Despite health care overhaul, the future of medicine looks pretty bleak—at least according to doctors. New research suggests that if physician practice trends continue, more than 44,000 physicians will be lost from the workforce in the next four years.

The survey of 13,575 U.S. physicians commissioned by The Physicians Foundation, a nonprofit organization, finds that physicians are working fewer hours, seeing fewer patients and limiting access to their practices in light of significant changes to the medical practice environment.

And if those patterns continue, the medical landscape will change significantly—and patients will be the ones who pay.

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