Eight years of school, four years of residency and still the road ahead can be steep. For physicians, higher operating costs, declining reimbursements, higher liability insurance premiums and the quick step of new technology have dwindled their resources. Their core mission has also been stymied by the lack of capacity of affiliated hospital services which have left patients feeling stranded. Some physicians are drawn away to create partnerships with the hospitals to capture some of the technical revenue or have become equity players new physician-owned specialty hospitals. Some have opted out of medicine, leaving chronic shortages in specialties like cardiology, orthopedics and general surgery.