A looming doctor shortage threatens to create a national health care crisis by further limiting access to physicians, jeopardizing quality and accelerating cost increases.
Twelve states - including California, Texas and Florida - report some physician shortages now or expect them within a few years. Across the country patients are experiencing, or soon will face, shortages in at least a dozen physician specialties, including cardiology and radiology and several pediatric and surgical subspecialties.
The shortages are putting pressure on medical schools to boost enrollment and on lawmakers to lift a cap on funding for physician training and to ease limits on immigration of foreign physicians, who already constitute 25 percent of the white-coated workforce.
But it might be too late to head off havoc for at least the next decade, experts say, given the long lead time to train surgeons and other specialists.
"People are waiting weeks for appointments, emergency departments have lines out the door," said Phil Miller, a spokesman for Merritt, Hawkins & Associates, a national physician search company. "Doctors are working longer hours than they want. They are having a hard time taking vacations, a hard time getting their patients into specialists."
The number of medical school graduates has remained virtually flat for a quarter century, because the schools limited enrollment out of concern that the nation was producing too many doctors. But demand has exploded, driven by population gains, a healthy economy and a technology-driven boom in physicians' repertoire, from joint replacement to liposuction.
Over the next 15 years, aging baby boomers will push urologists, geriatricians and other physicians into overdrive. Their cloudy eyes alone, one study found, could boost the demand for cataract surgery by 47 percent.
Yet, much of the nation's physician workforce also is graying and headed for the door. One-third of the nation's 750,000 active, post-residency physicians are older than 55 and likely to retire just as the boomer generation moves into its time of greatest medical need.
By 2020, physicians are expected to hang up their stethoscopes at a rate of 22,000 a year, up from 9,000 in 2000. That is only slightly less than the number of doctors who completed their training last year.
At the same time, younger male physicians and women - who constitute half of all medical students - are less inclined to work the slavish hours that long typified the profession. As a result, the next generation of physicians is expected to be 10 percent less productive, Edward Salsberg, director of the Association of American Medical Colleges Center for Workforce Studies, told a congressional committee in May.
Although some communities still enjoy a glut of physicians, shortages have arrived in many places. One in five U.S. residents lives in a rural or urban area that has so few physicians the federal government considers medically underserved.
Wait times increasing
The nation's physician workforce is approaching a tipping point, beyond which patients face dangerously long wait times and distances to see physicians. Or they get more care from nurses, physician assistants and other substitutes, whose ranks also are stretched thin. Or they go without.
Wait times for appointments are a sign of the emerging strain. The wait to see a dermatologist for a routine skin cancer examination in 15 big cities averaged 24 days, according to a 2004 survey by Merritt Hawkins.
For a routine gynecological checkup, women faced an average wait of 23 days, the survey showed. To see a cardiologist for a heart checkup, the wait was 19 days. And to have an orthopedic surgeon check out a knee injury, the average wait was 17 days.
Hospitals, practices and academic medical centers in places not considered health care backwaters report more difficulty recruiting physicians - primary care doctors and specialists alike. Recruiters charging as much as $30,000 per placement now count some of the nation's most prestigious medical centers as their clients.
It has gotten even more challenging for medical groups in resort communities from the Florida Keys to California's Coachella Valley, places where it was once easier to recruit a doctor than it was to get a tee time.
"I can remember five, six years ago, I had general surgeons calling me, asking, do I have a job?" said Dr. Marc Hoffing, medical director of the Desert Medical Group in Palm Springs, Calif.
Pay offers have been rising steadily in places where practices and hospitals are competing most vigorously for available physicians.
With a greater premium on physicians, some experts fear an acceleration of a trend among some doctors to limit their practices to wealthy patients who can afford to pay cash. These so-called concierge practices further exacerbate the disparity in care between the rich and everyone else.
If nothing changes, experts say, the prognosis for the quality of health care is poor.
"People are going to really hurt," said Dr. Richard Cooper, a professor of medicine and economics at the University of Pennsylvania. "Right now we have well-trained nurse practitioners to pick up a lot of the work, but when even they are overwhelmed, the whole thing really falls apart. We're at the cusp, and it's a little worrisome."