As the state seeks ways to trim Medicaid, an increasing number of doctors frustrated with reimbursements are opting not to see new Medicaid patients. As a result, Medicaid patients often grow sicker while hunting for a doctor. "The inability to find a Medicaid doctor drives up the cost for everyone because they then frequent the emergency room," Lewis said. Dallas ranks last among 15 major cities in the percentage of physicians accepting Medicaid, according to a study by Merritt Hawkins & Associates, an Irving-based health care consulting and recruiting company. In that study, 1,162 medical offices were surveyed between September 2008 and March. Dallas had a Medicaid acceptance rate of 38.6 percent, compared with the national average of 55 percent Medicaid patients have trouble finding doctors in Dallas area | News for Dallas, Texas | Dallas Morning News | Dallas Business News Giving someone an insurance card and telling them they are insured is one thing, having a place to use it is another. The current bill set to pass in the Senate aims to use Medicaid as the primary instrument to achieve it's goal of insuring many of those so called 47 million uninsured. When those uninsured get those Medicaid cards, I highly doubt that they will consider it reform by any stretch of the imagination. In Oregon , 14 hospitals, four clinics and two health departments in rural areas are short a total of 70 physicians, according to the Office of Rural Health at Oregon Health & Science University. Throughout the country, at least 1,500 positions for rural doctors are vacant, according to the Madison, Wis.-based Rural Recruitment and Retention Network. The people that have insurance live in cities, said Roger Piepenbrink, a Navy-trained internist at Pioneer Memorial, who now is the towns only such doctor. Its hard to make a living off subsidized medicine, he said. You can make your overhead, but you cant pay yourself. Doctor shortage takes toll in rural areas If you have ever been to a DMV office on a busy day in a large metro area then you will get some idea of the Senate's vision of healthcare reform using the Medicaid model.