Yet while some doctors could afford to do so, most probably could not. In primary care, particularly, where physicians are in short supply and young patients need their services, it would be easy for doctors to protect their incomes by reducing their share of lower-paying Medicare customers, and many already do. But in several medical specialties—orthopedics, cardiology, oncology, rheumatology—the elderly are the core of the customer base. People over 65 tend to use medical services at four times the rate of younger Americans, meaning it would be hard for many doctors to turn away seniors and maintain a viable business.

It’s not like physicians can’t get a haircut. Doctors recently absorbed a 2 percent pay reduction, their first in a decade, when the sequester kicked in. Industry consultants have seen few major ripple effects. “There are a lot of scare tactics going on,” says Martin Gaynor, a health economist at Carnegie-Mellon University. Gaynor doesn’t endorse the big, all-at-once hit that would ensue if Congress failed to pass a doc fix, but he doesn’t think the sky would fall if it did. “For all the gnashing of teeth and the tearing of clothes and the wearing of sackcloth by the medical profession and their advocates, I don’t think things would be nearly as bad as they say.”…

Med-school applications are booming, as are applications from foreign-trained physicians to enter U.S. residency programs. Even current doctors, who enjoy high incomes, say their major career satisfaction is patient relationships, not financial rewards, according to a recent survey from the Physicians Foundation. “It’s an inherently appealing profession,” says Berenson, who adds that lower physician pay might have a “salubrious” affect. “We would have people who wanted to be in the profession for the right reason.”