Clinics, patients reckon with physician shortage in Southern Oregon
By Erick Bengel, Rogue Valley Times
Southern Oregon is short on doctors.
At Providence Medical Group, one of two major health systems in Jackson County, patients whose primary care physicians leave may have trouble getting an appointment with another physician.
As the medical group’s physicians have retired or gone elsewhere, nurse practitioners and physician assistants have absorbed many of their patients and worked to fill gaps in primary care.
In addition, for at least two months, the medical group has been closed to new patients except on a limited basis.
Anyone who phoned Providence’s new patient call center in July heard a recorded message: “For callers new to Providence, we are unable to schedule a new patient appointment at this time. Please call again in August.”
It was an update from an earlier recording that advised would-be patients to call back in July. On Friday, the message said to call back in September.
Following national trends, Providence, Asante and other medical providers in the Rogue Valley don’t have enough primary care physicians — medical doctors who serve as patients’ main point of contact with the health care system. They perform routine check-ups, listen to patients’ concerns, diagnose their conditions, recommend treatment options and refer them to specialists.
Other providers of primary care, including nurse practitioners and physician assistants, are in short supply, as well.
“There is absolutely a shortage of primary care in the valley,” said Doug Ward, vice president of Asante Health Network.
The Rogue Valley Times called around to get a sense of the options available in the county and found few physicians at major health systems and smaller clinics accepting new patients. Most physicians who could add patients to their roster came with limitations; for example, many didn’t take Oregon Health Plan — the state’s health insurance program for low-income patients and children — and/or had waitlists backed up for weeks or months.
When a Providence physician in Ashland with about 1,200 patients recently retired, the patients who called right away could see another physician. Meanwhile, providers in Central Point have also announced they are leaving. One is staying with Providence but switching from primary to specialty care.
With even fewer physicians to choose from, Providence is scheduling appointments in December and beyond. Patients who wish to be seen sooner may be offered a nurse practitioner or physician assistant.
Patricia Alvarez, 71, uses the Central Point clinic and has had trouble maintaining primary care there.
Her nurse practitioner left in June. Then Alvarez was assigned a doctor, who had arranged to see her in February 2024. With that doctor leaving, Alvarez called the clinic this week. She was told Providence could not schedule her now but that a new provider would arrive at the end of August.
“It’s very frustrating,” she said. “Very frustrating.”
Over at Asante, most family medicine clinics said they were not taking new patients regardless of their insurance type.
Earlier this year, Asante patient Diane Werich’s primary care physician was out sick for several weeks.
Werich, who is in her 70s, tried to make an appointment with a different provider in the same Ashland clinic. She had received concerning test results and needed recommendations for further treatment. The clinic had no one for her there or — sometimes a backup clinic — in Talent, she said.
“I kept asking the schedulers, ‘Well, my gosh, what’s happening,’ you know? ‘We don’t have enough doctors,’” she recalled. “And they kept saying, ‘No, we don’t.’”
Her doctor also told her that he was more than 300 patients over his panel capacity, or patient load.
“The overflow from his practice — I mean, the people that weren’t getting taken care of — it would be difficult to cram all of those people in the full practices of the other people,” she said.
Ward said that Asante’s primary care workforce is already 10% above its expected panel capacity.
“The overwhelming majority have already met or exceeded their target panel size,” he said.
The health system changed its compensation plans over the last year to reward providers for taking on more patients than Asante’s target. That incentive is one way Asante has dealt with the shortage, Ward said.
Werich has lived in Ashland for 37 years. She feels for the first time as if she’s living in a health care desert, she said.
“I don’t think that’s any fault of Asante’s. I think they’re trying like heck,” she said. “But I think health care’s screwed everywhere.”
La Clinica, a federally qualified health center that focuses on low-income patients and underserved communities, has a six- to nine-month waitlist for anyone looking to establish primary care.
Dr. Chris Alftine, La Clinica’s chief medical director, said, “There’s such a national problem with not having enough primary care doctors that recruiting new primary care is very difficult.”
