Practices facing 'existential' threats, uncertainty about future of primary care, survey finds

As the country makes progress on the vaccination front, primary care practices and clinicians are now more involved in COVID-19 vaccinations.

But practice leaders continue to report major concerns about the stability of the sector.

As the country experiences COVID surges again and struggles to reach the Biden administration’s vaccination goals, new data released by the Larry A. Green Center, in collaboration with the Primary Care Collaborative (PCC) and 3rd Conversation, show that primary care is playing a deeper role in vaccination efforts.

The importance of primary care using their trusted relationships with the public to provide outreach and education regarding the vaccine is becoming clearer, with President Biden and his administration stressing primary care’s role.
More than half (52%) of practices reported receiving enough or more than enough vaccines for their patients, and 31% are partnering with local organizations or government to prioritize people for vaccination, according to results of a survey of about 700 primary care doctors conducted July 9-13.
While the supply of vaccines is now flowing to primary care, clinicians are sometimes finding that getting shots in patients’ arms is challenging. More than half of the survey’s respondents—53%—note that hesitancy among unvaccinated patients is high and hard to counter.

RELATED: 1 in 5 primary care doctors currently administering COVID-19 vaccines: survey

“Vaccine hesitancy requires at least 5-10 minutes of counseling for a less than 30% success rate," said one primary care clinician based in Illinois, according to the survey.

Another clinician working in Nevada said dealing with patients who don't want to get vaccinated is "leading to burnout."

Many parts of the country are seeing COVID cases surge again from the spread of the Delta variant, causing primary care and other parts of the healthcare system to ramp up their response. Yet a sizable minority of primary care clinicians has grim doubts about their future: 40% of respondents say they worry that primary care will be gone in five years, and 21% say they expect to leave primary care within three years, the survey found.
But primary care doctors report that their stress levels have eased recently after the intense surges of COVID cases in 2020 and early 2021. A large majority of respondents—76%—rank the strain on their practice from COVID-19-related changes and pressures on the low or moderate end of the scale. However, more than 1 in 3 (36%) say they are constantly lethargic, find it hard to find joy in anything, and/or struggle at times to maintain clear thinking.

“Primary care is the front door to the healthcare system for most Americans, and the door is coming off its hinges,“ said Christine Bechtel, co-founder of 3rd Conversation, a community of patients and clinicians, in a statement. “The fact that 40% of clinicians are worried about the future of primary care is of deep concern, and it’s time for new public policies that value primary care for the common good that it is. Policymakers need look no further than the recent National Academies of Sciences, Engineering and Medicine report on primary care, which provides a road map to primary care’s future."

The fatigue reflected in the survey data shows potential threats to the primary care workforce or the existence of the sector itself, according to leaders at the Primary Care Collaborative.

RELATED: Docs stitched together creative responses in pandemic's first year. Now, they need more targeted support: study

"[Our system] cut pay, closed clinics, laid off staff. One-third of our providers quit and we have literally 4,000 patients to reassign and nowhere to put them," said one primary care clinician based in Washington, according to the survey.

Many clinicians see a role for the federal government in changing policy in primary care: Their top three requests of the government are to protect primary care as a "common good"—available to anyone regardless of ability to pay, according to 56% of primary care doctors, change how primary care is financed so that it is not in direct competition with specialty care (46%) and change how primary care is paid, moving away from majority fee-for-service models (46%).

"The administration has now recognized the key role primary care is able to play in reaching vaccination goals,” said Rebecca Etz, Ph.D., co-director of the Larry A. Green Center, in a statement. “While the pressure is now on primary care to convert the most vaccine-hesitant, little has been done to support primary care to date. Policymakers need to bear witness to the quiet heroism of primary care—a workforce that suffered five times more COVID-related deaths than any other medical discipline."
“As the federal government updates guidance to keep COVID-19 at bay, it also needs to implement strategies to support primary care, which is a vital ally in the vaccination effort,” said Ann Greiner, PCC’s president and CEO.