Part One of a Three-Part Series
This series makes the case for a Southern Oregon Community Purchasing Alliance. ReImagine Healthcare is a research and advocacy organization. We do not have the organizational infrastructure to build or operate what we are describing. Our role is to put the evidence and the argument in front of the institutions that do.
There is a version of the Southern Oregon provider shortage story that is told often, and it goes like this: there aren’t enough doctors, the ones we have are overworked, and we need to recruit more. The solution, in that version, is better incentives — loan repayment, signing bonuses, rural stipends.
That version is not wrong. But it is incomplete in a way that matters practically. It describes the symptom without fully mapping the system producing it. And because the map is incomplete, the interventions derived from it are limited in reach — useful at the margins, but insufficient to change the underlying dynamic.
This article attempts a more complete map. It traces why Southern Oregon’s provider shortage persists despite years of targeted programs, identifies the cost-of-living factors that those programs structurally cannot address, and argues that the shortage is better understood as a compounding problem than a simple supply deficit. The second and third articles in this series propose a structural response.
The Shortage Is Documented, Persistent, and Getting Worse
Start with what we know.
Jackson and Josephine counties are federally designated Health Professional Shortage Areas — a designation that has remained in place not because it hasn’t been noticed, but because the conditions producing it have not materially changed. The region averages fewer than 60 primary care providers per 100,000 residents, compared to Oregon’s statewide average of 83. Rural and remote areas across the region have a primary care capacity ratio of 0.69, according to Oregon’s 2025 Healthcare Workforce Needs Assessment — meaning the workforce is roughly 30% below what demand requires. A nationwide shortage of between 17,800 and 48,000 primary care physicians is projected by 2034, and Oregon is not exempt from that trajectory.
The consequences of the shortage are visible in concrete operational terms. La Clinica, the federally qualified health center serving low-income and underserved patients, has a six-to-nine-month waitlist for primary care. Most Asante family medicine clinics are closed to new patients. At Providence Medical Group, patients who lose a provider — because that provider burned out, retired, or relocated — are routinely told a replacement won’t be available for months. Diane Werich, an Ashland resident of 37 years, described receiving concerning test results and being unable to get an appointment with any provider in her clinic system. “I feel for the first time as if I’m living in a healthcare desert,” she said. “I don’t think that’s any fault of Asante’s. I think they’re trying like heck.”
That observation — that the people closest to the problem are working hard and the problem is still getting worse — is the clearest possible signal of a structural failure rather than an effort failure.
The shortage is not evenly distributed across provider types. Behavioral health is perhaps the most acute gap: wait times for outpatient mental health appointments in the region regularly exceed three months, and inpatient psychiatric capacity is severely constrained. Dental access, particularly for OHP members, is deeply limited. Specialist access is concentrated in Medford and Ashland, meaning that for residents of Rogue River, Gold Hill, Cave Junction, or any community outside those urban centers, routine specialty care requires 30–60 miles of one-way travel — a distance that quietly inflates no-show rates above 20% in some clinic settings and causes preventive care to be deferred until symptoms escalate.
This is what a shortage looks like in practice: it isn’t just a number on a workforce report. It is a patient who postpones care until an emergency, a provider who burns out under impossible caseload, and a community that normalizes a level of access that would not be tolerated in a resource-rich region.
What Existing Programs Can and Cannot Do
Oregon has a portfolio of programs designed to address exactly this problem. It’s worth being specific about what they accomplish and where they stop.
The Health Care Provider Incentive Program, administered through OHSU, has provided more than $21.4 million in loan repayment to 335 participants since 2018, including 72 primary care physicians working in rural parts of the state. HPSA designation unlocks a 10% Medicare bonus for physicians providing services in shortage areas, plus enhanced Rural Health Clinic reimbursement, eligibility for National Health Service Corps loan repayment, and access to more than 30 other federal programs. Oregon Senate Bill 476, signed in 2024, created a pathway for internationally educated and trained physicians to obtain provisional licenses in the state — a meaningful expansion of the recruitment pipeline.
