While front-line health workers across the country began receiving the COVID-19 vaccine last month, many primary care doctors and their staff members are left in the dark about their turn in line.
"Generally speaking, unaffiliated community practices are having tremendous challenges obtaining vaccines for the physicians and care teams at those sites," Shawn Martin, executive vice president and CEO for the American Academy of Family Physicians (AAFP), told Fierce Healthcare.
"There are some large health systems that are collaborating with community physicians to provide access to vaccines, but for physicians not aligned with a health system or hospital, as a general rule, they are having a high degree of difficulty," he said.
Only about a quarter (23%) of primary care doctors say they know where they are getting the vaccine, and just 20% know how the vaccine will be stored, according to a survey from the Primary Care Collaborative conducted back in mid-December.
The survey results from nearly 1,500 primary care clinicians highlight the growing concern that doctors who are not affiliated with hospitals have no direct link to the vaccine rollout and are being left out of the process.
It also echos an alarming pattern seen throughout the COVID-19 pandemic where primary care doctors and community-based physicians have lacked access to resources such as personal protective equipment and COVID-19 tests, said Ann Greiner, president and CEO of the Primary Care Collaborative, in an interview with Fierce Healthcare.
The federal government has largely left vaccine rollout to the states and public health departments, and they, in turn, are relying on hospitals to be the main distribution points. Many states are following the recommendations of the Centers for Disease Control and Prevention (CDC) in its phased vaccine distribution plan, and healthcare workers, including primary care doctors and staff, are included in phase 1a.
"But the CDC policy is silent as to how and where to get those vaccines to primary care physicians if they are not associated with a hospital or with a retail pharmacy," Greiner said.
For primary care doctors, the process to get a vaccine varies state by state, with some states setting up dedicated online portals for clinicians to put their names on the list while other states still have no process in place, according to Emily Maxson, M.D., chief medical officer at Aledade, a company that works with more than 7,300 providers across 27 states.
"In many states, they are being left out of the initial vaccination efforts, and we even see health system employees get vaccinated who don't have exposure to patient care," she said.
As a result, primary care clinicians continue to be dangerously exposed to the virus while caring for patients, she said.
"[Primary care physicians] are frankly getting to the point where they are just totally discouraged and disappointed and feel undervalued. With COVID, PCPs are being asked to step into uncertainty and expose themselves to patients who may or may not be wearing masks or staying home and they're being asked to triage, test, and care for these patients."
In some areas, vaccines are available if clinicians know about it. For instance, with Virginia still requiring vaccinations only go to those in tier 1a, or healthcare workers, Inova Health System currently has more available slots for distributing the vaccine than they have arms to put shots in—a point of frustration for the health system, said Inova President and CEO Stephen Jones, M.D.
After Inova ensured its own front-line workforce had a chance to get the vaccine, the Fairfax, Virginia-based health system opened up vaccination slots for all other healthcare workers in the community.
"Anyone who can prove that they're a healthcare worker, we're bringing them in and getting them their vaccine," Jones said. "And even with that, we've got the ability to expand it more if we're allowed."
In Pennsylvania, the secretary of health has mandated that 10% of the vaccine stock be allocated to the vaccination of community-based independent physicians and their staff, according to Jaan Sidorov, M.D., CEO of the PA Clinical Network, a clinically integrated network for independent practices.
"We're hearing that the hospitals and chain pharmacies are still figuring that out, but that may be a model for other states to emulate," he said.
In areas where primary care doctors are being included in vaccine rollout plans, one key factor appears to be strong leadership by public health departments and greater efforts to collaborate with local providers, according to Martin.
Primary care's role in vaccination efforts
Inoculating the primary care workforce is key to fighting the COVID-19 pandemic, industry stakeholders say. These clinicians are on the front lines, and it's critical to create a safe environment for patients to get care.
Primary care doctors also have an established, trusted relationship with their patients.
Survey data indicate that patients feel more comfortable getting vaccinated by their primary care doctors, and these clinicians can help combat misinformation about the vaccine as well as answer questions about safety and efficacy, Maxson said.
"I don’t think we can rely on retail pharmacies to convince patients [to get vaccinated]," she said.
Reports of rare allergic reactions to the COVID-19 vaccine have generated skepticism among doctors and patients that the pharmacies will be able to handle an adverse event, and that could hamper downstream vaccination rates, Sidorov said.
"It remains to be seen if patients are going to say, 'I’m willing to take the chance of an adverse reaction in the cash register area of a drug store,'" he said, noting that physicians are equipped to handle an adverse reaction if one should occur.
Independent practices and community-based clinics also can play a critical role in encouraging vulnerable and marginalized populations to get the COVID-19 vaccine, stakeholders say.
The Primary Care Collaborative survey found that 89% of primary care doctors will take the vaccine themselves, and 90% are recommending the vaccine to their patients.
But most practices haven't received word on when they will receive vaccine doses for their patients, and few practices are set up to distribute the COVID-19 vaccine, the survey found.
Primary care clinic vaccinations are hampered by the freezer requirement, as the Pfizer vaccine needs to be kept extremely cold: minus 70 degrees Celsius.
There are also minimum batch size order requirements that are putting this further out of reach for many practices, Sidorov said.
"What we've heard is that the batch size order was in excess of 900 doses," he said.
Martin recommends that primary care physicians contact their state governor's office or public health departments to get more information about the process to obtain vaccines for practice staff and patients.
"We need to escalate the issue that primary care physicians have been left unvaccinated and that means our triage workforce could be taken out, which would exacerbate a public health emergency. State and local public health agencies should recognize this and make sure they have a line of sight on how PCPs and their staff can be vaccinated so our infrastructure for public health doesn’t crumble," Maxson said.