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A survey of academy members nationwide shows 83 percent take new Medicare patients. But there is an overall shortage of primary care physicians that still makes it hard for retirees to find a family doctor.

The real problem, he said, is that the health care system “has not supported a robust, adequate primary care workforce for over 30 years.”

According to the American Association of Medical Colleges, rural areas need about 20,000 primary care doctors to make up for the shortages, but only about 16,500 medical doctors and 3,500 doctors of osteopathy graduate yearly.

“We are always trying to recruit doctors. We are barely keeping even,” said Lyle Jackson, the medical director at the Mid-Rogue Independent Physician Association, a cooperative of doctors in Josephine County, where Musselman lives.

Taking part in the Medicare Advantage program, which pays a higher rate to doctors than standard Medicare, helps, but is still not enough, said Jackson, a former family physician.

A 2009 survey of doctors in the Oregon Medical Association showed concern over Medicare reimbursement rates topping the list of 23 issues, with 79 percent rating it as very important, said Joy Conklin, an official at the association.

The survey showed 19.1 percent of Oregon doctors had closed their practices to Medicare, and 28.1 percent had restricted the numbers of Medicare patients.

That really becomes evident in Josephine County, which attracted retirees after the timber industry collapsed.

Low taxes, cheap housing, wineries, a symphony and low traffic put it in top 10 lists for retirement communities. The 2010 census puts the number of people older than 65 at 23 percent, compared to 14 percent for the state.

But the website County Health Rankings & Roadmaps, which gathers a wide range of health care data nationwide, shows 933 patients for every primary care physician in the county, nearly 50 percent higher than the national 631-to-one rate.

At the Grants Pass Clinic, Dr. Bruce Stowell said they are no longer taking new Medicare patients. Medicare pays about 45 percent of what commercial insurance pays.

As it is, their proportion of Medicare patients is double that of a similar Portland practice.

“We used to get a steady stream of high-quality (resumes) from U.S.-trained and U.S.-born physicians,” he said. “Over the last year, that stream has declined into a trickle. Very few (doctors) are choosing to go into primary care.”

Schools are turning out more nurse practitioners and physician assistants.

How well they fill the doctor gap will depend largely on how much independence states give them to practice, said Tay Kopanos, director of health care policy for state affairs at the American Academy of Nurse Practitioners.

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