in America will reach 130,000 by 2025.

Legislative caps on residency funding will only worsen the current physician shortage.

One of the main reasons for the shortage is that the federal government has capped its funding for doctor residencies. Because there are so many deficit hawks in Congress now, it’s unlikely that the cap will be increased anytime soon – and efforts at private funding have stalled. You know we’re in trouble when a Congressman named “Price” (Tom Price, R-Ga.) bemoans the price of training physicians, but can’t muster the votes to change things.

Atul Grover, the AAMC’s chief public policy officer, recently said that “we’re going to have to find ways to see more patients with fewer physicians” to handle the increased volume.

And that’s exactly what telemedicine is doing. While politicians dither and medical schools stay in no-growth mode, telemedicine is enabling the doctors we do have to extend their reach. In fact, telemedicine solves one of today’s thorniest problems: the need for doctor relocation. These days, a young doctor can improve the quality of care in rural communities without ever leavingPhiladelphia or San Francisco.

Like a storm blowing through a western town in that Clint Eastwood movie, there’s a perfect storm on the horizon: millions of new patients, not enough doctors. That storm may be strong enough to blow away all remaining barriers to telemedicine.