IRVING, Tex., Oct. 25 -- Half of physicians from ages 50 to 65 are frustrated with their practices and plan to sharply cut back or abandon patient care within the next three years, according to a survey.



Fifty-two percent of these older physicians said they find medicine has become less satisfying over the past five years, according to a survey by Merritt Hawkins & Associates, a national physician search and consulting firm.



Only 10% of nearly 1,200 responding physicians said the practice of medicine is "very satisfying," down from 20% in earlier surveys.



What's more, 44% of the surveyed physicians said they wouldn't choose medicine as a career if they were starting out today and 57% would discourage their children or other young people from doing so.



These doctors don't intend to remain unhappy for much longer, though. Almost half of survey respondents said they will retire over the next three years, seek nonclinical jobs, work part time, close their practices to new patients (18% have already done so), or significantly reduce the number of patients they see.



If that trend continues, patient access to health care could be severely jeopardized. "Almost half the physicians in the United States are 50 years old or older," said Mark Smith, executive vice-president of Merritt Hawkins. "An exodus of older doctors from medicine would be a disaster for patient care in this country."



The Council on Graduate Medical Education (COGME), a panel of health care authorities, has endorsed a study predicting a shortage of 96,000 physicians by the year 2020. If only 20% of physicians in the 50 to 65 age bracket opt for retirement or nonclinical roles in the next three years, nearly 60,000 physicians would be removed from the clinical workforce, the survey noted.



"The tens of millions of patient encounters these physicians handle would have to be absorbed by younger physicians or by those older physicians remaining in clinical practice."



Why do physicians claim to be so disgruntled? Reimbursement issues were cited by 33% of doctors as their greatest single source of professional frustration, followed by malpractice worries (18%) and long hours (15%).



That represents a significant shift. In the 2004 Merritt Hawkins survey, malpractice worries were the main source of frustration (28%). Reimbursement issues were cited by only 16%.



"When Baby Boom doctors entered medicine, they had control over how they practiced and the fees they charged," noted Smith. "But the rules changed on them in midstream and now many are looking for a ticket out."



These older physicians don't have much regard for the work ethic of their younger counterparts. More than two-thirds of respondents said physicians being trained today are less dedicated and hard-working than they are.



Recently trained physicians may put a higher premium on "quality of life" issues than senior physicians often do. "We find that younger physicians today generally prefer and expect fixed hours, a good call schedule with reliable coverage, and regular vacation time," the survey report noted.



A much higher percentage of young physicians today are female than was the case in the past, and female physicians work 18% fewer hours per week than male physicians, according to the AMA. For these reasons, it may take two younger physicians to replace a more senior doctor.



On a more positive note, six in 10 older physicians said patient relationships are their single greatest source of professional satisfaction.



Also, 48% of physicians indicated that the quality of health care in the United States has generally improved over the last 20 years, compared with 33% who indicated it has generally declined.



So, the survey authors concluded, although the practice of medicine may have become problematic for many older physicians, patient care has generally improved.



The survey was mailed to 10,000 physicians across the nation and 1,175 participated, a 12% response rate. Surgical and internal medicine subspecialists comprised 47% of respondents, followed by primary care physicians (36%) and hospital-based doctors (17%).