House Democratic leaders intend to approve a rule Friday that would govern debate on legislation to change the way doctors are paid under Medicare, but Majority Leader Steny H. Hoyer , D-Md., said the bill would not be considered until the week of Nov. 16.

Without congressional action, doctors would see their Medicare payment rates cut about 21 percent on Jan. 1, thanks to a budget formula called the “sustainable growth rate,” or SGR. The formula has called for cuts in doctors’ pay in many of the last nine years, but under heavy pressure from doctors’ associations, Congress has reversed the cuts most years.

Now, however, Democrats would like to scrap the SGR and replace it with a formula that would promise doctors regular, inflationary increases in their pay. The American Medical Association, the strongest doctors’ lobby, has supported Democrats’ health overhaul effort in part because of the promise that the SGR will be repealed.

But a permanent SGR repeal has run into trouble in the Senate, where moderate Democrats demand that its approximately $247 billion cost — over 10 years — must be offset. That could be difficult, because Democrats have already included steep reductions in the growth of spending in Medicare — the likeliest source of money for the SGR repeal — in their health care overhaul bills, in order to offset the cost of that legislation.