On March 10, the day obstetrician David Gunn was shot to death outside a Florida abortion clinic, Howard Savage, a fourth-year medical student, received a pamphlet called "Bottomfeeder" in the mail.

The often scatological 14-page booklet, which was sent to more than 33,000 medical students around the country by a Texas publisher, contained the following "joke:"

Q. What would you do if you found yourself in a room with Hitler, Mussolini and an abortionist and you had a gun with only two bullets?

A. Shoot the abortionist twice.

"It was very upsetting, especially coming on the day that Dr. Gunn was murdered," said Savage, who attends the University of North Carolina at Chapel Hill. "The illustrations remind me of Nazi propaganda about Jews. And the jokes all describe ob-gyns who perform abortions as people who should be killed. It's an attempt to discourage people {in medical} training from even thinking about doing abortions."

Although the publisher declined to discuss it, the purpose of the booklet is clear, supporters and opponents of abortion agree. "Bottomfeeder" is designed to discourage medical students, residents and practicing physicians from performing abortions.

"We may not get laws changed or be able to change people's minds," said Bruce Cadle, field director of Operation Rescue National, an anti-abortion group that is targetting doctors. "But if there is no one willing to conduct abortions, there are no abortions."

Campaigns against individual physicians, coupled with the aging of many doctors who perform abortions and the dwindling number of residency programs that train new doctors, have led to personnel shortages. Increasingly, clinic administrators say, they are having trouble recruiting physicians, especially younger doctors.

"It's not just a problem, it's the problem," said Ron Fitzsimmons, executive director of the National Coalition of Abortion Providers, an Alexandria-based organization that represents half of the nation's 600 independent abortion clinics. "You don't exactly have doctors out there pounding down the doors for work."

The scarcity of doctors willing to perform abortions has long been a problem in rural areas where medical services of all kinds are in short supply. In recent years, the problem has surfaced in cities, including New York, which has nine medical schools and 30 programs that train residents in obstetrics and gynecology.

"Here we are in the medical capital of the universe and we were unable to find substitute doctors to cover when one of our physicians is sick," said Alexander C. Sanger, president and chief executive officer of Planned Parenthood of New York City, which operates three clinics that provide abortions.

The dwindling ranks of doctors mirrors a decline in the number of hospitals and clinics where abortion is performed. In 1988, the most recent year for which statistics are available, abortions were performed in 2,582 hospitals, clinics and physicians' offices, according to a report by the Alan Guttmacher Institute. In 1982, abortions were performed at 2,908 sites. Nationally, about 1.6 million abortions are performed annually in the United States, making it the most common surgical procedure.

Medical schools are offering fewer training programs that teach residents to perform abortions. A 1991 study found that only 12 percent of American medical schools and residency programs teach doctors to perform abortions. In 1986, 22 percent offered such training.

In many residency programs, abortion training is optional; as such, it is an elective many overworked residents, who would rather learn more intricate and lucrative procedures such as infertility treatments, forgo. One third of residency programs and medical schools do not teach abortion.

The dearth of physicians, Sanger and others said, is also a function of low pay, the monotony of the procedure and the residual stigma of being labeled "an abortionist." Abortions are among the cheapest surgical procedures: Most physicians earn between $40 and $50 for a first-trimester abortion, which costs patients between $250 and $350.

In New York City, Planned Parenthood pays one of its doctors $150,000 annually for a four-day week, about half of what Sanger estimates a board-certified obstetrician-gynecologist in New York City typically earns in private practice.

A first-trimester abortion, said Irving S. Rust, director of Planned Parenthood's clinic in the South Bronx, is "like swimming. It can be sort of boring and kind of monotonous, but unless you're good at it, you can wind up with some major complications." As with all surgical procedures, the more abortions a doctor performs, the more proficient he or she is likely to become.

Money and monotony are only partly responsible for the shortage. A generation gap separates doctors who perform the procedure from those who do not, said David A. Grimes, vice-chairman of the department of obstetrics and gynecology at the University of California at San Francisco.

Most physicians younger than 45 have never seen the results of botched abortions, which abounded on hospital wards before the procedure was legalized in 1973. Grimes said he remembers as a resident in the early 1970s treating a woman who arrived in an emergency room in agonizing pain with a temperature of 106

and a catheter from an incomplete, illegal abortion protruding from her uterus.

Other older doctors say they recall taking care of women who died of sepsis, a massive systemic bacterial infection; of 18-year-olds with gangrene who underwent life-saving hysterectomies, of women so desperate that they tried to abort themselves using knitting needles and lye.

"We as a profession have lost our collective memory of the bad old days," said Grimes. Such patients "leave an indelible impression in the mind of a young doctor."

Those experiences, some older doctors say, spur them to continue to perform abortions despite the low pay, stigma, the harrassment by certain anti-abortion groups and, in some cases, their advancing age.

The "graying" of abortion doctors is a national phenomenon. Until recently in New York City, all of Planned Parenthood's doctors were, like Rust, over 60. A clinic in Duluth, Minn., which serves 42 counties in Michigan, Wisconsin and Minnesota, as well as southern Ontario, Canada, relies on the services of a 78-year-old physician who flies in every week. And in Birmingham, Ala., a 79-year-old doctor spends 14-hours every week driving to and from his home in northern Kentucky.

"We have always had to import physicians from out-of-state even though 68 percent of our referrals are from {local} doctors," said Diane Derzis, executive director of Summit Medical Center in Birmingham. That is not likely to change, she said. Abortion is not taught at any medical school or residency program in Alabama, nor is it performed at any hospital in the state, according to Derzis.

"We have their support under the table," she added, citing the source of referrals. "We have allowed the medical community the luxury all these years of doing a procedure they don't want to handle."

To combat the shortage Planned Parenthood of New York City is training young doctors to perform abortions. Last year, the group trained three physicians, two of whom went to work for its clinics. Next month Planned Parenthood will launch a more formal program in which a dozen resident physicians are enrolled.

Some experts say they believe that the ultimate answer to the shortage may lie in training non-physicians, such as nurse practitioners or physicians' assistants, to perform first-trimester abortions. A program in Vermont, launched in the early 1970s, uses physicians' assistants to perform abortions.

"In the future, I expect that a lot of abortions will be done by technicians," said Rust. "You don't need a medical degree or an IQ of an Einstein to do certain things in medicine."