Primary Care & COVID-19: Round 27 Survey

• Much of primary care is willing to administer COVID-19 vaccines, and half are ready to do so. Three quarters of respondents say they are willing to administer COVID-19 vaccines, and 49% say they are “ready and able” to administer them. Patients also expect primary care practices to play a role: 46% of respondents say patients are calling and demanding to be vaccinated.
• Still, primary care continues to lack reliable sources of the vaccine. Less than 10% of surveyed primary care clinicians report that their practice generally has a reliable vendor for COVID-19 vaccine and that they know when their practice will receive it. State and local coordination with primary care remains lacking: less than a fifth of respondents report that their state has actively engaged primary care to help with vaccination distribution; just over a quarter (27%) say their local health department has engaged primary care.
• Telehealth has benefits for patients and clinicians. Telehealth continues to make up a larger-than-normal share of care during the pandemic, with a fifth of surveyed clinicians using phone or video for at least half of their patient visits. This has its benefits for both patients and clinicians: 45% of respondents say they are motivated to use telehealth because their patients “really like it,” and 67% are motivated to use it to meet patient needs. Nearly a quarter (23%) report that telehealth appointments have significantly reduced their no-show rates.
• Yet primary care remains cautious about telehealth’s downsides. Nearly half (46%) of surveyed clinicians worry about misdiagnoses due to lack of in-person care. And in some cases, telehealth may not be an option for patients: Surveyed clinicians say that at least a fifth of their patients have difficulties accessing telehealth due to lack of computer literacy (57%) and/or lack of broadband (35%).
• Clinicians warn that communities—and primary care practices—are not yet out of the woods on COVID-19. A third of respondents worry that overconfidence in vaccines will cause a spike in COVID-19 infections. And over a quarter (27%) still have clinicians out due to illness or self-quarantine. Nearly a third (30%) say their burnout is at an all-time high. The pandemic’s impact persists even financially: Only 21% say their practice revenue is within 10% of pre-pandemic levels; many more describe their financial state as “fragile.”
• Primary care is playing a public health role, but COVID-19 testing capacity is still not ubiquitous. Nearly half (46%) of those surveyed say their practice added or extended services to patients during the pandemic in order to prevent use of hospital/specialty care; and 67% monitor COVID-19-positive patients to prevent hospital/specialty care. Yet their capacity to respond remains limited: Only 59% have capacity within their practice to test for COVID-19. Others test through their health system, but more than 15% still have no capacity to test for COVID-19 through their practice or health system.
• The pandemic may be spurring a more comprehensive set of services. 72% of surveyed clinicians report their practice has become more involved in mental health support during the pandemic. Social risks are also being increasingly addressed: 30% have increased offers of assistance to patients with financial insecurity, and 27% have increased support for those with food insecurities.
• More primary care clinicians may see value-based payment as a way forward. 32% of respondents believe, based on their experience during the pandemic, that value-based payments should account for the majority of primary care payment; whereas 24% believe the majority should be fee-for-service.

Voice from the Front Lines

“Of all specialties, family medicine has had the highest rate of COVID cases and COVID deaths among physicians. WE have been the hardest-hit and impacted during the pandemic. We need support.” – Family medicine clinician in Illinois

A peer-reviewed publication supports this statement. It found that “general practice/family medicine/primary care” account for 26.9% of physician deaths among 19 specialties reported in the study. Pediatrics (4.7% of deaths) and internal medicine (5.5% of deaths) were calculated separately. See Gouda D, Singh PM, Gouda P, Goudra B. An Overview of Health Care Worker Reported Deaths During the COVID-19 Pandemic. J Am Board Fam Med. 2021 Feb;34(Suppl):S244-246.

Percent of physician deaths (round 27 COVID survey).png

Chart couresy of American Board of Family Medicine