A "secret shopper" study led by OHSU researchers has revealed that Portland has the worst primary care access among four major U.S. cities, with only 35% of clinics accepting new Medicare patients compared to nearly 97% in Los Angeles and an overall average of 77.5% across the four cities studied. Published in Health Affairs Scholar, the study had investigators call 444 clinics in New York, Los Angeles, Chicago, and Portland posing as Medicare beneficiaries seeking an initial primary care appointment. Portland's median wait time of 61 days dwarfed New York's 8-day median, quantifying an access crisis that Oregon providers and patients have long described anecdotally.

The study, led by senior author Dr. Jane Zhu of OHSU with co-authors from Brown University and UCSF, identified a key structural factor behind Portland's outlier status: nearly 60% of primary care clinics in the Portland area are affiliated with large health systems, a far higher concentration than in the other cities studied. Hospital and health system-affiliated practices showed consistently longer wait times than independent practices, with the most prolonged delays concentrated in Portland. The city also has a disproportionately high share of Medicare Advantage enrollees relative to traditional Medicare, and a low density of federally qualified health centers — both factors that constrain appointment availability for traditional Medicare patients.

The findings have serious implications for Oregon's 1.4 million Oregon Health Plan members and the state's aging population. If Medicare patients face 61-day waits, Medicaid patients — who face even lower reimbursement rates — likely confront similar or worse barriers. Oregon's primary care workforce shortage is well-documented: the state has designated Health Professional Shortage Areas across much of rural and urban Oregon. The consolidation of primary care under large health systems — including Providence, Legacy, OHSU, and Kaiser — means that scheduling bottlenecks at a few organizations cascade across the entire metro area. For dental and specialty providers who depend on primary care referrals, the downstream effects on patient flow are significant.

Watch for whether Oregon Health Authority or the legislature responds with policy interventions targeting system-affiliated clinic access. Monitor if the study prompts CMS scrutiny of Medicare Advantage network adequacy in the Portland market. Track OHSU's related "ghost provider" research, which found that Medicaid provider directories are rife with listings for providers who are not actually accepting patients — compounding the access crisis. The convergence of these studies paints a picture of a market where directory listings overstate real access by a wide margin.