07:20 AM PDT on Tuesday, June 22, 2004

Associated Press

Roughly 50 percent of Oregon doctors limit the number of Medicaid patients they see or don't accept them at all, according to a survey by the Oregon Medical Association.

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Holly Card, 46, an unemployed single mother from Milwaukie, might be surprised that the percentage isn't higher.

Card qualifies for the Oregon Health Plan because of her low income. But after receiving her OHP Standard card May 1, she had problems getting an appointment.

Card told The Oregonian that she phoned about 20 doctors and clinics, with each saying they do not take new OHP Standard patients who aren't in managed care.

"They all said no, unless I was an established patient or if I was pregnant," said Card, who has no acute illness.

Ten weeks later, Card got an appointment at a Portland clinic serving the homeless and low-income residents.

Cutbacks in the Oregon Health Plan, low payments for care of Medicare and Medicaid patients, rising malpractice premiums and a shortage of doctors in some areas are making appointments tough to get.

State budget troubles and uncertainty over the future of the Oregon Health Plan -- the state's version of Medicaid -- have made doctors even more wary of taking new patients.

"When you have an insurance card, you think you'll be covered for what you need when you get sick -- but it's not like that," said Vanetta Abdellatif, director of primary services for Multnomah County.

Access to primary care is particularly important, because most patients cannot get specialized care without being referred by a primary care doctor. Patients with preventable or manageable chronic conditions often wind up in a hospital emergency room, where care is more expensive.

About 10 percent of doctors, and 13 percent of those in primary care, accept no new patients, according to the Oregon Medical Association survey, which was filled out by almost 5,000 doctors in 2003.

Only one in three primary care doctors accepts all patients, the survey found.

Low reimbursement is a complaint among Oregon doctors. Though Medicare is a federal program, its payment to doctors varies from state to state, based on historical costs. The going rate in Oregon is significantly lower than in Eastern or Midwestern states, said Jim Kronenberg, the medical association's chief operating officer.

"If a surgeon in Portland takes your appendix out, the payment is 25 percent less than if the same surgeon took it out in Dade County, Florida," he said.

Another problem is a lack of doctors.

In the Salem area, for example, even patients with private insurance have trouble getting a nonemergency appointment "because there just aren't enough primary care doctors to go around," Kronenberg said.

In many rural areas, the shortage of doctors is even more apparent.

"They're moving away, and they're retiring early, and the new ones we're training can't afford to stay here," said Dr. Chuck Hofmann, a former Oregon Medical Association president and the only internist in Baker City.