As Pandemic Surges, Evidence Emerges of Failure to Invest in Primary Care

Majority of Practices Have Contracted While Patient Health and Social Burdens Grow

WASHINGTON, November 24, 2020 – As month nine of the pandemic unfolds, primary care patients are worse off medically, their mental health has plummeted, social needs have grown exponentially, and patients are confused about COVID-19 basics, according to a survey of clinicians conducted in mid-November. The results of the survey were released today by the Larry A. Green Center, a research organization, in collaboration with the Primary Care Collaborative (PCC) and 3rd Conversation

A quarter of clinicians (25%) who responded to the survey have permanently lost staff, and nearly two-thirds (63%) reported colleagues out to illness or quarantine. In an ominous sign of the future, a quarter report that their fee-for-service volume is down by more than 30%, and 44% have faced salary cuts.  

These findings come as U.S. COVID-19 cases have risen to their highest level yet, with experts concerned that the upcoming holidays and cold weather will only exacerbate this challenging situation. Nearly 90% of primary care clinicians reported higher levels of mental health concerns among their patients, with two-thirds using telehealth to provide mental health services – even when they are not adequately reimbursed. Nearly two-thirds (64%) reported higher unemployment among patients, and one-third report higher levels of food and housing insecurity. 

“Primary care is devoting significant time to answering patients’ questions about COVID and combatting misinformation,” said Rebecca Etz, PhD, co-director of The Larry A. Green Center. “This is likely to ramp up as the surge continues and as a vaccine comes online. Our nation needs primary care’s front door open. Patients trust primary care to explain the facts and guide their choices.” 

“Keeping primary care robust and able to respond to myriad patient needs – medical and beyond – is going to take payers committed to continuing telehealth parity, reducing financial barriers patients face in getting primary care, and providing additional support,” said Ann Greiner, President and CEO of the PCC. “Further strengthening primary care is good medicine for patients and the health system overall.”

“This Thanksgiving week, I'm grateful for the role primary care is playing in mitigating the pandemic, addressing the impacts of structural racism, and helping create health for all people,” said Christine Bechtel, co-founder of 3rd Conversation. “Primary care is doing incredible work in spite of dramatic staffing shortages. I hope policymakers see their way toward creative solutions that address unemployment while investing in the primary care workforce that patients need to preserve and improve their health and wellbeing.”  

The survey was conducted by the Larry A. Green Center, based in Richmond, Virginia. The survey is part of a regular Green Center series to look at the attitudes of primary care clinicians and patients during the COVID-19 pandemic and the abilities of practices to meet patients’ needs.

The survey of clinicians received 1,472 responses from 49 states, the District of Columbia and Guam. It was conducted November 13-17, 2020. 69% of respondents work in family medicine; 13% internal medicine; and 9% pediatrics. 70% are MDs, 5% Dos, 12% NPs, 3% PAs, and 10% other. In terms of care settings, 33% work in CHCs or similar settings, 21% rural, 27% had 1-3 clinicians and 46% had more than 10 clinicians. 

More information about the survey

Experts are available to provide insight and comment on the survey:
  • Ann Greiner, president and CEO of the Primary Care Collaborative
  • Rebecca Etz, PhD, co-director of The Larry A. Green Center
  • Christine Bechtel, co-founder of 3rd Conversation
If you would like to speak with them, please contact Stephen Padre (Primary Care Collaborative's communications manager), [email protected], 202-417-3911

About the PCC

About The Green Center:

The The Larry A. Green Center for the Advancement of Primary Health Care for the Public Good is a research group founded by Rebecca Etz, PhD at Virginia Commonwealth University and Kurt Stange, MD, PhD at Case Western Reserve University. The Green Center works to reclaim and reconstitute the intellectual foundations of primary care, to advance the science of medicine learned and practiced within layered and competing social frameworks of meaning, and to deliver on a now 50 year old promise: better health and improved health care through a synergistic focus on both humanism and healing. We are nimble, inquisitive, curious, and open. We make personal doctoring and innovation visible.

About 3rd Conversation:

3rd Conversation is a national initiative reimagining the future of health care by reinventing the provider-patient relationship for the modern era. Powered by X4 Health, 3rd Conversation works at both the local and national levels to address health professional burnout, improve patient experience and realize the promise of humanity and connection in our health care system. Funding support is provided by the Morris-Singer Foundation.

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