Doctor shortages will affect primary care

By Scott Bond

Each week, our Information and Referral staff talks to hundreds of people by phone as well as those who visit our offices. The questions and requests for help are like a relentless drum beat seeking help. These people need help with medical care, food, clothing, income and care giving assistance for a loved one. Our agency is part of the safety net that local, state and federal funding pays for in an attempt to provide something for people who often have next to nothing.
We frequently address questions regarding how to find a doctor when Medicare or Medicaid is the primary medical insurance. The questions come from new residents to Oregon, or from someone who is helping a parent relocate to Oregon to be closer to supportive family members.

In many parts of the country, finding a primary care doctor can be difficult. Doctors frequently place a limit on the number of Medicare or Medicaid patients. There are very sound reasons for this. The financial reimbursement from both of these programs is limited by state and federal governments, and the amount of paperwork that it takes — along with the potential delays in getting a check — can be frustrating. The recent budget wrangling at the federal level for 5- to 10-percent cuts to Medicare reimbursements for physician payments creates obstacles, to say the least.

I wanted to hear about these issues from a local perspective, and so I spoke with Dr. Kevin Ewanchyna, vice president of medical affairs for Samaritan Health Services, about the key issues in the medical system that create problems all across the country.

Dr. Ewanchyna confirmed Medicare reimbursements for many physician services don’t cover the cost of providing the service.

Another local issue is the physician shortage. New doctors are being actively recruited to replace those who are retiring and to meet our region’s increasing health care demands.

As to whether Samaritan Health Services has the capacity to serve all requests for services from people whose primary insurance is Medicare or Medicaid: Dr. Ewanchyna said that, as a mission-driven organization, Samaritan Health is committed to meeting all requests for primary care, regardless of the type of insurance carried by the individual or family.

New solutions are being developed. A medical school in Lebanon is in the work through a partnership that includes Samaritan, and that eventually could ease the local physician shortage.

New concepts in medical care include “medical home,� where patients work with a team of medical professionals who collaborate in the care of patients with the oversight and direction of the physician.

According to one recent study by the University of Missouri, the United States could face a shortage of 44,000 primary care physicians by the year 2025. The 65-and-older adult population will increase by an estimated 73 percent by then. Demand for physicians’ time will increase by 29 percent as these older citizens require more health care. The number of general internists and family physicians is expected to increase by less than 5 percent.

In short, the demand for medical services clearly will increase in the next 15 years, and we will need to find innovative and creative solutions to provide these services.

Scott Bond is the director of senior and disability services for Oregon Cascades West Council of Governments, the Area Agency on Aging for Benton, Linn and Lincoln counties. He can be reached at 812-6008 or

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