A new secret‑shopper study says Portland’s primary care clinics are far less likely than those in other major U.S. cities to take on new Medicare patients. Researchers found that only about one in three Portland clinics were willing to add a Medicare patient, and even when clinics said yes, the median wait to see a physician in Portland stretched to roughly two months.
Oregon Health & Science University led the research and put out a news release after the manuscript was accepted for publication in Health Affairs Scholar. “Primary care is the front door to the health care system,” senior author Jane Zhu told OHSU, warning that when people cannot get timely primary care, chronic conditions can go unmanaged and patients are more likely to end up in the emergency room.
How the cities compared
The study phoned 444 primary care clinics across Chicago, Los Angeles, New York City and Portland to see whether practices would schedule a visit for a new Medicare patient. According to Health Affairs Scholar, 77.5% of clinics overall accepted new Medicare patients. The city‑by‑city breakdown looked very different: 96.9% of clinics said yes in Los Angeles, 92.8% in Chicago and 82.3% in New York, compared with just 35.0% in Portland. Among clinics that did offer appointments, median physician wait times ranged from eight days in New York to 61 days in Portland.
Market structure may be creating a bottleneck
The authors and OHSU note that Portland’s health care market looks unusually consolidated. Even with a relatively high supply of primary care clinicians, a large share of clinics are owned by big health systems and Medicare Advantage enrollment is high, features the researchers say can tighten scheduling flexibility. The news release points to centralized scheduling at large systems as a mechanism that may lengthen waits and limit how many new patients clinics are willing to take. The authors argue that these structural issues, rather than a basic shortage of clinicians, help explain why Portland lagged so far behind the other cities in their sample.
What it means for patients and policy
In adjusted analyses, the paper found that each additional practice site was linked to a 1.5‑percentage‑point lower probability of accepting new Medicare patients. Hospital‑ or system‑affiliated practices also had waits about 15 days longer than independent clinics, findings the researchers say point to the need for better workforce planning and closer monitoring of access. They recommend that policymakers and insurers strengthen how appointment availability and provider networks are tracked so Medicare beneficiaries do not end up without a usual source of care. According to Health Affairs Scholar, addressing these structural issues could help shorten delays and reduce avoidable emergency‑room visits.
