In a bayou community so isolated, it's actually called Cut Off, Louisana, Dr. Gary Birdsall has been singularly focused on getting his hands on the one thing his rural patients desperately need: doses of the COVID-19 vaccine.
Among the town’s 25,000 residents, many people still have concerns about the vaccine, but they've told Birdsall they would get the shot if he administered it.
The only other option is for patients in that coastal area to drive up to two hours one-way to a vaccination site, Birdsall told Fierce Healthcare.
Through January, there was no word from Louisiana health officials about when practices would get the vaccine. “I’ve been contacting the state through emails. They never gave us phone numbers,” Birdsall said.
Almost 1,400 miles away in New York City, family physician Mark Horowitz, M.D. also hit a wall. He’s been lobbying city health officials and local politicians to quickly allocate vaccines to primary care doctors like himself to help get shots in arms.
This week, one of these doctors succeeded.
Birdsall received a shipment of Moderna COVID-19 vaccines on Monday. He’s been giving them to high-risk patients in groups of ten. His office also created a stand-by list so if someone doesn’t show up for an appointment, another patient can come in on a moment’s notice, he said.
He’s one of the few independent primary care practices to receive the COVID vaccine, according to Aledade, a network of 750 practices across the country, of which Birdsall is a member.
“Because we’re in a linear community, people have to travel 50 to 60 miles to get the vaccine. Having it available here is going to be a great asset to my patients,” he said.
His advice to other primary care doctors: Be persistent.
“Don’t give up. I think that’s what happened with us. We never had feedback but I just kept sending emails out. It’s like that Bible verse—knock on the door for a loaf of bread and they will finally give it to you just to get rid of you.”
In Manhattan, Horowitz doesn’t know when he will get doses of the vaccine for his 4,000 patients. After being approved for the vaccination program, he bought a compliant vaccine freezer, which is still sitting in the box waiting to be used.
“Last month the Department of Health informed me I’d get vaccines in early February. And then we went through that shortage in the last two weeks. It’s clear I’m not getting the vaccine any time soon,” he said. In the meantime, Horowitz is keeping his patients informed about vaccination sites throughout New York City that are open for walk-ins.
Missed opportunities to get shots in arms
Across the country, there’s growing frustration among independent practices and medical groups about being shut out of the vaccine distribution process.
Some primary care doctors are concerned that powerful hospital lobbying groups and big corporate pharmacy chains like CVS and Walgreens have influenced the direction of the vaccine rollout process. There needs to be stronger advocacy for getting vaccines to smaller medical practices, doctors say.
Leaving primary care doctors out of the initial vaccine rollout is a crucial missed opportunity to help save lives during the pandemic, physicians say.
“We have long-standing relationships with our patients, who have a tremendous amount of trust in us. We also can provide vaccines for people who may not have the technical capabilities to go on websites to make reservations. Even tech-savvy people are finding the reservation process rather daunting,” Horowitz said.
He added, “We can reduce the bottleneck at the various vaccination centers, improve vaccine equity, and help overcome vaccine hesitancy if they gave us 5% or 10% of the vaccine allocation that the city gets.”
Birdsall also believes primary care doctors are in a position to help push more people to get the vaccine.
“I had three patients this morning who said they were not going to take it and then agreed to get it if I administered it. That’s how I can make a difference,” he said.
But many smaller practices will face obstacles to administer the COVID-19 vaccine. Ultra-cold refrigeration is required, and few office-based practices have or can afford to purchase the specialized equipment required, some doctors say.
For many practices, especially in rural areas, vaccine management will largely be a time-consuming, manual process.
At Birdsall’s practice, staff are calling patients to verify whether they have received the vaccine and to book appointments.
“Through our electronic health record system, we can also send emails and texts. Bear in mind, with our patients aged 70 and above in this community, probably around 50% only have a landline or they have a flip phone, so a text or email does not go through.”
But in a year marked by triumphs and heart-wrenching defeats, getting the vaccine was a major victory, Birdsall said.
Thirty patients in his practice died of COVID-19 since the pandemic started.
“My patients are my neighbors and my friends. This has been very difficult,” he said.
He added,"[Getting the vaccine] has put some degree of power back in my hands to prevent some of the illness I’m seeing.”