Survey: Many clinicians say future of primary care is ‘uncertain’
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New survey results show that primary care clinicians have an increasingly active role in COVID-19 vaccination efforts, but they are simultaneously grappling with an “uncertain” future, according to the Primary Care Collaborative.
The survey was completed by 702 primary care clinicians in the U.S. and its territories from July 9 to 13. The data, released by the Larry A. Green Center in conjunction with the Primary Care Collaborative and 3rd Conversation, revealed that 4 in 10 clinicians worry primary care will be gone in 5 years, and 1 in 5 expect to leave the field within the next 3 years.
“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,” Ann Greiner, president and CEO of the Primary Care Collaborative, said in a press release.
Although the stress from the pandemic had partially subsided during the time of the survey, with 76% of clinicians reporting the strain of COVID-19-related changes and pressures as low to moderate, many primary care clinicians were “just not hopeful about what the future holds,” Greiner told Healio Primary Care. According to the results, 36% of primary care clinicians are constantly lethargic, struggling to find joy in anything and/or maintain clear thinking.
The results further showed that 38% of clinicians face structural obstacles such as an inability to staff positions or maintain patient volume. Although more than half of clinicians reported having enough COVID-19 vaccines for their patients, 53% also reported that vaccine hesitancy is high and hard to counter.
Many survey respondents believe that the federal government has a role in improving primary care. Forty-six percent requested policy changes regarding payment and a move away from fee-for-service models. Despite 13% citing that their main challenge for the next 6 months was high-level burnout/exhaustion and were considering selling their practice, 56% said that policymakers should protect primary care.
“Primary care is the front door to the health care system for most Americans, and the door is coming off its hinges,” Christine Bechtel, co-founder of 3rd Conversation, said in the release. “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.”
A weakened primary care system would likely impact other specialties, and local manifestations of this problem have already been seen, according to Greiner, who identified Delaware as an example. Specialists in the state were struggling to care for an overflow of patients, many of whom could have been seen in a primary care setting, Greiner said. In response, specialists joined their colleagues in primary care to advocate for a bill that aimed to strengthen the primary care health system.
Greiner encouraged primary care clinicians to work with diverse stakeholders to “make the case to decisionmakers about the importance of primary care.”
“They are successfully doing that state after state,” she said. “Also, we are getting some traction at the federal level. I’m confident we can turn the current picture around.”
References:
Primary Care Collaborative. Primary care & COVID-19: Round 29 survey. https://www.pcpcc.org/2021/07/26/primary-care-covid-19-round-29-survey. Accessed August 2, 2021.
Primary Care Collaborative. Primary care stepping up involvement in COVID vaccination effort but future of primary care is uncertain. https://www.pcpcc.org/2021/07/30/primary-care-stepping-involvement-covid-vaccination-effort-future-primary-care-uncertain. Accessed August 2, 2021.
Primary Care Collaborative. Quick COVID-19 primary care survey. https://www.pcpcc.org/sites/default/files/news_files/C19%20Series%2029%20National%20Executive%20Summary.pdf. Accessed August 2, 2021.
Perspective
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John M. Westfall, MD, MPH
Primary care is not at risk. Primary care has been around as long as people have suffered, and a few caring and curious leaders wanted to help decrease their suffering. And primary care will continue as long as we continue to be curious and committed to our patients. What will primary care look like? That may be the bigger question.
The largest primary care specialty of family medicine was born out of the social and counter-culture of the 1960’s. Sixty years later we may be in the midst of another round of social turbulence with a rampant COVID-19 virus, a structural racism reckoning and a largely for-profit hospital driven medical system. It is likely that the primary care of 2030 will not be the same as the primary care of 1970 or even 2000. But primary care will continue.
The changes emerging in primary care may be unacceptable to some, and they will leave medical practice. But many others are innovating the very changes that our patients and communities need. Linking the clinical care of the exam room with community, public and population health may support better health promotion and disease prevention. Acknowledging the strong links between mind and body will provide opportunity for integrated behavioral health and primary care. Changing payment from the individual office visit to a more comprehensive and holistic approach will provide primary care practices the support necessary to offer new ways of delivering services: telehealth, group visits, synchronous and asynchronous virtual communication, education and lifestyle coaching. Payment reform is a crucial next step. And, I believe, most primary care practices are ready.
The COVID-19 pandemic revealed (again) some of the weak spots in American medicine. Health inequities are rampant. Primary care physicians and practices are tired. But our patients and communities are still with us. They trust us most; they need us and they support us.
I get to teach at a medical school and primary care family medicine residency training program. I think it is an exciting time to be a primary care doctor. The American Academy of Family Physicians’ Robert Graham Center for policy research in primary care and family medicine is working to flip the emerging script, as seen in the recent survey report. That is, we seek to create and curate evidence to inform policies that support a robust primary care system in the U.S. We want to be part of a renewed primary care vigor to begin healing from COVID-19, ending structural racism, and flipping the payment model to support health rather than disease.
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