As a young reporter, I once wrote that doctors almost all seemed to be happy, that far more than business people or other professionals, they found satisfaction in their work and their lives.

As an old reporter some decades later, I find this no longer seems to be true. Almost every place that I encounter doctors, I hear them, at least many of them, complaining --

often bitterly -- about losing their control of the practice of medicine.

As a patient and as a writer trying to be an advocate for patients, that worries me. Like all patients, I want my doctors thinking about helping me, not preoccupied with all the stuff bugging them.

What's bugging them?

Restrictions and regulations. Paperwork. A growing number of annoying, time-consuming controls on the way they practice. Second guessing. Having to phone a nurse -- a "coordinator" for a health plan or insurance company -- to get permission to send a patient to the hospital. And sometimes hearing "no."

Next, if the answer is "yes," satisfying another coordinator that the patient hasn't been in the hospital too long. Later, sometimes -- long after care is completed -- being notified that the treatment was "inapproprate" and the insurer or government won't pay.

All these and more are regulations implemented to control zooming health care costs and, so it's intended, improve quality. All, or some better methods, are certainly necessary, given the way things had been going in medicine: the vast over-use and indifferent quality of much testing, hospitalization and care, and the dire effects on the costs.

But these restraints seem to be consuming so much time and causing so much frustration that even the best, most conscientious doctors are complaining of a "hassle factor" that gets in the way of good care.

"We're no longer in charge," said a noted neurosurgeon I know. "We have to create the quality care, if there's to be any quality. But everything is being reshaped, and we're without influence."

Another medical friend, uttering words I've heard from many, says, "Every time I see a patient, I think, 'Will this patient sue me if something goes wrong?' "

Another statement one hears from many doctors: "I would not tell a young person to go into medicine today."

And one repeatedly hears the words "harrassed," "disillusioned," "discouraged."

Are these physicians merely a sore- headed minority, angry because there are increasing controls on their fees as well as their acts?

No, says the conscientious Joseph Boyle, executive vice president of the American Society of Internal Medicine: "Physicians go to bed many nights fuming over allegations that they've mistreated some patients by failing to order a test, while standing accused of fraud when their use of the same test is deemed unnecessary by the same faceless bureaucrats."

No, says physician Arnold Relman, crusading, pro-patient editor of the New England Journal of Medicine: "Doctors are fed up to the teeth with the increasingly obtrusive regulations," he told a recent conference at Johns Hopkins. "You can't manage doctors to the point we have now. They say, 'I went into medicine because I like to take care of patients, and now everyone tells me what to do.'

"A sullen, demoralized medical profession will give you the worst quality in the world. I don't want to be taken care of by an angry, sullen and demoralized doctor."

Nor do I.

The doctors' main complaints are not about earnings. For the most part, they are in fact doing very well.

According to a survey by Medical Economics magazine, the 1989 median net income of American practitioners -- the sum they earned after expenses -- was $132,500, up 12.5 percent from 1988 for the highest gain in real income, after inflation, in the survey's 61 years. Of course, not every doctor earned as much. Half did better, some spectacularly better, half worse, some far worse. Young doctors just starting in practice don't do as well as starting doctors did a generation ago.

I do not defend doctors earning incomes in the hundreds of thousands by turning medicine into a hard-boiled business. I do not defend those who treat patients like cattle. I do not defend those who refuse to admit any shortcomings and put the entire blame on "doctor bashers" or "doctor haters" or "the media" for unjustifiably "alleging" that some doctors are incompetent, that some milk patients, that some unjustifiably "refer" their patients to their own medical businesses of one kind or another from which they make added profit.

All these unworthy doctors exist.

I believe, however, that we -- we patients or sometimes, it is true, we of the media -- fail to appreciate the strain and uncertainty of daily medical practice. We fail to appreciate the fact that there is often no sure course of treatment and a doctor must rely on judgment, which sometimes turns out wrong.

We fail to appreciate the fact that medical practice for the conscientious -- most doctors -- is full of stress. It is full of feelings of failure and guilt when treatment fails and patients die, sometimes because judgment was wrong. Even the best treatments fail, and then families and friends sometimes say, "The doctor did nothing" or "The doctor really screwed up."

And we blame doctors for keeping declining or near-dead patients alive "too long," when their entire ethic and training -- at least past training -- tells them: "Do all you can."

So doctors agonize.

Barbara Bowers is a practitioner in Minneapolis, a city where half the population belongs to health plans that place many controls on what doctors can do. "Patients, and the physician, frequently have no choice in the care provided. Rationing is occurring but in an obscure way," she writes in the Internist. "We see numerous examples . . . It is a formidable task to get a patient into the hospital if a complex situation exists and the diagnosis is unknown . . . Some tests are covered poorly or not covered at all . . .

"{In some plans} the physician is paid a net amount for each patient . . . This tends to penalize conscientious physicians, especially those who get sicker patients and tend to evaluate each patient's complaints thoroughly.

"Physicians in one group had several high-risk patients who needed intensive care monitoring for many weeks . . . The physicians became financially responsible for the patients' hospital bills and needed to take out loans to pay them."

And so on from many doctors.

Many are leaving practice early. Medical schools are digging deeper into smaller applicant pools and enrolling poorer students, by no means dumbbells, but students with poorer records than those of a decade ago.

Ronald Hurst is a former executive vice president of the American Medical Care and Review Association, composed of health plans that place restrictions on doctors. A few years ago, he likened the control systems to a work elephant, useful but potentially dangerous. "Let's try," he said, "to ensure that the elephant doesn't become a rogue that tramples those most responsible for quality, namely, the doctors."

Does the widespread dissatisfaction by doctors amount to a crisis? Yes, I think so, but it is only one part of the far larger crisis in which millions of Americans lack affordable access to treatment, and there is growing dissatisfaction by both patients and doctors with much about American medical care.Next: Inside doctors' minds.