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The economic downturn and primary care


The challenges of the COVID-19 pandemic exacerbated economic issues already facing many healthcare professionals. Between the virus outbreak that caused many independent practices to severely reduce patient visits or close entirely, staffing difficulties, and growing inflation numbers, there is a clear connection between the economic downturn and primary care struggles.

A study conducted in early 2022 by the Larry A. Green Center, in partnership with the Primary Care Collaborative (PCC) was published in April. Results from the survey of clinicians in 49 states and Washington, DC, revealed that 25% of primary care providers plan to leave the field in the next three years. Over half of the participants indicated that their ability to bounce back from or adjust to adversity has become limited.

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Specific results from the survey include:

  • Two years into the pandemic, primary care practices—those still open—continue to feel the strain of COVID-19. Close to half (>46%) say that “U.S. primary care is crumbling.”
  • Only a fifth of the participating providers report that their practice is fully staffed, with 68% saying they have open staff positions that cannot be filled. 29% say they have personal knowledge of practices that have closed during the pandemic. And a majority (52%) report that their practice staffing ratios have changed to fewer staff per clinician.
  • Clinician burnout remains strikingly high. Over a third (36%) still say their level of burnout is at an all-time high, and over half (53%) say their ability to bounce back and/or adjust to adversity has become limited. Two-thirds (62%) have personal knowledge of clinicians who have retired early or quit during the pandemic.
  • Patients are flooding into clinics, many with unmet needs. 40% of respondents say they are “flooded to overwhelmed” by patient needs. This may be, in part, due to patients needing to find new sites of care: 40% of clinicians report getting more new patients because of practice closures. And nearly 60% of respondents say that patient visits take longer than they used to because of unresolved or exacerbated concerns from delayed access to care during the pandemic.
  • Primary care is adapting to meet patients’ needs in new and creative ways. Close to half (47%) of all respondents report adding or extending services not usually provided in order to prevent patients’ use of hospital or specialty care; 70% say they monitor COVID-19-positive patients at home or in the practice to prevent the use of hospital or specialty care.
  • Notably, 72% of clinicians say they have become more involved in mental health support.
  • Telehealth is likely here to stay. A quarter (24%) of respondents report relying on telehealth (either phone or video) for at least 30% of patient visits. A big driver of this may be patient preference: nearly half (49%) say they are motivated to use telehealth because their patients really like it.
  • Barriers to telehealth remain a challenge. Over half (52%) of surveyed clinicians say that computer illiteracy makes it difficult to use telehealth with at least a fifth of their patients. About a third (30%) point to lack of broadband as a barrier for at least a fifth of their patients. And over a quarter (28%) blame insufficient payment as an obstacle that limits their practice’s use of telehealth.
  • Another factor is reduced staffing. 20% of clinicians say lack of sufficient staffing has caused expanded use of telehealth in their practice.
  • Over a quarter (25%) of respondents say they have lost clinicians or staff because of a vaccine mandate in the practice.
  • Comprehensive primary care is stepping up, expanding care to fully meet patients’ needs during the pandemic and beyond: A third of clinicians have increased their support for patients with food or housing insecurities; a quarter (26%) have increased offers of assistance to those with financial insecurity; and another quarter (26%) ask more screening questions about domestic violence and child abuse.