A minuscule 1% of Maryland’s 16,000 doctors have registered to recommend medical cannabis to patients, signaling that the state’s industry could face an uphill battle when it comes to its potential patient pool.

In addition, two of the largest hospital systems in the state have prohibited their doctors from registering with the program, the Baltimore Sun reported Monday.

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Reluctance on the part of physicians to opt into MMJ programs has led to smaller-than-expected patient pools in states such as Illinois, Minnesota and New York and can be a big hurdle for cannabis industry participants.

So far, only 172 doctors in the entire state of Maryland have signed up to recommend MMJ.

That’s “going to create a problem” for the program at large if more physicians don’t opt in, the head of the state’s professional physician association told the Sun. And 95% of the doctors who have registered plan to serve only patients in the Baltimore area, leaving many potential MMJ consumers without easy access to a doctor’s recommendation.

The issue could balloon for the highly-anticipated cannabis market if more physicians don’t change their minds before the program launches next year. For example, the tiny patient pool in New York led to some dispensaries not seeing a single patient on opening day in January.