Facing pressure on all fronts, an increasing number of physicians are planning to retire early, and the medical school pipeline is not ready to replace them.
Meanwhile, many specialists in seemingly lucrative fields struggle to make ends meet.
Welcome to the new medical field, where doctors may not be as rich or secure as once supposed.
Deloitte's 2013 survey of U.S. physicians found deep pessimism in the profession, including 60 percent predicting early retirement and asserting that the "practice of medicine is in jeopardy."
At CNN Money, Parija Kavilanz reported on a number of doctors in private practice who are struggling or going under.
"Doctors also blame shrinking insurance reimbursements, changing regulations, and the rising costs of malpractice insurance, drugs and other business necessities for making it harder to keep their practices afloat," Kavilanz reported.
The problem has been brewing for years now, driven in part by sharp declines in reimbursements for Medicare.45 comments on this story
Last year, Kavilanz reported on doctors struggling in private practice, noting claims that "recent steep 35 percent to 40 percent cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue."
"These cuts have destabilized private cardiology practices," Dr. William Penz, a Philadelphia cardiologist told Kavilanz last year. "A third of our patients are on Medicare. So these Medicare cuts are by far the biggest factor. Private insurers follow Medicare rates. So those reimbursements are going down as well."
In addition to a wave of retirements, newly hatched doctors are pushing away from general practice, toward more lucrative specialties. The result is a growing shortage of general practitioners, according to John Commins at Health Leaders Magazine.
"The timing really could not be worse," Commins wrote, "One out of three practicing physicians in the United States is over the age of 55, and many of them are expected to retire in the next 10 or 15 years. Meanwhile, U.S. medical schools have not provided for the loss of 33 percent of the nation’s physician work force."