These are real programs with real impact. And they are not enough, because they address educational debt and reimbursement rates, but they do not address the full financial picture of relocating to Southern Oregon and building a life here. A provider who eliminates $60,000 in student loan debt through state loan repayment still faces:
- A housing market with a median home price above $415,000
- Home appreciation rates lower than 90% of other Oregon cities
- Homeowners insurance premiums that have increased more than 27% since 2020 in wildfire-risk areas
- Major insurers pulling out of rural coverage areas entirely, forcing homeowners to the FAIR Plan — an insurer of last resort with limited coverage
- A professional environment where burnout rates are high, specialist backup is thin, and colleagues leave with regularity
Loan repayment is a meaningful offset to educational debt. It does not change the housing calculation, the insurance calculation, or the professional environment calculation. A provider making the decision to relocate is making all of those calculations simultaneously. The incentive programs we have address one line item in a multi-factor decision.
This is not a criticism of the programs or the people running them. It is an observation about structural scope. The programs were designed to address what they were designed to address. They were not designed to reshape the cost-of-living environment as a whole.
The Housing Problem Is More Specific Than It Appears
When healthcare leaders and recruiters in Southern Oregon name housing as a barrier to recruitment, they are usually referring to housing cost in general terms — the region is expensive, homes are hard to afford, the market is tight. That’s true. But the more specific problem is worth stating precisely because the intervention it implies is different.
The issue for a healthcare provider considering Southern Oregon is not just that housing is expensive. It is that housing is expensive and the financial return on homeownership here is poor and the risk environment has materially worsened. Those three factors together create a calculation that is different from, say, a high-cost urban market where housing is expensive but appreciates reliably.
A provider buying a home in Portland or Eugene accepts high cost but gets reliable appreciation and a liquid market if they need to leave. A provider buying a home in the Medford area accepts comparable or only slightly lower cost, gets appreciation rates lower than 90% of Oregon cities, and now faces a homeowners insurance market in active contraction. The 2020 Labor Day fires destroyed more than 4,000 homes across Southern Oregon and transformed the insurance market. In Ashland and Medford, major carriers — Travelers, Nationwide, Capital Insurance Group — have become nearly impossible to place new policies with outside city limits. One Ashland homeowner saw her annual premium triple from $556 to over $1,400 in four years. Others have had their policies canceled outright and found no viable alternative.
Insurance broker Jeff Melville of High Desert Insurance in Bend put the insurer logic plainly: “Insurance companies don’t say: ‘Well, Steve lives on this street, and he’s got defensible space, but Billy lives four houses down and he hasn’t done anything yet.’ They really aren’t going to take a look at each house, there’s just not enough premium there. They’d rather just say: ‘We’re not insuring any of them.’”
This is important. Insurers price by area. Individual mitigation efforts have limited effect on coverage availability because insurers are making community-level risk assessments, not property-level ones. That fact, which is currently experienced as a source of frustration by individual homeowners, is also the basis for a community-level intervention — one we return to in Article 2.
For a healthcare provider doing the math on whether to relocate to Southern Oregon, the housing calculation currently looks like this: pay comparable prices to urban markets, accept lower appreciation, absorb higher and rising insurance costs, and take on the risk that your insurer exits the market while you own. That is a materially worse financial proposition than comparably-priced markets elsewhere in Oregon. And it is a barrier that loan repayment does not address.
The Compounding Dynamic
What makes this a compounding problem rather than a simple shortage is the interaction among its components.
The workforce shortage produces high caseloads for the providers who are here. High caseloads produce burnout. Burnout produces attrition — providers leaving not because Southern Oregon failed to recruit them, but because it failed to retain them once the workload became unsustainable. Attrition increases caseloads for the providers who remain. The cycle accelerates.
At the same time, the cost-of-living environment discourages recruitment. Providers who evaluate the full financial picture — housing costs, appreciation rates, insurance availability, spousal employment prospects — and compare it to other markets decline to relocate. The shortage deepens. Recruitment incentives that address only part of the financial picture produce some results but not enough to offset the underlying dynamic.
