Readers alarmed to learn in the first part of this series that nearly half of doctors would consider quitting if the government's health care overhaul goes through won't find much solace in another finding - that most of them also expect fewer people to go into their profession.
By better than a 3-to-1 margin, practicing physicians responding to a new IBD/TIPP Poll said they expect fewer students to apply for medical school in the future if Congress' plan passes.
The exact breakdown was 67% to 22%, with 11% not responding. That was the widest margin of response to questions asked in a survey that was mailed to 25, 600 physicians on Aug. 28 and to which 1,376 responded by Sept. 15. Doctors' names were purchased from a list broker.
Combined with the 45% who said they would consider leaving their practice or taking an early retirement, it's small wonder that 71% do not buy proponents' claim that the government can cover 47 million more people with better care and lower cost.
"I am a specialist with 15 postsecondary years after high school who didn't educate himself to this level to be dictated to by a socialist, leftward-leaning administration of nonphysicians," noted one doctor foe of President Obama's plan.
Many doctors voiced similar concerns, worried about higher costs, more bureaucracy and the impact on their profession now and in the future if the medical system is overhauled as planned.
"Physicians will be expected to work more for less, so many will just opt out," said one respondent. "Many elements of (the) plan will be left to the whim of (a) director of health care."
Doctors' loss of control over how they practice medicine, the advent of rationing and lack of tort reform could have a big impact on the next generation of doctors, some worry.
"(This) plan will result in a rapid and steep decline in the number and quality of physician trainees ... an influx of inferior, foreign-trained physicians and a shift toward lesser trained 'physician extenders,'" asserted one doctor.
Already, the medical world is bracing for a predicted physician shortage over the next 30 years that potentially will boost the cost of medicine and force patients onto waiting lists for treatment.
"Potential reforms, such as universal health care coverage, will add to overall demand for doctors and increase the projected shortfall (of physicians) by 25%," said a 2008 report by the Association of American Medical Colleges (AAMC).
From 2006 to 2050, the U.S. population is expected to add about 50 million people. Add to that the current estimated uninsured population of 46.3 million and an aging population, and the number of people in need of physician care will increase significantly - without a corresponding increase in medical professionals.
In 2006, the full-time physicians who worked in the U.S. numbered 680,500, not counting residents. Based on current population trends, demand for doctors is expected to grow 34% by 2025 to 909,300 physicians.
The AAMC estimates the "most plausible supply" of doctors at 750,000 by 2025 - leaving a significant shortage of 159,000.
Take just one vital part of the practice of medicine - primary care, or patients' first point of consultation. In 2002, 5,746 medical school graduates opted to be primary care physicians. By 2007, just 4,210 did - a 27% decline.
Primary care physicians make up about 30% of all doctors.
So the U.S. will soon suffer an extreme shortage of primary care doctors, the essential gatekeepers to our entire system of medicine.
The picture isn't a pretty one. "Shortages are likely to be manifested in a number of ways, some subtle and some not," said the AAMC in its report.
"This includes longer waiting times for appointments, increased travel distances to get care, shorter visit times with physicians, expanded use of nonphysicians for care and higher prices."
Even worse, the report added, "If shortages are extensive, in some cases it will lead to a loss of access altogether."
Shortages will hit the working poor hardest. Some 20% of Americans, 64 million of us, live in rural or inner-city areas that already suffer from shortages. It will only get worse - even with universal care, which proponents argue will help the poor most.
Once it begins, a shortage of doctors is hard to turn around. It takes an average of 10 years for a person to go through medical training, so anything that's done today to boost the number of physicians will take years to have an impact.
And responses to the IBD/TIPP Poll indicate that the overhaul proposed in Congress will make the situation worse.
In addition to the time spent mastering a highly technical profession, doctors today typically graduate with debt of six figures incurred to pay for their education and training. Add to that annual malpractice insurance premiums that range from $100,000 to $200,000, and doctors fear a dry-up in the supply of future doctors - whose pay, they worry, won't keep pace with costs.
As a result, many intelligent, driven people who might have gone into medicine will choose to go into other fields - decreasing the overall quality of our medical work force.
"Fewer talented people will be attracted to the profession," one doctor told us.
Another bemoaned the fact that "medical school/residency is eight-12 years of post-grad rigorous training, privately funded by students (and ) families."
Under the overhaul, that same doctor added, those who choose medicine can expect "low final salaries."
"The plan is reportedly to include 'cost changes,'" said another doctor, echoing others' concern. "I would ... anticipate 'health care reform' to cap future earnings while leaving education costs uncapped."
Less pay, longer hours, larger financial burdens - these are the conditions that doctors fear will put their own already sickly profession on the critical list.
Thursday: What doctors think can be done to lower health care costs