Fewer doctors are likely to accept Medicare as a result of fee cuts planned next year, causing concern about access to health care for seniors, the nation's largest doctors group said Thursday.

Federal officials have proposed a 5.1 percent cut in Medicare payments to doctors, but most Americans aren't aware of the impending changes, the American Medical Association reported Thursday. When informed, the association said, 86 percent of survey respondents expressed concern that seniors would have less access to care.

The findings come after an earlier AMA poll in which 45 percent of doctors surveyed said that they would limit the number of Medicare patients they see, or quit accepting the federal insurance program altogether, if the cuts go through. Across North Carolina, about 25 percent of patients seen by family physicians are on Medicare, said Dr. J. Carson Rounds, president of the state Academy of Family Physicians.

"That means that in 25 percent of your visits, you literally lose money," Rounds said. "It costs you more to see them than you are going to get paid."

He said that retirees moving into the area can have a hard time finding a practice that takes Medicare. Many say it will get worse with the proposed cuts.

"All I know is we get asked to see folks because there are a lot of practices that aren't going to take Medicare," said Dr. James S. Parsons of Raleigh, who has stopped taking new Medicare patients in most cases.

Parsons said that even before the proposed fee cut, many treatments for Medicare patients have ended up costing him money. As an example, he cited the case of a hypothetical patient who requires injectable antibiotics.

"I think it's critical that I do that," he said, "yet the antibiotic medication costs me $50 and my reimbursement from Medicare for it is $9. If I get $35 for the office visit, I'm still losing money."

How many doctors in the area accept Medicare, the federal health insurance program offered to Americans over the age of 65, is not easily determined. A federal Web page, http://www.medicare.gov /Physician/Search/PhysicianSearch.asp, indicates there are 99 family practitioners in the Raleigh area who take Medicare. But it doesn't say whether they are accepting new patients.

Peter Ashkenaz, a Medicare spokesman, said Thursday that the giant government program needs an overhaul.

"We believe that the system itself is broken and that we shouldn't be sending money into a bad system; we should fix it," Ashkenaz said. "What we want to do is move away from paying for volume and instead pay for quality."

Asked about problems with access to care, Ashkenaz said, "What I have heard anecdotally is that it may take a longer wait. It may take you a couple of weeks to get a first appointment. I find I have the same problem [in Washington, D.C.] in getting in to see a doctor."

The proposed Medicare reduction for doctors is likely to be fought in Congress, which is supposed to adjourn in October but still has many priorities on its plate.

"The AMA has never met a payment cut that they like," said Jon Oberlander, associate professor of social medicine and health policy administration at UNC-Chapel Hill. "If they are going to play their political trump card, the best one they have is access [to care]."

Continued reductions in payment rates to doctors will result in reduced access, Oberlander said.

A study last year by the nonpartisan Center for Studying Health System Change showed that about 73 percent of doctors nationally accepted Medicare patients. Of those who took no new Medicare patients, about seven out of 10 listed inadequate payments as moderately or very important.

A change of course on the rate would come too late for Dr. Conrad Flick of Family Medical Associates of Raleigh.

"We have proactively not taken new Medicare patients in the last two years," Flick said. "These are the sickest of the sick; these are the most difficult patients to take care of and have the most problems."

Parsons, the solo practitioner, still takes patients who are related to or referred by other patients or associates. Because he is a geriatrician as well as a primary care provider, he can't stop treating Medicare patients.

"The patients are generally quite complex; you need a lot of time to do it well," he said, noting that it can take five minutes just to get an elderly patient on the examining table. "With the medical economy situation now, people don't have time to devote to that. They'd rather take care of 25-year-old healthy people."