Saturday, I volunteered to sit in a boardroom on a sunny day with 30 other people from various professions talking about the crisis we face in our community: inadequate access to good-quality primary care for adults in our area.
At this point, we have a huge victory: 15,000 adults have been assigned a primary care provider (PCP) since last November. Many of these individuals have had no access to healthcare for decades. The stories are compelling:
- A woman in her fifties who has never had a mammogram.
- A gentleman who has smoked for many years, has a chronic, worsening cough, but was never seen by a doctor.
- A diabetic woman without a blood sugar meter.
Now, they have hope for better care.
But there are 10,000 more adults in our area who have signed up for primary care and are yet unassigned to a PCP due to an inadequate numbers of medical providers.
Our provider workforce is aging quickly — the average age of adult primary care providers in Lane County is 55 years. And if we don’t soon address the need to inject new, young blood in our medical community, there will be only a few providers left here in a few years to take care of all of us.
The primary care offices are being overwhelmed. People are forced to go to the wrong place for their primary care needs. Urgent care, emergency rooms and medical subspecialists are being hit by a tsunami of people needing primary care services inappropriate for those settings.
Historically, Oregon has had low Medicare and Medicaid reimbursement rates compared with other states, reducing the income potential for physicians caring for those populations. And the work of caring for patients on the Oregon Health Plan is unevenly spread through the medical community. Some clinics take no patients; others, a modest percentage; and some see almost entirely OHP. There are many reasons, but as it stands, the work is being shouldered inequitably.
Adults with private insurance are also unable to get timely appointments as easily with their primary care providers due to the lack of availability. The revenue those visits could provide to help run the medical care engine are often lost as patients stay home rather than see a medical provider.
In the face of an explosion of new regulatory requirements, paperwork and extraordinary costs associated with purchasing electronic health records — and the additional staff necessary to meet new metrics on their work — dozens of primary care doctors in Eugene-Springfield have retired. Many of them have left their careers in their fifties or early sixties, at the height of their productivity.
Among factors affecting the next generation of doctors is debt. OHSU has among the highest tuition and graduate debt of any state medical school in the country: $400,000. That’s a difficult sum to pay back when salaries are substantially lower for primary care physicians than many surgical specialists. There are a variety of reasons specialists are paid more, so this is not a criticism of those physicians in any way. It’s just the reality, which matters to young physicians choosing their area to study.
Oregon has few training programs for residents in primary care compared with other states, and we have none in Lane County. Many medical residents work close to the area in which they trained.
Adding to the problem for Oregon is its weakened K-12 school system, which is a disincentive for attracting medical providers with families. As well, the suffering local economy is a disincentive for incoming new providers when the trailing spouse is unable to find an appropriate job. The community has never worked in a coordinated fashion to recruit or retain physicians and other medical providers.
These issues quickly are reaching a point where innovation and solutions are necessary. The fixes require help from many sectors working together. This past weekend physicians, politicians, United Way 100% Access, other non-profits, Lane County Public Health, Trillium Community Health Plan (our Medicaid/Medicare administration) and others concerned with the health of our community put our heads together to think of those solutions.
What can be done? In Part 2, I summarize what we believe should happen.