The pediatric neurology department at Children's Hospital came dangerously close to shutting down last year because the staff went from seven to three physicians.

Dr. Rebecca Hanson, a neurologist at the hospital, said the staff found it tough to recruit qualified doctors to fill the vacancies.

Eventually the hospital found three neurologists to fill the posts, but two of them only work part-time, creating a heavier workload for the staff.

"We were fortunate to be able to find doctors who had spouses who had jobs in the Los Angeles area," she said. "But two of us are approaching retirement and it will be the same problem again."

The doctor shortage encountered by Children's Hospital is just one of the problems facing the medical community in California.

In a just-released survey by the California Medical Association, more than half of the state's doctors polled say they are having a tough time attracting new doctors to their practices because many young physicians prefer to practice in states where the cost of living is not as high.

Furthermore, half of the doctors responding to the survey plan to quit, retire or move out of the state in the next three years because they are frustrated with managed health care, low reimbursement rates for patient treatment, and the rising costs of dispensing quality health care.

"In five years we are going to be facing a crisis," said Dr. Frank Staggers, president of the CMA. He warned that the state might soon be facing a shortage of physicians, particularly those in neurology, neurosurgery, orthopedic surgery and primary care, unless doctors receive higher reimbursement rates from the various health plans. "We need to look at ways to ward off a potential exodus of physicians from this state."

In Los Angeles County, more than 80 percent of the local doctors surveyed said practicing medicine was less satisfying than five years ago. Another 47 percent said they planned to move out of state, retire early or change professions. And while 61 percent would still choose medicine as a career, only 35 percent would choose to practice in California.

"For a young person leaving a residency program with a large debt load, what they are looking for is a way to earn money, pay back their loans and have a reasonable way of life," said Dr. Marie Kuffner, past president of the California Medical Association and an anesthesiologist at UCLA Medical Center.

But the California Association of Health Plans, a Sacramento-based organization that represents 36 full-service health plans, disputes the survey's findings.

"This is obviously a self-selected survey of CMA members which is heavily biased to the older physicians who have specialties," said Walter Zelman, the organization's president and chief executive officer.

Zelman said 80 percent of the respondents were male and more than half practiced in small medical groups.

The CMA, which estimates the state has 55,000 practicing and licensed physicians, distributed 19,000 survey questionnaires to California physicians. More than 2,300 surveys were returned.

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