Medicare crises, looming doctor shortages, more patients without health insurance. And that doesn't even count the big changes coming from a revamped health care system.
It's a troubling time for doctors as they gather for the annual American Medical Association meeting.
The group's president, Dr. Cecil Wilson, is an avid sailor, and he says his hobby has served him well in navigating these uncharted, murky waters.
An internist in Winter Park, Fla., Wilson told the Associated Press this week that the nation's health care system "is sick, and that's why we've gone through this agony developing health care reform. We've got to make it better."
His yearlong term as AMA president ends Tuesday during the group's 160th annual meeting, where it votes on policy measures to adopt and lobby for. But new challenges are just beginning for doctors as the Obama administration's Affordable Care Act starts kicking in.
"The ground is shifting under our feet," said Dr. Jacqueline Fincher, a primary care doctor in rural Thomson, Ga. "We're all anticipating and hoping for the best and preparing for the worst."
Some of those challenges will be debated at the AMA meeting, which starts today in Chicago. Doctors who oppose the Affordable Care Act want the AMA to revoke its support. The AMA is unlikely to change its stance on health care overhaul in voting that begins Monday, but Wilson stressed that the group views reform as something that can be tweaked and made better.
"This law is not the final step -- it's the first step for overhaul of the system," he said.
Other measures on the AMA meeting agenda include proposals asking the group to support a ban on synthetic recreational drugs sometimes called "bath salts" that have sickened thousands; to study the safety of airport body scanners; and to declare that prohibiting gay marriage is discriminatory.
But the same haze of uncertainty and anticipation hanging over the entire industry is certain to pervade the meeting as doctors try to figure out what the upcoming reforms mean for them.
Dr. Vineet Arora, who works in medical education at the University of Chicago and plans to attend the meeting, said students and doctors-in-training have lots of questions "but it's hard to know what the system is that they're going to inherit."
Arora supports reform's major push to get millions more Americans health insurance coverage, but worries that there won't be enough primary care doctors to treat all those patients when that provision begins in 2014.