Opinion: Primary care access in Portland is worse than you think
This op-ed originally published in The Lund Report on March 12.
As a primary care doctor, I’ve been hearing the same question almost everywhere I go: How do I get a primary care physician?
Friends tell me they’ve called clinic after clinic and still can’t find a primary care clinician. Acquaintances admit they rely on urgent care for routine needs because they don’t have a regular provider. Patients ask me sheepishly at the end of their visit whether I might take on a family member who has been searching for months.
These stories reflect a broader concern. Primary care is the front door to the health care system, connecting patients to chronic disease management, preventative health, and longitudinal, coordinated care to avoid costly hospitalizations and emergency room visits. Yet one in five Americans reports no usual source of care.
When access is limited, conditions go unmanaged, diagnoses are delayed, and emergency departments become a default solution. The opposite is also true: Consistent access to primary care is associated with better health outcomes and lower overall costs.
Spurred by these experiences, my team recently conducted a “secret shopper” study to evaluate access to primary care. We called 444 primary care clinics in Chicago, Los Angeles, New York City, and Portland, posing as family members of Medicare patients seeking an appointment. We asked whether clinics were accepting new patients and how long the first appointment would take.
What we found was striking. While nearly 8 in 10 clinics overall accepted new Medicare patients, acceptance ranged from 97% in Los Angeles to just 35% in Portland. Even when clinics were accepting patients, wait times differed dramatically. Median wait times to see a physician ranged from 8 days in New York City to 61 days in Portland.
In other words, Portland is an outlier — but not in a good way.
Our findings echo other reports documenting geographic variation in primary care access. National audits for commercially insured populations have consistently found longer wait times in some metropolitan areas, including Portland and Boston, compared with cities like Los Angeles and New York. Studies in other populations, including veterans and Medicaid beneficiaries, show similar variation. The problem is not unique to one insurance program or patient group.
A key question remains: why? What are the factors explaining such variation? Importantly, Portland does not have fewer primary care clinicians per capita than other cities we studied, suggesting that workforce supply alone does not explain its longer waits. Local market structure may play a role.
Portland has a concentrated market compared to other cities, with nearly 60% of clinics affiliated with large health systems. Prior literature suggests that concentrated markets may be less responsive to pressures to reduce wait times or expand access. Portland also had the highest Medicare Advantage penetration among the cities we studied. In markets where Medicare Advantage enrollment is high, practices may face incentives to prioritize patients within contracted networks or aligned systems.
Within cities, how care is organized also matters. In Portland, hospital-affiliated clinics and community health centers were more likely to accept new Medicare patients. But acceptance did not guarantee timely care. Larger, multi-site systems may centralize decisions about new patient panels and scheduling, shaping access across entire regions. These decisions can help manage patient flow and staffing constraints, but they can also affect how quickly new patients are seen.
For patients, the painful reality is that finding a primary care clinician in Portland and surrounding areas may require persistence and strategy. Asking to be placed on cancellation lists, considering nurse practitioners or physician assistants, and being flexible about location can improve the chances of getting in sooner. Calling a health system’s central scheduling line rather than individual clinics may also reveal earlier openings.
From a broader perspective, our data highlights an urgent access challenge. More attention should be paid to the factors that are contributing to Portland’s outlier patterns, including understanding local market structure, competition, and organization. Importantly, while our study focused on major metropolitan areas, access barriers are often greater in non-metropolitan and rural communities. Policymakers thus should expand such audits across the state to measure and report wait times, strengthen the capacity of primary care teams, and sustain community health centers that serve as critical access points. Payment and regulatory policies must support practices’ ability to accept and see patients in a timely way.
Oregon has been a national leader in efforts to strengthen primary care, including requiring insurers to increase primary care investments, promoting team-based care models, and grappling with systemic issues like consolidation and rising costs. These efforts recognize that strong primary care is essential to improving health and controlling spending. But our findings suggest that reform must be judged not only by investment levels, but by patient experience — whether patients can actually get an appointment when they need one. On that measure, we have work to do.
Jane M. Zhu, MD, MPP, MSHP, is a practicing primary care physician and associate professor of medicine in the Division of General Internal Medicine at Oregon Health & Science University. She serves as faculty research lead for the division, providing strategic leadership for faculty research development, mentorship, and collaborative initiatives. Dr. Zhu is core faculty at the Center for Health Systems Effectiveness and holds a secondary appointment in Health Systems Management & Policy at the OHSU-PSU School of Public Health.