Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Primary care faces a very difficult winter

Ken Terry
Policy
December 14, 2020
Share
Tweet
Share

Primary care is in trouble again. Last summer, as government assistance programs expired or wound down, primary care practices across the country were struggling to stay afloat because of lost business. By October, patient visits had rebounded in most specialties. But by mid-November, as COVID-19 surged everywhere, primary care physicians reported that they faced critical staffing shortages and limited resources, according to a survey of 1,472 doctors by the Primary Care Collaborative and the Larry Green Center.

The monthly survey, last conducted from November 13 to 17, found that 63% of practices had staff out due to illness or quarantine. One in five practices lacked sufficient testing supplies.

Specifically, 25% of respondents said they’d permanently lost staff members, and 41% had unfilled staff positions.

Clinicians were also under siege. Forty-four percent of them had experienced salary cuts; 55% reported health declines from stress and fatigue; and 44% were out because of illness or quarantine.

Meanwhile, 14% of the physicians said their practices still didn’t have flu vaccine supplies, and 32% said they either lacked sufficient PPE or were concerned that reuse of PPE was unsafe.

In a sign that the early fall rebound in business is reversing, 25% of respondents reported their fee-for-service volume was down over 30%. Yet 20% of the practices were waiving copays and reducing fees to serve their patients.

Nine in 10 physicians said they saw worsening mental health among patients, and 37% had observed higher rates of substance abuse. Nearly two-thirds said an increased number of patients were unemployed, and 39% reported increased health insurance loss. A third of the respondents reported high levels of food and housing insecurity among patients.

While the PCC and Larry Green Center haven’t yet fielded their December survey, it can be surmised that the results will be bleaker than those of the November poll. Given the rapidly rising COVID-19 infection rates and the increasingly strident calls for people to stay home when they can and socially distance when they can’t, primary care practices are likely seeing their patient volume fall again.

Weirdly, some practices will actually benefit from this dropoff in business in the short term, because they don’t have enough doctors or staff to meet a higher demand. But how many practices can economically sustain themselves in the long term under current conditions?

Their use of telemedicine will undoubtedly jump, as it did last spring. According to the survey, 64% of respondents used telehealth for mental health counseling, and 69% used it to treat patients with chronic conditions. However, nearly 50% reported most telehealth visits are not covered at parity with in-person visits. So, once again, telehealth will help fill the care gap but won’t fill the coffers of primary care practices.

The vaccines are coming, no doubt, but experts say that that the pandemic won’t begin to recede until late spring or summer, after most people with comorbid conditions have been vaccinated. So we probably have four to six more months of fighting large-scale COVID-19 infections. During that period, many primary care practices will continue struggling to stay in business. How many will close during that period is anyone’s guess.

Public health departments and governments are rightly focused on the mounting crisis in hospitals right now, as ICUs overflow and evidence begins to emerge that some patients with serious COVID-19 cases are not being admitted. More rationing is likely on the horizon.

Meanwhile, however, let’s not forget about the plight of primary care practices, which form our first line of defense against COVID and essential to a functioning health care system. A second round of aid from the federal government is urgently required, although it seems unlikely to be included in the rescue package now being debated in Congress.

ADVERTISEMENT

Failing that, financial incentives will be required to resuscitate our primary care practices after the pandemic begins to recede, and things get back to normal. Without adequate primary care, our population’s health will continue to worsen, and our health costs will keep on rising.

Ken Terry is a journalist and author of Physician-Led Health Care Reform: A New Approach to Medicare for All.

Image credit: Shutterstock.com

Prev

New Medicare documentation and payment changes starting next year that deliver relief for clinicians

December 14, 2020 Kevin 4
…
Next

Why can I trust the COVID vaccine?

December 14, 2020 Kevin 7
…

Tagged as: Primary Care, Public Health & Policy

Post navigation

< Previous Post
New Medicare documentation and payment changes starting next year that deliver relief for clinicians
Next Post >
Why can I trust the COVID vaccine?

ADVERTISEMENT

More by Ken Terry

  • PCPs could counter virtual plans by increasing telehealth visits

    Ken Terry
  • Direct primary care: Great for some doctors, but challenging for patients

    Ken Terry
  • Physicians of America, unite! You don’t have to work for hospitals.

    Ken Terry

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • The biggest health care fix: a relentless focus on primary care

    Suneel Dhand, MD
  • Primary care today: There are several concerning trends

    Sue S. Bornstein, MD
  • Primary Care First: CMS develops a value-based primary care program for independent practices

    Robert Colton, MD
  • The promise and challenge of integrating primary care into community-based mental health centers

    Betty Rabinowitz, MD
  • How the CPT system shortchanges primary care

    Richard Young, MD

More in Policy

  • How pediatricians can address the health problems raised in the MAHA child health report

    Joseph Barrocas, MD
  • How reforming insurance, drug prices, and prevention can cut health care costs

    Patrick M. O'Shaughnessy, DO, MBA
  • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

    AMA Committee on Economics and Quality in Medicine, Medical Student Section
  • Who gets to be well in America: Immigrant health is on the line

    Joshua Vasquez, MD
  • Online eye exams spark legal battle over health care access

    Joshua Windham, JD and Daryl James
  • The One Big Beautiful Bill and the fragile heart of rural health care

    Holland Haynie, MD
  • Most Popular

  • Past Week

    • How AI, animals, and ecosystems reveal a new kind of intelligence

      Fateh Entabi, MD | Tech
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • The hidden moral injury behind value-based health care

      Jonathan Bushman, DO | Physician
    • Nurse-initiated protocols for sepsis: a strategic imperative for patient care and hospital operations

      Rhonda Collins, DNP, RN | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN should know

      Frank I. Jackson, DO | Conditions
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • How are prostate exams done and why you shouldn’t avoid them

      Martina Ambardjieva, MD, PhD | Conditions
    • Airlines’ policy ignores your do not resuscitate (DNR): Discover why and some ways to protect yourself

      Althea Halchuck, EJD | Conditions
    • A dual citizen’s choice between two imperfect systems [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • How AI, animals, and ecosystems reveal a new kind of intelligence

      Fateh Entabi, MD | Tech
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • The hidden moral injury behind value-based health care

      Jonathan Bushman, DO | Physician
    • Nurse-initiated protocols for sepsis: a strategic imperative for patient care and hospital operations

      Rhonda Collins, DNP, RN | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN should know

      Frank I. Jackson, DO | Conditions
    • Why kratom addiction is the next public health crisis

      Muhamad Aly Rifai, MD | Meds
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
    • How are prostate exams done and why you shouldn’t avoid them

      Martina Ambardjieva, MD, PhD | Conditions
    • Airlines’ policy ignores your do not resuscitate (DNR): Discover why and some ways to protect yourself

      Althea Halchuck, EJD | Conditions
    • A dual citizen’s choice between two imperfect systems [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...