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, radiology and several pediatric and surgical subspecialties.
There is pressure on medical schools to boost enrollment and on lawmakers to lift a cap on funding for physician training and ease limits on immigration of foreign physicians, who make up 25 percent of the work force.
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 in to 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, including joint replacement and liposuction.
Over the next 15 years, baby boomers will push urologists, geriatricians and other physicians into overdrive.
Yet, 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.
At the same time, younger male physicians and women - who make up half of all medical students - are less inclined to work the long hours that long typified the profession. 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 enjoy a glut of physicians, shortages have arrived in many places. One in five U.S. residents lives in an area that has so few physicians the federal government considers it medically underserved.
The nation's physician work force 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.
Hospitals, practices and academic medical centers in places not considered health care backwaters report more difficulty recruiting physicians. 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.
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.
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."
Lisa Girion writes for the Los Angeles Times.