Neighborhood House board member Eric Wiser advocates for patients – and doctors – for better health outcomes
By Kristine de Leon | The Oregonian/OregonLive
Christopher Trout never imagined finding a primary care doctor in the Portland area would become a monthslong ordeal.
When his longtime physician retired last August, the 24-year-old Tualatin resident expected a straightforward transition. Instead, he found himself caught in an exhausting cycle of phone calls and waiting lists. He has yet to find a physician who he can see regularly to manage a chronic medical condition that requires bimonthly infusions.
“It’s definitely concerning,” Trout said. “I feel the only reason I was able to get diagnosed and get the treatment I needed is because of consistent care and having a doctor who knew my history.”
Trout is not alone in his frustration.
Increasingly, Portland-area residents say they can’t find a primary care provider. In a poll of 600 Portland-area voters commissioned by The Oregonian/OregonLive, more than half said they found it harder to get an appointment with a primary care doctor than three years ago. Only 5% of those polled by Portland polling firm DHM Research reported it was easier.
Even those who have an established relationship with a primary care provider can expect to wait months for an appointment. Victor Valles Cano, a Beaverton resident who responded to the poll, said he had to wait three months for his most recent doctor’s visit.
“Making an appointment is not easy sometimes, and I have a primary doctor,” he said. “When I started having pain last fall, I called in November hoping to have an appointment by December, but the first day he had available wasn’t until February.”
The poll, conducted between March 6 and 13, had an overall margin of error of plus or minus 4 percentage points. Survey participants were reached by telephone or text, and the demographics of respondents was tailored to be representative of the area’s adult population by age, gender, race, education, income and political party.
On paper, Oregonians should have easier access to primary care than the national average.
According to the latest available data from the Association of American Medical Colleges, Oregon had 113 practicing primary care doctors per 100,000 people in 2023, surpassing the national average of 97. Oregon’s physician-to-population ratio was also higher than neighboring states like Washington and California, which each had about 104 primary care doctors per 100,000 that year.
More recent data from the Oregon Health Authority shows a similar ratio for primary care physicians but notes that primary care is also provided by physician assistants, nurse practitioners and naturopathic physicians. Including them would put Oregon at about 170 providers per 100,000 residents, the eighth-highest ratio of primary care providers to people in the U.S.
But experts say these figures don’t tell the entire story.
Betsy Boyd-Flynn, president and executive director of the Oregon Academy of Family Medicine Physicians, said counts of primary care practitioners rely on specialties like family medicine, internal medicine and pediatrics. Some under that umbrella — like hospitalists and pediatric specialists — don’t actually provide primary care.
“If all we’re looking at is full-time equivalent providers versus the population, it’s not like we have a count of the … appointments available,” she said.
Experts say primary care access in Portland and across the state has been eroding for years, but the COVID-19 pandemic accelerated it.
Deb Cohen, vice chair for research at Oregon Health & Science University’s family medicine department, said the medical community has been sounding the alarm about the decline in primary care providers for over two decades.
“What we’re seeing now,” she said, “is that this problem has gotten to a point where regular people are now feeling it.”
Family medicine physicians take on heavy student debt but earn significantly less than specialists. As a result, fewer medical graduates choose primary care. Recent studies show that less than 9% of internal medicine residents now pursue primary care careers, exacerbating the shortage.
The state has also reported that fewer new Oregon physicians are training in primary care than the nationwide average. And in 2023, the state had more than 200 vacant family medicine physician jobs that employers struggled to fill.
“It’s a labor economics issue,” Cohen said. “Family medicine physicians, in particular, carry a pretty heavy debt from medical school … they make significantly less money than a specialist would, and their workload is greater.”
And, she said, family nurse practitioners and physician associates trained in primary care can burn out and leave family medicine for specialty work.
“If there are opportunities where they can get better salaries or more manageable workloads, they are likely going to move into those careers,” she said.
Other factors, including an aging population that needs increasing care and ever-growing workloads for primary care doctors, has added to the strain of those already in the field.
Dr. Eric Wiser, a family medicine physician who teaches at OHSU, described a daily workload increasingly dominated by electronic medical record systems. He said these electronic systems have been around for over two decades but have evolved into demanding administrative tasks that blur professional and personal boundaries.
“Electronic records now add an hour or two of extra work each day,” Wiser said. “Yes, they were supposed to make it more efficient to chart and share medical information between patients and their health care teams … but now they’re capturing more data than ever, and I’m spending more time in front of the computer.”
On top of that, he said, patient messaging portals like MyChart have grown in popularity. Wiser said he gets hundreds of messages from patients each day, and the burden is on him to answer patients’ questions.
“We call this work we have to do after hours at home ‘pajama time’ because there’s just so much more we have to do for electronic record keeping and responding to patient messages,” he said.
Wiser said the crushing workload has contributed to physician burnout in primary care and that some doctors have decided to retire early or reduce their hours. That includes Wiser himself, who has shifted more of his work to his teaching over the past decade.
Susan Skillman, senior deputy director of the University of Washington’s Center for Health Workforce Studies, said industry consolidation has put more pressure on doctors to contribute to health care companies’ bottom lines by seeing more patients, and that’s also contributed to burnout.
A bill before the Oregon Legislature this year aims to make it easier for doctors trained abroad to get a license in Oregon. The state has also created a financial incentive program that includes loan forgiveness for medical students who pursue primary care training.
But bringing new primary care providers into the field will only go so far, Skillman said.
“If you’re pouring the water out of the spigot into a leaky bucket, you’re never going to fill it, Skillman said. “And that’s what’s happening in primary care.”
Quarrels with insurers, too, have made it harder to find a doctor, Skillman said. Some practices are dropping insurance providers that they find too difficult to work with or whose reimbursement rates are too low. Some clinics refuse to see Medicaid patients because of low reimbursements.
Limited access to primary care providers has shifted the burden to other parts of the health care system, like hospital emergency departments and urgent care centers.
Experts say that if people don’t get the preventive care they need or can’t access a primary care doctor in time for non-emergency symptoms, they just get sicker. That’s contributing to bottlenecks at hospitals, whose patients are too sick to discharge.
“Having access to primary care makes communities healthier, and saves people money because they avoid the ER,” said Cohen, the OHSU family medicine researcher.
Trout, the Tualatin resident and poll respondent whose doctor retired in August, said he worries his health problems could worsen if he doesn’t find a provider soon.
For four months, Trout said he called various doctor’s offices twice a week — Mondays and Fridays — because he figured that’s when patients would cancel an appointment, creating a last-minute opening.
By the end of November, Trout said he finally found a clinic that was accepting a new patient. But the first appointment he could get wasn’t until mid-April, and the clinic was a 35 minute drive from his home. So he’s still looking for one that’s closer or has an earlier availability.
“I haven’t stopped trying,” he said.
