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“Secret shoppers” tried to set up primary care appointments for someone with Medicare insurance in four cities: New York, Los Angeles, Chicago and Portland.
Overall, they found that 77% of the sample clinics in the four cities accepted new Medicare patients.
But there was an outlier: Portland. Just 35% of the clinics contacted in the city accepted new Medicare patients.
It got worse. Among those that did accept new patients, median wait times in Portland were higher than normal—61 days, compared with just eight days in New York City.
“If I were a leader at the state level, at the local level, I would be really interested in trying to understand why Portland is such an outlier,” says Dr. Jane Zhu, an Oregon Health & Science University researcher on the study, which was published this week in Health Affairs Scholar.
The study underscores that, for certain groups of people at least, it is markedly more difficult to get primary care in Portland than in other major cities.
It also underscores that numerous efforts of state and local policy makers in recent years to boost primary care access have not fixed the access problem, which is central to normal people’s everyday experience of the health care system.
Among many other things, officials have sought to expand the Oregon primary care workforce and invest more money in primary care.
And yet, while important, Zhu says, “these investments have not translated into better patient experience or better access to care.”
The question is why. The answer is not completely clear, but, notably, the problem in Portland does not appear to be a lack of doctors. Researchers say the city has a similar number of primary care clinicians per capita as other cities in the study.
There are other ways that Portland stands out, though. It has a high number of people on Medicare Advantage opposed to Medicare plans, for example, and a low number of federally qualified health centers.
Another big difference, researchers note, is market consolidation. A notably-high 60% percent of primary care clinics in Oregon are affiliated with large health systems—which, one theory suggests, might feel less incentive to respond to market demands.
The claim has not been proved empirically, Zhu said, but it’s a potential hypothesis for future studies. The new study did find that hospital and health system-affiliated practices tended to have longer wait times than independent practices, “with prolonged delays concentrated in Portland.”
Additionally, she noted, Portland stood out for its long wait times in prior study with a small sample size published by AMN Healthcare.
She’s among those who see primary care as a vital component of a functioning health system, and so she sought to quantify the problem.
Pretending to be seeking care for a family member, the research team called almost every primary care clinic in Portland, Zhu says, seeing whether they could establish care for someone in Medicare—and the earliest available date if so. The callers tried back up to two times during business hours if the first call received no answer, Zhu says.
A primary care doctor herself, Zhu tells WW she worked on the study because she’s been hearing from patients and colleagues and friends—and observing in her own life—that “nobody can get a primary care physician in Portland.”
