Oregon Business Q4 2025

doctors, behavioral health specialists and oral health providers (dentists, hygienists and dental assistants), who have had their loans repaid in exchange for serving in rural areas. This program has been funded to the tune of $26 million for the 2025-2027 biennium. A decade ago, a group of doctors, policy directors and insurance provider directors formed the Primary Care Payment Reform Collaborative to come up with better ways to pay primary care doctors than the current “fee-for-service” model. One of the group’s ideas is “capitated payments,” which has also been put forth by the Centers for Medicare & Medicaid Services (CMS). Simply put, an insurance company would pay a clinic a set dollar amount for each of the patients it serves for a set time frame, such as once a month. “With fee-for-service, doctors need to increase the volume in order to meet their needs,” says Pierce-Wrobel. Capitated payments would give clinics a guaranteed monthly income and flexible funding to pay for additional staff whether they see a patient once or five times per month. It also reduces bookkeeping because there would be no need to bill for each individual service or test the doctor offers. The majority of Oregon’s Medicaid insurers already make capitation payments with some primary care providers. In its latest workforce needs assessment, the Oregon Health Authority published a long list of recommendations to help grow and diversify the state’s health care workforce. The list includes increasing compensation and other benefits (including offering stipends for housing, child care and transportation); reducing administrative burdens; increasing training opportunities and pre-college learning pathways for younger students—especially in rural areas; and continuing the Health Care Provider Incentive Program. In some good news from the federal government, the latest physician payment schedule for Medicare is increasing rates for primary care doctors in 2026. That’s important, says Pierce-Wrobel, because a lot of insurers base their own rates on Medicare’s fee schedule, which is publicly available. “This is something that you don’t see very often, and we’re interested in watching how that may slowly start to change in a direction that would move more investment into primary care,” Pierce-Wrobel says. At the end of the day, the primary care doctor shortage is going to take multipronged solutions: investment in residencies in rural parts of the state, perks (including housing, child care and other creative lures), and loan forgiveness and repayment programs. But some of the experts I interviewed said that the solutions need to start even further upstream. “I don’t care how many of these conversations or articles get published — or if you give me a billion dollars in my loan repayment and loan forgiveness programs,” says Deuhmig at OHSU. “We will never solve the problem of shortages of health care providers in rural areas unless we start educating rural kids in science and show them a pathway in which they can actually succeed,” says Duehmig. He points out that if you attend high school in Portland and then go to OHSU, you’re not likely to move to Baker City to practice medicine. “You might like it for a long weekend. You might go out and do some locums there,” he says, referring to the short stints doctors do to fill in for colleagues when they’re out sick or on vacation. “But you’re not going to move your family out.” But if you grew up in Baker City, you’re more likely to want to return because you have roots there. These are hard problems, but they are solvable, says Boyd-Flynn at the Oregon Academy of Family Physicians. She points out that some of these issues — like lack of housing and day care, for instance—are community problems. “Communities need to get involved and push for change,” she says. “Employers should expect more emphasis on primary care in the health insurance they buy for their employees, and that might mean that health insurers have to pay more for that primary care,” she says. “Don’t settle for a new urgent care clinic when what people need is a primary care physician who can take care of them when things are not urgent.” ***** Connie Cloyed eventually sold her house in Corbett, which she and her husband shared with their daughter, and moved to Netarts, 6.5 miles from Tillamook. She assumed correctly that she’d have a long wait to see a new PCP. In January she tried to make an appointment with a doctor of osteopathy at a Tillamook clinic. But even though the clinic’s website said she was accepting new patients, she wasn’t. (“That’s another thing. Nobody updates their websites!” Cloyed says, with exasperation.) But the receptionist recommended another M.D., and the first available appointment was at the beginning of September. “I was really excited! I said, ‘Whoa, honey! You should call this clinic right away. They have an M.D. who is accepting new patients!’” Connie Cloyed in her Netarts home JASON E. KAPLAN 26

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