Primary care has not fully bounced back from the COVID-19 pandemic as one-third of primary care physicians say revenue and pay are still significantly lower and net losses threaten current and future viability.
Another third of clinicians say the financial picture has been slowly improving, but the workforce is fragile and in trouble. And 1 in 5 practices report they have clinicians who have chosen early retirement or left their jobs as a direct result of the pandemic, according to a new survey of 500 primary care clinicians.
These findings come at a time when school re-openings are threatening to increase the spread of the coronavirus and the country faces a potential resurgence of the virus in the upcoming winter flu season.
The condition of primary care has improved modestly in the past several weeks, primary care remains in significant need of support, according to the survey released by the Larry A. Green Center, a research organization, in collaboration with the Primary Care Collaborative (PCC).
"An overwhelming number of clinicians—81%—disagree emphatically with the notion that primary care has rebounded,” said Rebecca Etz, Ph.D., co-director of The Larry A. Green Center. “Practice clinicians and staff are working longer hours to keep up with patient needs and still have yet to reach pre-pandemic capacity. Significant furloughs, practice members out for child and elder care, and clinicians out due to illness and self-quarantine have caused the primary care platform to shrink."
"The past six months have shown us what short-term planning and lack of investment yields during times of crisis— devastation of a critical workforce. But the question is now: Are we committed enough to do something about it?" Etz said.
The primary care system is fragile and shrinking as we approach the cold and flu season, said Ann Greiner, president and CEO of the PCC.
“Practices need state, federal, and private-sector support to address disruptions to primary care funding so that they can safeguard the health of the public. Primary care is pandemic preparedness," she said.
Staffing shortages continue to plague primary care practices as both staff and clinicians face child care barriers and other demands. A third of respondents report that their practice has empty positions that they cannot fill. Many say that staff (37%) and clinicians (27%) in the practice are limiting their availability due to child care needs. Elder care needs also pose challenges to staff and clinician availability, but to a much lesser extent (8%).
Most clinicians believe that levels of telehealth use are sufficient—or even above what is suitable for patient care. Only around 10% of respondents report that their practices’ use of telehealth is below what would be helpful due to insufficient funding to increase it. Alternatively, over a quarter say that use of telehealth is “above what seems good medicine” but that they need it to maintain patient volume.
And, in general, payers continue to cover it: Over 80% of respondents did not report that insurers have pulled back on telehealth (18% said they have).
As federal and state pandemic financial support ends, practices are feeling pressure but still not enough to anticipate closing. Over a quarter (27%) of respondents report “previous pandemic financial support has run out or will soon” as a pressure they will face over the next four weeks. Still, only 3% say that they will likely close before December without additional state or federal support.
With flu season on the horizon, equipment shortages continue to pose an ongoing threat to primary care. Thirty percent of respondents report difficulty obtaining enough COVID-19 testing supplies (e.g., swabs and reagents) to meet their office needs. Another quarter (26%) are having difficulty getting personal protective equipment for staff and clinicians. A smaller percentage of respondents (8%) say that they are unable to buy needed supplies for flu season.
Front-line primary care clinicians are both mentally strained by, and personally committed to, serving patients during these challenging time. Half (49%) of respondents say that their mental exhaustion from work is at an all-time high. Twelve percent report that members of their practice have left primary care because of the pandemic.
Yet, even under such mental strain, those that have stayed are feeling committed: A fifth of respondents report that their “sense of purpose in primary care is at an all-time high.”
"My volume is coming back but I lost significant revenue from March to August. Since I am 120 days behind in payments—I am starting to feel the loss of revenue now and will continue through the winter," said one primary care physician based in Arizona.
A practice leader in Idaho said, "Support staff are harder to acquire. Volume is not the same mix as pre-pandemic levels. Care for chronic conditions is being deferred. Mental health issues are far more prevalent but insurance companies continue to provide poor coverage."
Among the respondents, 70% identify their practice as family medicine, 13% as internal medicine, 6% as pediatrics, and 5% as geriatrics. Settings include 24% rural, 13% community health centers, 9% in schools/offices and 28% in designated patient-centered primary care homes.