Consultant numbers are rising too slowly to meet demand or the requirements of the European Working Time Directive, a survey finds.
It shows only a 4.3% growth in England, Wales and Northern Ireland, and a 6% growth in Scotland.
However, the potential expansion if all available posts were filled is 7-8%.
The survey, by the Federation of Royal Colleges of Physicians of the UK, found nearly a third of all advertised posts are not being filled.
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Consultants and hospital managers face tough choices in the coming year.
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Dr Rodney Burnham
The colleges blame a shortage of qualified candidates, and lack of specialist training posts.
The government has now agreed to expand the number of training posts.
But the report says it is likely that there will be severe problems in consultant recruitment for the next few years until this happens.
Long hours
The survey found nearly all consultant physicians work more than their contracted hours.
Consultants in their early 30s work an average 53.5 hours per week - but consultants in their 60s rack up 59 hours a week.
Some of this can be explained by the increased need for part-time working and flexible training while bringing up a family.
But other research by the Royal College of Physicians has shown that both male and female junior doctors and young consultants want to work more flexibly in future and have a better work/life balance.
Women consultants now make up 20% of the physician workforce, and 5.7% of those exclusively on NHS contracts currently work part time.
The research also shows that if all consultants complied with the European Working Time Directive, then 16.9% more would be needed.
If this does not happen, says the report, then up to 18% of elective work in the major acute specialities will be lost.
The new consultant contract may also have a major effect on work practices and patient care.
Contract complications
The new contract will be either 40 or 44 hours per week. As most consultants work more than this already, there will be a significant reduction of hours - unless they agree to additional paid work.
Dr Rodney Burnham, director of the RCP's Medical Workforce Unit, said: "The data show just how hard consultant physicians are working and the pressures being experienced by them as well as the NHS as a whole.
"The difficulties in consultant recruitment, the effects of the European Working Time Directive and the various targets set for hospitals exacerbate this.
"Implementation of the new consultant contract may also make things worse.
"Consultants and hospital managers face tough choices in the coming year."
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