Americans are showing signs of impatience with their new president as Barack Obama enters a pivotal period facing a raft of critical decisions ranging from healthcare to Afghanistan. A wide variety of public opinion polls paint a difficult picture for Obama, with Americans expressing doubts about his handling of the US economy, healthcare and Afghanistan. His job approval rating has drifted down to around 50 percent. It was at 68 percent when he took office in January. White House officials are aware of the challenges and are working to try to regain the initiative on his top domestic priority, a healthcare overhaul by year's end, after a tumultuous summer. Obama will give a speech to a joint session of Congress on Sept. 9 and may use the rare forum to argue for his retooled strategy. “The president is considering all of his options on how to advance the debate and get reform passed. This includes possibly laying out a more specific vision. No decisions have been made though,” said a senior official. Complicating the picture for Obama, there has been no broad feeling of economic rebirth despite gains in the stock market, a slowing in job losses and other signs of improvement. He also faces foreign-policy challenges. Amid mounting American casualties, he is reviewing a US military report on Afghanistan and is facing conflicting pressures on how to confront the deteriorating situation there, with some liberals arguing for fewer troops and some at the Pentagon wanting to send more. He is trying to coax Middle East peace moves back to life, engage Iran in diplomatic negotiations over its nuclear program with an end-of-September deadline approaching, and get North Korea back to nuclear talks. His administration is also conducting policy reviews on a cluster of challenges – Burma, Sudan and missile defense. “It is a pivotal phase of his presidency on how he not only resolves healthcare but also deals with North Korea, Afghanistan and energy,” said Democratic strategist Doug Schoen, who worked in the Clinton White House. The Democratic president also is trying to nurse the US economy out of a lingering recession that did not start on his watch but has lasted long enough to create political problems for him. “Part of the problem here is the American public's appetite for immediate resolution of everything,” said Democratic strategist Bud Jackson. “The biggest thing that President Obama could hope for is more patience from people.” Opposition Republicans, hoping to gain ground on Democratic majorities in the US Congress in 2010 congressional elections, charge a $787 billion economic stimulus plan has done nothing to cure the country's 9.4 percent unemployment rate. His financial regulatory reform plans are working their way through Congress and he sits down with world leaders at both the UN General Assembly in New York and at a Group of 20 summit in Pittsburgh this month to try to work out ways to boost the global economy. Elections in November to determine governors of Virginia and New Jersey are looming as an early referendum on the president. The races are far from over but Republican candidates are in the lead. “Obama is on the ballot, front and center, like it or not,” said Republican strategist Scott Reed. The first issue to confront Obama on his return next week from a two-week working vacation is healthcare, after raucous town hall meetings conducted by lawmakers showed that Americans are far from agreement on how deeply to revamp the system and confused as to what the overhaul would mean for them. Many experts believe he will be forced to accept an agreement that is less than what he desired, well under the $1 trillion price tag and not as sweeping, without a government-run insurance option to compete with private insurers. Some liberals say he should use the Democrats' power to ram through his plan even if by a slim majority, while some Republicans urge him to start afresh and conduct a more bipartisan approach. “The American people believe we're headed in the wrong direction on healthcare and believe we should come back to Washington next week and start over,” said Tennessee Republican Senator Lamar Alexander. Pollster John Zogby said to some extent Obama is a victim of the high expectations that accompanied his ascension to power last January. “This was bound to happen. The expectations were very high, at least relative to the previous administration where expectations had sort of bottomed out. Here's a new president, young and dynamic, lots of promise and promises, and this is what happens,” he said.