A looming doctor shortage threatens to create a national healthcare 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.
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% of the white-coated workforce.
But it may 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 firm. "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."
North Hollywood resident Anneliese Ohler, who had a cancerous lesion removed from her face several years ago, had to wait two months recently to see a dermatologist after her hairdresser -- and then her primary doctor -- told her they saw worrisome spots on the top of her head.
"I was lucky it was not cancer," said Ohler, 83. "But what if it had been?"
Experts say her wait was a symptom of a wider problem: Demand for doctors is accelerating more rapidly than supply.
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' repertoires, which now include such procedures as joint replacement and 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%.
Yet much of the physician workforce also is graying, and headed for the door. A third of the nation's 750,000 active post-residency physicians are older than 55 and likely to retire 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% less productive, Edward Salsberg, the director of the Assn. of American Medical Colleges' Center for Workforce Studies, told a congressional committee in May.
Although some communities still have 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 that the federal government considers it to be medically underserved.
The scarcity hit home for Dr. Robert Werra three years ago when he tried to find a family practitioner to fill his shoes before he retired from a medical group that he helped found in the Northern California city of Ukiah.
Despite nibbles from physicians in the Midwest, Werra couldn't persuade a single one to pay a visit. In the end, his patients were added to his colleagues' caseloads, extending wait times in a practice that is now closed to newcomers.
"We can't get any family doctors to come here," said Werra, 75.
Experts worry that Werra's problem is becoming more common, and not just in rural communities. 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 including Los Angeles 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.