Bob Elfers, an Oregon state bar official, said he was surprised to hear that doctors are having the same problem in Portland that lawyers here have had for several years.
The problem is there are too many of them.
"I had always heard there was a shortage of doctors," Elfers said.
Portland has one of the highest per capita concentrations of physicians in the nation: one for every 167 residents, according to the Multnomah County Medical Society. The national average is about one for every 650.
"I wasn't aware there was a surplus until this past year. Now I'm hearing doctors saying that they're not quite as busy as they were two or three years ago," said Dr. Tom Reardon, president of the county society.
Although doctors are not evenly distributed in Portland, especially in poorer neighborhoods, the Oregon Medical Association last year closed its job placement service for out-of-state physicians. The county society has prepared a pamphlet entitled, "So You Want to Practice in Portland," that clearly points out the glut.
Now, Portland is becoming a test of whether an overabundance of physicians results in better health services, reduced fees, or both.
The competition for clients is becoming keen.
"We see outselves as being in the vanguard," Reagan said. "Lots of other places that are desirable to live in will be feeling the pressures of a doctor surplus."
Portland, a city noted for its outdoor attractions, convenient size and relaxed atmosphere, receives a large share of the doctors, lawyers, dentists, veterinarians and others crowding into regions where the weather and living can be easier.
Census Bureau statistics for professionals and technical workers for 1975 to 1979 show that 265,000 of them left the northeastern and north-central states in that period and 153,000 ended up in the West.
As the glut of doctors grows, Portland's contingent of private practitioners, prepaid groups, hospitals and clinics increasingly must sell themselves to the public to keep revenues coming in.
"We must face it -- we are vendors. We are an industry. And if we are an industry, we're going to have to think about things like competition and marketing practices," said Dr. Jack Blumberg, a surgeon who heads the Oregon Medical Association's private practice committee.
"The medical profession has been slower than it should have been to perceive the needs of society."
Blumberg sees Oregon and Portland in particular as ideal places to test theories on marketing the practice of medicine.
Reardon, the Multonomah County Medical Society president, said the physician who markets himself, who is sensitive to patient needs, is the doctor who will survive the competition.
He said doctors who suddenly realize they aren't quite as busy as they were a couple of years ago might consider changing their office hours. At least several days a week they might open earlier and close later, giving working people greater access without taking time off, Reardon said.
They might also fill out patients' insurance forms, make sure their office staff is courteous and efficient and improve telephone communications with patients, he said.
Oregon would be particularly suitable as a site for testing medical marketing approaches, according to Blumberg, because of the mix of competing health carel delivery systems that exists here.
Some examples of competition: private practitioners vs. prepaid group practice plans such as Kaiser, private doctors vs. hospital emergency rooms or hospital outpatient clinics, and increasingly, private practitioner vs. private practitioner.
In addition, Oregon is one of the few states that permit nurse practitioners to prescribe drugs without a doctor's approval. This privilege is based on the supposition that the six years of training required to become a nurse practitioner (an ordinary registered nurse degree can be attained in as little as two years) provides the necessary expertise.
Nurse practitioners have been allowed to open their own offices since 1973, and many doctors see the newly added drup prescription privilege as an inducement for more nurses to do so, adding another source of competition.
Kaiser is a major competitor for Portland's private doctors. It currently serves more than 20 percent of the residents of the general three-county Portland area, owns two hospitals and is adding a 107-bed wing to one of them. p
The hospital outpatient clinics, intended to siphon patients away from emergency rooms, which ofter are clogged with patients seeking non-emergency care, have been successful here and throughout the nation.
Some doctors contended that the outpatient clinics have also siphoned patients away from doctors' offices. The main attractions are long hours of operation and no appointments.
And now the medical profession -- and the hospitals -- see a new marketing threat on the horizon: "urgent care clinics."
Drs. Steve Pliska and Robert Thornton operate six clinics in the Portland area. Pliska described them as "walk-in, no-appointment clinics that cater to 80 percent to 85 percent of the people who used to go to emergency rooms for trivia, plus the 40 percent of the population who don't have a doctor."
The clinics -- often located in shopping centers -- are open 10 to 14 hours a day, six or seven days a week, and according to Pliska are doing a brisk business in treating ear aches, colds, stomach aches and sore throats. They do no surgery except to repair minor wounds. An X-ray machine and laboratory are on the premises.
"We're in the black. The key is to try not to have them wait," Pliska said. "The patients love them because they don't need an appointment and they're in and out in 30 to 40 minutes."
Urgent care clinics are increasing the competitive pressure, said Chester Stock, administrator of Good Samaritan Hospital. "They are taking the easy stuff. They are increasingly popular."
Whether the health of Portlanders is being affected either positively or negatively by the abundance of health manpower cannot yet be determined in most areas. The city's health statistics reveal nothing out of the ordinary.
Neither is there a consensus on the effect the proliferation of professionals is having on the cost of health care, although some planners and members of the public believe the competition will help keep a lid on some costs.
"Lots of doctors around here are facing the fact that they must increase the utilization of some device they have in the office -- an X-ray or treadmill, for example -- in order to pay the rent," said one Portland physician who asked not to be named.
"Everybody wants to make what doctors make, including doctors. They have high ideas of living."