"I think for a lot of students right now, it's very hard to be confronted with the constant negative energy and constant fighting" that surrounds abortion, said Miller, who grew up in a southern Virginia city where antiabortion sentiment runs high. Just learning about the procedure at the state school in Richmond can be a challenge. Medical students who want training in the procedure usually must arrange an elective "externship" in Northern Virginia, she said.

Thirty-six years after it was legalized, abortion remains one of the most common procedures in American medicine -- and the most stigmatized. In 2005, 1.2 million abortions were performed, dwarfing the number of appendectomies (341,000), gallbladder removals (398,000) and hysterectomies (575,000). "There's this feeling it's dirty and should not be spoken about," said Miller. "It's hard to be brave and seek everything out yourself."

Her soul-searching underscores a long-standing problem some reproductive health experts say is worsening: a shortage of physicians willing to perform abortions. Although nearly one-third of American women will have an abortion by age 45, according to the Guttmacher Institute, a respected New York research organization, the number of abortion providers dropped from 2,908 in 1982 to 1,787 in 2005. Eighty-seven percent of counties in the United States and 31 percent of metropolitan areas have no abortion services.

In a January report, an ACOG committee found that one-third of American medical schools provide a formal lecture about abortion. Unlike most clinical experiences, which are integrated into the curriculum, abortion training is often optional, leaving time-starved trainees to learn about the procedure on their own. Medical school administrators contacted for this story declined to discuss abortion education.

In 1996, concerned about the lack of training in OB-GYN residencies, the Accreditation Council for Graduate Medical Education required that "induced abortion must be part of residency training" but allowed residents or programs with moral or religious objections to opt out; all residents must learn how to manage abortion complications. A 2008 study found that among OB-GYN residents who said they wanted to provide abortions once they started practicing, about half actually did.

"Our doctors are graying and are not being replaced," said Susan Hill, president of the National Women's Health Foundation in Raleigh, N.C., which operates abortion clinics in largely rural states, including Georgia, Indiana and Mississippi, where only one doctor in the state performs pregnancy terminations.

"We need young doctors and we need them badly," said Hill, whose clinics have been firebombed or set ablaze 18 times. "The situation is pretty grave, pretty dire."

A report in the journal Contraception last year found that 66 percent of physicians performing second-trimester abortions are more than 50 years old. Unlike their younger counterparts, many older doctors cite searing memories of days before the procedure was legal, when they cared for women who tried to perform abortions on themselves using lye or coat hangers.

Scaring Young Doctors

The same cannot be said of Joseph Booker.

Booker, 65, a board-certified OB-GYN, has described himself as "Yankee, pro-choice, outspoken, and black . . . a bad combination in Mississippi."

For 18 months in the mid-1990s he was guarded round-the-clock by U.S. marshals. Today he is the only doctor who performs abortions in Mississippi, which has one of the nation's most restrictive abortion laws, requiring, among other things, that a woman make two visits to a clinic 24 hours apart before receiving an abortion. Booker's practice is the target of frequent protests; he sometimes wears a bulletproof vest to work.

His Jackson clinic sits across the street from the state's medical school, where abortion is not taught. Many of the women he sees are from the Mississippi Delta, the poorest region in the nation's poorest state. His youngest patient was 11.

Who will take his place if he retires?

"That's a good question," he replied.

In Jacksonville, N.C., 72-year-old OB-GYN Takey Crist isn't sure of the answer, either. Crist has not faced the harassment experienced by Booker; no one has contacted his neighbors to ask if they knew a "baby killer" lived in their midst. He began performing abortions in 1973, the memory of treating University of North Carolina students who had undergone illegal abortions in neighboring South Carolina fresh in his mind. Among them, he said, was an 18-year-old freshman forced to undergo a hysterectomy to treat a life-threatening infection. "It left an impression on me," said Crist, the only doctor in Jacksonville who performs abortions.