GRANTS PASS, Ore. -- Nina Musselman had no trouble finding a family doctor when she retired to rural Oregon nine years ago to be closer to her children - but then that doctor moved away, leaving her to search for another who would take Medicare.
After a year of going from doctor to doctor, she finally found one who stuck.
As record numbers of Baby Boomers go into retirement, many are thinking about moving from the places they needed to live to make a living, and going someplace warmer, quieter or prettier.
If they choose small towns like Grants Pass, 250 miles south of Portland, they could well have a hard time finding a family doctor willing to take Medicare, even supplemental plans, rather than private insurance.
"It's a sad situation for seniors," Musselman said.
There are several reasons why Boomers, the 78 million Americans born between 1946 and 1964, could face difficulties finding a doctor if they retire to small towns over the next 20 years.
First, many primary-care doctors prefer to live and work in urban areas because of greater cultural opportunities, better schools and job opportunities for spouses.
Also, Medicare pays rural doctors less per procedure than urban physicians because their operating costs are supposedly less. That makes rural doctors less likely to accept Medicare patients.
With cuts to Medicare reimbursement for doctors targeted under the Obama administration's health-care overhaul, the shortage likely will get even worse, said Mark Pauly, professor of health-care management at the University of Pennsylvania.
That is, unless increasing reimbursements for nurse practitioners and physicians' assistants encourages those providers to take up the slack, Pauly said.
If the Medicare cuts go through, "the doctors are saying: "We're out of here,'" Pauly said. "The least they are saying is: 'We'll treat Medicare patients like we treat Medicaid patients,' which is mostly not."
Still, there is some good news, depending on where you live.
Pauly said the Affordable Care Act "puts a lot of emphasis on wellness programs and primary care. Nurses, especially nurse practitioners, are intended to play a major role there."
In Oregon, Washington and 14 other states, nurses and nurse practioners "can operate independently of doctors, writing prescriptions, ordering tests and even running clinics," Pauly said.
Nationwide, the 22.5 percent of primary-care doctors who practice in rural areas roughly matches the 24 percent of Medicare patients living there, said Dr. Roland Goertz, chairman of the American Academy of Family Physicians board.
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 work force 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.