<p>Doctors in the Washington area are facing a crisis, much like their counterparts throughout the nation. Malpractice insurance rates and government restrictions on Medicare payments are making it tough to go about the day-to-day business of treating patients. Some doctors are giving up high-risk practices completely, leaving their patients with fewer options for treatment. Would-be doctors are entering medical school only to change their career goals as they see the hard realities ahead. "You have a situation where the viability of a physician's practice is in great jeopardy," said Dr. Donald Palmisano, president of the American Medical Association (AMA). The AMA says the financial and liability difficulties of doctors in 19 states are bad enough that doctors are giving up high-risk procedures. Another 26 states are reaching the same point, including Maryland, Virginia and the District. "The overall costs of practicing medicine are increasing while payments are decreasing," Dr. Palmisano said. Some doctors — both locally and nationally — are doing what would have been unthinkable several decades ago: They are leaving the profession, either by retiring early or taking different jobs. Sam Roberts will decide in December whether he will continue his obstetrics practice in Elkins, W.Va. That's when his medical malpractice insurance company will tell him his premium rate for 2004. If it rises above the $55,000 a year he currently pays, he will pull out of obstetrics completely, keeping only a family medical practice. "I'm basically paying as much as I make in obstetrical practice," Dr. Roberts said. "I'm doing it because I love it." If he leaves, he will end a two-generation obstetrical practice that has included deliveries of more than 9,000 West Virginia babies.</p>