At Rogue Community Health, two physicians were taking new patients but were booked four months out.
At one clinic, a physician who retired in late 2022 transferred her patients to two providers at the same practice. Both are nurse practitioners, and both had a full patient list.
The RV Times left a voicemail at another clinic. The physician responded via text a short time later to say his practice was closing.
According to 2022 data from Oregon Health and Science University’s Oregon Office of Rural Health, the Medford primary care service area has 233 primary care physicians for 141,744 residents — 1.64 per 1,000 — while the Ashland service area has 50 primary care physicians for 26,474 residents — 1.89 per 1,000.
The population in these areas is large enough to support primary care doctors who work in family medicine, internal medicine, general practice, osteopathy, obstetrics and gynecology, and pediatrics.
The Phoenix/Talent service area has two primary care physicians for 12,642 residents, the Eagle Point service area four primary care physicians for 17,109 residents. The Rogue River service area has two primary care physicians for 12,853 people, the Shady Cove service area one primary care physician for 6,110 residents.
The Grants Pass service area — largely in Josephine County but extending into Jackson — has 70 primary care physicians for 77,171 residents — 0.91 per 1,000. The Applegate/Williams service area, which also straddles both counties, has two primary care physicians for 9,666 residents.
A 2021 report from the Association of American Medical Colleges projects a nationwide shortage of between 17,800 and 48,000 primary care physicians by 2034. A shortage of physicians numbering in the tens of thousands is also projected in non-primary care specialties.
Data shows that Oregon has an above-average number of primary care providers, “but there is a significant misdistribution of physicians,” said Dr. Roger Garvin, a family medicine physician at OHSU, in an email.
He noted, using 2018 figures, that slightly more than 50% of physicians who train in Oregon stay in Oregon, and only 27% of physicians practicing in Oregon were trained in the state. “We are a significant net importer of physicians, many of whom gravitate to larger population centers,” he wrote.
Aaron Rust, executive director at Providence Medical Group in Southern Oregon, pointed to several things that contribute to the regional shortage.
Physicians have been choosing specialty practices — a career move that often pays better than primary care. Doctors have retired or relocated. Some providers have simply burned out. On the education level, the financial cost of medical school, as well as the schools’ inability to keep up with a growing demand for services, furthers the shortfall, he said.
“Additionally, the population of Southern Oregon keeps growing, faster than we can hire additional providers,” he said in an email. “The tight housing market is a factor.”
And there are the patients: “We are a retirement community with an aging population and a lot of underlying conditions, including obesity, diabetes and high blood pressure,” he wrote.
Alftine said that patients without primary care end up going to urgent care and emergency rooms for their primary care needs. “Or they just defer care altogether,” he said.
Providence, in addition to its urgent care locations and partnerships with virtual providers in Portland, has “hired physicians, nurse practitioners and physician assistants who have same-day appointments at each location,” Rust wrote.
La Clinica has an Acute Care Clinic, where people who are on the waitlist but can’t see their primary care doctor or provider can get their medical needs met.
Both Providence and Asante are focused on recruiting and retaining providers, Rust and Ward said.
This year, La Clinica launched an Advanced Practitioner Residency Program, which starts in September and will train nurse practitioners and physician assistants over the course of a year.
“We just see this happening, generally speaking, that the shift will be away from physicians to nurse practitioners and PAs everywhere,” Alftine said. “There just aren’t going to be enough primary care physicians in general, so we have to find new models to do primary care.”
While the residency program won’t help on the physician side, the newly minted practitioners will help grow the health care workforce in Southern Oregon.
“The physician brings a different kind of depth and expertise to medical care,” Alftine said. Nurse practitioners and physician assistants will need more consultative assistance and ask La Clinica’s physicians for help with managing patients.
“But on the other hand, generally speaking, patients are just as happy, or happier, when they’re seeing a nurse practitioner as compared to a physician,” he said.
Reach reporter Erick Bengel at [email protected] or 458-488-2031. This story first appeared in the Rogue Valley Times.
