A few weeks ago, Dr. Thomas St. Clair of the Oregon Health Authority in the state capital, Portland, sat in his office with his two small, leather chairs facing the wall.
A plastic bag rested next to the sink, and a plastic bag sat on a table in the corner.
He sat at the end of the table, staring at a calendar in his desk, which lists his hours of operation.
The calendar said he would open an hour early Monday morning.
“I just have to do it,” St. Claire said.
The health authority is trying to fill a critical gap in the market for high-quality medical care in the Northwest, which is experiencing a sharp increase in opioid-related deaths.
About half of the region’s physicians are employed by health authorities, and it is a critical area of care for patients.
The region is experiencing an increase in deaths from overdoses, which includes heroin, fentanyl, and prescription opioid painkillers, the Centers for Disease Control and Prevention has said.
St. Louis, Missouri, has the most doctors per capita.
Portland, with a population of about 4 million, has about 4,200 doctors, or about 12% of the entire state’s medical-equipment manufacturing capacity.
It is among the most expensive regions for health-care providers to work.
But the health authority, which employs about 1,200 people, has been struggling for years to find more qualified physicians.
As of last fall, St. Clare, the head of the Portland Health and Human Services Bureau, was working at about 400 hours per year.
The state’s total medical-services spending for fiscal year 2017 was $14.5 billion, according to data provided by the state.
The agency is struggling to hire doctors.
“We are not the number one place for doctors to work in the country,” said Dr. David J. Stokes, the health-services commissioner.
“But we are one of the most attractive places for them to come, particularly for those who are looking for something that they can make a living from.”
Stokes said the health authorities was working to bring more physicians to the state’s workforce, including hiring more qualified doctors to serve in administrative positions.
“The bottom line is we have a shortage of physicians, and that’s what we are working to address,” Stokes told the Oregonian.
Health authorities are also trying to recruit physicians from other states to work on the state budget, a priority in the wake of the opioid crisis.
In January, the state passed legislation that would give health authorities up to $2,500 per physician per year in compensation for recruiting and training new medical-care personnel.
The law will take effect in 2019.
Stakes said that could include recruiting from California, Colorado, Connecticut, Florida, Illinois, Iowa, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, Wisconsin, and the District of Columbia.
In February, the Oregon Legislature passed a law that would allow health authorities to add another 1,000 to 1,600 employees to their workforce.
The bill also includes new rules for medical-marijuana sales.
Oregon Health and Science University in Portland will be the state lab to administer the new law, and will be a center for clinical research, clinical trials, and quality improvement.
“It is a long-term plan that will create a lot of new opportunities for Oregon health-service providers,” said Stokes.
The new law was passed to address growing concerns that health-health systems could not adequately address opioid- and other opioid-addiction issues in the health care system.
Oregon also passed a bill in June to require medical-use cannabis, and has plans to allow dispensaries to sell medical cannabis.
But it has not passed any legislation to expand access to medical marijuana, and Stokes acknowledged that some providers may struggle to find qualified patients.
Stiles said his agency is trying, but he acknowledged the effort will be difficult.
“At the end we will be able to make some progress, but it will be slow,” Stiles told the paper.
“There will be challenges, but we have to be realistic about it.”
He added that the health department is still “working out the details” of how to address this challenge.
Stains acknowledged the challenges in recruiting more doctors, and he said it is not easy to find doctors who are willing to take on a new role.
“You need to have a lot more people in your corner, and I think we have that here,” he said.
“And I think the reality is that a lot will depend on how the system is structured.”
The health authorities have tried to hire more doctors from other parts of the country.
In 2016, the agency added 100 new positions in a new position: Medical Director of Medical Care.
Dr. Daniel P. Regan of Oregon Health Sciences University in Eugene, who is based in California