THE true physician, said Plato, is not a mere moneymaker. America's well-off doctors would heartily agree—and not just because (as Plato explained) their minds are on their patients' welfare. Today's doctors too often feel like over-worked clerks. They have to slog their way through a nightmarish jungle of insurance claims and other paperwork.

That is part of the reason why the number of Americans wanting to go to medical college has fallen for five years in a row. Some of the decline can be chalked up to the past decade's economic boom, when other work looked so much more lucrative. But a lot of potential doctors have been put off by horror stories of graduates who work 100 high-stress hours a week at training hospitals for a mere $40,000 a year, after piling up an average of $100,000 in medical-school debt. And then, having finished their training, doctors find themselves facing a mountain of administrative work. Other professions, notably the law, have recently halted the decline in their applicant numbers; but medicine is still on the skids.

Jordan Cohen, president of the Association of American Medical Colleges (AAMC), says that medical colleges are still getting a reasonable number of good students. The AAMC has a more pressing worry: money. Most teaching hospitals (where students do resident-work for at least three years) get their money mainly from the federal and state governments, plus doctors' fees and undergraduate students' tuition fees. These days they are hard up. According to Robert Dickler, the AAMC's senior vice-president, between 25% and 30% of the big teaching hospitals are losing money each quarter.

This is partly because teaching hospitals are expensive to run: teaching costs money, and teaching hospitals also tend to treat more uninsured patients, and do more specialised surgery, than regular hospitals. They also do a lot of research, the cost of which is rising fast, despite generous injections of cash from the National Institutes of Health. There is less money than ever to pay for all this: teaching hospitals' budgets have been squeezed by the managed-care system, which has cut the price and frequency of services such as diagnostic tests, and by the scrimping imposed by the 1997 balanced-budget act. So far, says Mr Dickler, most have managed to scrape by; but they may not be able to do so much longer.

As money gets tighter, teaching gets shorter shrift. A recent study by the Commonwealth Fund Task Force on Academic Health Centres showed that teaching hospitals don't do nearly as much teaching as they should. Patients are hustled out of hospitals sooner—partly because of surgery's technological advances—and this deprives students of the chance to learn follow-up care. Teachers have less time to teach; their pay cheques come mostly from clinical care, not from teaching. Earnings from clinical care also help to pay for other hospital activities, such as research, so Medicare's slashing of doctors' pay (by more than 5% this year) hurts.

Money worries at teaching hospitals could get even worse as resident students clamour for better conditions. Last month the Accreditation Council for Graduate Medical Education decreed an 80-hour-a-week cap on residents' work hours; this will probably mean poorer service for patients. In May, several doctors filed an anti-trust lawsuit claiming that the National Matching System—which single-handedly assigns all medical-school graduates to their residencies—keeps wages unfairly low and hours horribly long. All very well to complain, says Mr Cohen, whose organisation is among the suit's defendants: but what, save chaos, is the alternative?

The medical establishment is creakily tackling its host of problems. Urged on by the AAMC, many colleges are vigorously trying to recruit more non-white, non-Asian students (currently a dismal minority). Some of them, such as Brown University, have set up partnerships with colleges in non-white areas, and go trawling for students there.

But the money problems are harder to fix. Some institutions are merging. Most have done painful cost-cutting, slicing down their administrative staffs. A few have closed; the largest of these was Mount Sinai Hospital in Cleveland, two years ago. And come October, medical education could lose yet more money from cuts in indirect Medicare payments. The profession is not in a healthy state.