Compared to their Canadian and German counterparts, American physicians were least satisfied with their nation's health care system, according to a 1991 study published in yesterday's New England Journal of Medicine.

The study, based on interviews with over 500 physicians in each country, reported that only 23 percent of U.S. physicians thought the nation's health care system "worked well." Of Canadian and German physicians surveyed, 33 percent and 48 percent, respectively, approved of their countries' systems.

The response rate overall was approximately 50 percent, with a margin of error of four percent.

The article concludes that "universal coverage and cost containment necessitate important trade-offs" in a country's health care reform decisions.

American physicians said poor Americans often do not have access to good health care, the report said. "Physicians in the United States were the only group in which a majority reported that patients' inability to afford treatment was a serious problem," the article noted.

"American doctors are most disturbed by the [number of] patients that cannot afford their services," according to the study's leader, Robert J. Blendon, Lee professor of health policy and management at the School of Public Health.

And more American physicians said their patients wait until the last minute to seek medical attention for their problems.

External interference from insurance companies, burdensome malpractice suits and inflated malpractice insurance costs were also cited by American physicians as major problems in the U.S.

Blendon said it is ironic American physicians are the least satisfied "even though they are supposed to be freer and are paid more than [those] in other countries."

Of the three countries surveyed, American physicians were least likely to recommend medicine as a career to qualified students, Blendon said. This contradicts the "usual slogan that if you have a national health care system, no one wants to go into medicine," he said.

Dr. David Blumenthal '70, assistant professor of health policy and lecturer on health policy and man- agement at Mass. General Hospital said yesterday he was not surprised by the results of the study.

"I'll take any system that has universal access and cost control," he said, citing these as the two most pressing problems in the current U.S. system.

But he noted that although many American doctors are "apprehensive" about health care reforms, most see some kind of change as "inevitable."

According to the study, neither German nor Canadian physicians cited access to care for low income patients as a problem in their respective countries. Both countries have universal coverage as part of their systems.

But Canadian physicians surveyed said they have difficulty getting specialized care for patients