Simultaneously, the patient population is aging. Providence Medical Group’s executive director noted it explicitly: “We are a retirement community with an aging population and a lot of underlying conditions, including obesity, diabetes and high blood pressure.” An aging population with high chronic disease burden requires more primary care visits per capita than a younger, healthier population. Demand is rising as supply falls.
There is also a pipeline problem that compounds downstream. Only about 27% of physicians practicing in Oregon were trained in the state, and slightly more than half of physicians who train in Oregon stay in Oregon. The region does not have a robust mechanism for cultivating providers who already have community ties — the people most likely to stay. Southern Oregon University has pre-med programs and genuine interest in developing healthcare pipelines, but there is no formal regional compact that ties medical education to rural placement in the way that models like WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) do for member states.
The result is a system that loses providers faster than it can recruit them, recruits from a national pool that has limited reasons to choose Southern Oregon over better-resourced markets, and faces growing demand from a patient population with no alternative if the system fails.
Why the Workforce Problem Is Also a Community Health Infrastructure Problem
Here is the framing shift that matters for the policy response:
The provider shortage is typically discussed as a workforce problem — a matter of recruitment pipelines, incentive structures, and training capacity. That framing is accurate but insufficient because it locates the solution primarily in the workforce policy domain.
A more complete framing recognizes that provider availability is itself a social determinant of health for the community. When providers are unavailable, patients defer preventive care, present in crisis rather than at routine visits, and experience worse outcomes for conditions that are manageable with consistent primary care. Those worse outcomes show up in emergency department utilization, in OHP quality metrics, in CCO performance scores, and in the downstream costs that fall on health systems, insurers, and public programs.
Jackson Care Connect and AllCare, Southern Oregon’s coordinated care organizations, have financial accountability for member health outcomes. They are not peripheral stakeholders in the provider shortage — they are directly affected by it, in measurable ways that show up in their performance contracts with the Oregon Health Authority. When members cannot access primary care and present instead in emergency settings, CCO costs rise and quality metrics fall.
Asante and Providence are not peripheral stakeholders either. They are the institutions bearing the immediate operational consequences of the shortage — closing clinics to new patients, paying premium rates for locum coverage, and watching their existing providers burn out under unsustainable caseloads.
Large employers in the region pay insurance premiums set in a market where costs are not being negotiated effectively on their behalf. Their employees are patients in the same strained system.
Every one of these institutions has a financial interest in a functioning provider supply. What they do not currently have is a mechanism for acting on that interest collectively in a way that addresses the cost-of-living barriers that individual incentive programs cannot reach.
That is what Article 2 proposes.
What This Article Is Not Arguing
Two clarifications before the second article builds the solution.
First, this article is not arguing that loan repayment programs, Medicare bonuses, or other existing incentives should be abandoned. They work at the margins and they should continue. The argument is that they are insufficient to change the structural dynamic, not that they are useless.
Second, this article is not arguing that housing cost and insurance availability are the only barriers to provider recruitment and retention. Professional isolation matters — providers who arrive here and find themselves without specialist backup, without academic engagement, and without the collegial environment that sustains clinical work will leave when their commitment ends regardless of housing subsidies. The spouse and partner employment problem is real: thin professional markets outside healthcare mean that a physician’s partner often cannot find equivalent opportunity here, and that calculation frequently determines whether a family says yes to a rural placement.
A housing-focused intervention addresses one critical dimension of the problem. It does not solve all dimensions. But it addresses the dimension that existing programs structurally cannot, and it creates the conditions — a stable financial footing for building a life here — without which other retention efforts have limited staying power.
The compounding problem requires a structural response that operates at the community level, not just the individual incentive level. The next article describes a model that has already been built, documented, and validated — and examines whether it can be adapted to Southern Oregon.
Part Two: The Peak Model: What Colorado Figured Out and What Southern Oregon Could Borrow
ReImagine Healthcare publishes research and analysis on healthcare system design in Southern Oregon. We are a subsidiary of Flourish Charity, a 501(c)(3) nonprofit. We do not have the infrastructure to implement the proposals in this series. We welcome responses and partnership inquiries from organizations that do.